activation).osteomalacia.psychiatric illness (avoid if
severe and discontinue if deterioration).pulmonary
disease.susceptibility to angle-closure glaucoma
lINTERACTIONS→Appendix 1 : carbidopa.levodopa
lSIDE-EFFECTS
▶Rare or very rareDrowsiness.seizure.sleep disorders
▶Frequency not knownAgranulocytosis.alertness decreased
.alopecia.anaemia.angioedema.anxiety.appetite
decreased.asthenia.cardiac disorder.chest pain.
compulsions.confusion.constipation.delusions.
dementia.depression.diarrhoea.dizziness.dry mouth.
dyskinesia.dysphagia.dyspnoea.eating disorders.
euphoric mood.eye disorders.fall.focal tremor.gait
abnormal.gastrointestinal discomfort.gastrointestinal
disorders.gastrointestinal haemorrhage.haemolytic
anaemia.hallucination.headache.Henoch-Schönlein
purpura.hiccups.hoarseness.Horner’s syndrome
exacerbated.hypertension.hypotension.leucopenia.
malaise.malignant melanoma.movement disorders.
muscle complaints.nausea.neuroleptic malignant
syndrome (on abrupt discontinuation).oedema.on and
off phenomenon.oral disorders.palpitations.
pathological gambling.postural disorders.psychotic
disorder.respiration abnormal.sensation abnormal.
sexual dysfunction.skin reactions.suicidal ideation.
sweat changes.syncope.taste bitter.teeth grinding.
thrombocytopenia.trismus.urinary disorders.urine dark
.vasodilation.vision disorders.vomiting.weight changes
lPREGNANCYUse with caution—toxicity has occurred in
animalstudies.
lBREAST FEEDINGMay suppress lactation; present in
milk—avoid.
lMONITORING REQUIREMENTSIn prolonged therapy,
psychiatric, hepatic, haematological, renal, and
cardiovascular monitoring is advisable; warn patients to
resume normal activities gradually.
lEFFECT ON LABORATORY TESTSFalse positive tests for
urinary ketones have been reported.
lTREATMENT CESSATIONAvoid abrupt withdrawal.
lPRESCRIBING AND DISPENSING INFORMATIONCo-
careldopa is a mixture of carbidopa and levodopa; the
proportions are expressed in the form x/y where x and y
are the strengths in milligrams of carbidopa and levodopa
respectively.
lPATIENT AND CARER ADVICEWarn patients to resume
normal activity gradually.
Driving and skilled tasks
Sudden onset of sleepExcessive daytime sleepiness and
sudden onset of sleep can occur with co-careldopa.
Patients starting treatment with these drugs should be
warned of the risk and of the need to exercise caution
when driving or operating machinery. Those who have
experienced excessive sedation or sudden onset of sleep
should refrain from driving or operating machines until
these effects have stopped occurring.
Management of excessive daytime sleepiness should
focus on the identification of an underlying cause, such as
depression or concomitant medication. Patients should be
counselled on improving sleep behaviour.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Modified-release tablet
CAUTIONARY AND ADVISORY LABELS10, 14, 25
▶Co-careldopa (Non-proprietary)
Carbidopa (as Carbidopa monohydrate) 25 mg, Levodopa
100 mgCo-careldopa 25 mg/ 100 mg modified-release tablets|
60 tabletPsDT = £ 11. 60Carbidopa (as Carbidopa monohydrate) 50 mg, Levodopa
200 mgCo-careldopa 50 mg/ 200 mg modified-release tablets|
60 tabletPsDT = £ 11. 60
▶Caramet CR(Teva UK Ltd)
Carbidopa (as Carbidopa monohydrate) 25 mg, Levodopa
100 mgCaramet 25 mg/ 100 mg CR tablets| 60 tabletP£ 11. 47
DT = £ 11. 60
Carbidopa (as Carbidopa monohydrate) 50 mg, Levodopa
200 mgCaramet 50 mg/ 200 mg CR tablets| 60 tabletP£ 11. 47
DT = £ 11. 60
▶Half Sinemet CR(Merck Sharp & Dohme Ltd)
Carbidopa (as Carbidopa monohydrate) 25 mg, Levodopa
100 mgHalf Sinemet CR 25 mg/ 100 mg tablets| 60 tabletP
£ 11. 60 DT = £ 11. 60
▶Lecado(Sandoz Ltd)
Carbidopa (as Carbidopa monohydrate) 25 mg, Levodopa
100 mgLecado 100 mg/ 25 mg modified-release tablets|
60 tabletP£ 9. 86 DT = £ 11. 60
Carbidopa (as Carbidopa monohydrate) 50 mg, Levodopa
200 mgLecado 200 mg/ 50 mg modified-release tablets|
60 tabletP£ 9. 86 DT = £ 11. 60
▶Sinemet CR(Merck Sharp & Dohme Ltd)
Carbidopa (as Carbidopa monohydrate) 50 mg, Levodopa
200 mgSinemet CR 50 mg/ 200 mg tablets| 60 tabletP£ 11. 60
DT = £ 11. 60
Tablet
CAUTIONARY AND ADVISORY LABELS10, 14
▶Co-careldopa (Non-proprietary)
Carbidopa (as Carbidopa monohydrate) 12.5 mg, Levodopa
50 mgCo-careldopa 12. 5 mg/ 50 mg tablets| 90 tabletP£ 6. 28
DT = £ 6. 28
Carbidopa (as Carbidopa monohydrate) 10 mg, Levodopa
100 mgCo-careldopa 10 mg/ 100 mg tablets| 100 tabletP
£ 10. 74 DT = £ 8. 95
Carbidopa (as Carbidopa monohydrate) 25 mg, Levodopa
100 mgCo-careldopa 25 mg/ 100 mg tablets| 90 tabletP£ 8. 14
| 100 tabletP£ 26. 99 DT = £ 9. 04
Carbidopa (as Carbidopa monohydrate) 25 mg, Levodopa
250 mgCo-careldopa 25 mg/ 250 mg tablets| 100 tabletP
£ 35. 00 DT = £ 34. 98
▶Sinemet 110 (Merck Sharp & Dohme Ltd)
Carbidopa (as Carbidopa monohydrate) 10 mg, Levodopa
100 mgSinemet 10 mg/ 100 mg tablets| 100 tabletP£ 7. 30 DT =
£ 8. 95
▶Sinemet 275 (Merck Sharp & Dohme Ltd)
Carbidopa (as Carbidopa monohydrate) 25 mg, Levodopa
250 mgSinemet 25 mg/ 250 mg tablets| 100 tabletP£ 18. 29 DT =
£ 34. 98
▶Sinemet 62. 5 (Merck Sharp & Dohme Ltd)
Carbidopa (as Carbidopa monohydrate) 12.5 mg, Levodopa
50 mgSinemet 12. 5 mg/ 50 mg tablets| 90 tabletP£ 6. 28 DT =
£ 6. 28
▶Sinemet Plus(Merck Sharp & Dohme Ltd)
Carbidopa (as Carbidopa monohydrate) 25 mg, Levodopa
100 mgSinemet Plus 25 mg/ 100 mg tablets| 100 tabletP£ 12. 88
DT = £ 9. 04MUSCLE RELAXANTS›PERIPHERALLY ACTING›
NEUROTOXINS (BOTULINUM TOXINS)Botulinum toxin type A 24-Apr-2017
lINDICATIONS AND DOSE
Dynamic equinus foot deformity caused by spasticity in
ambulant paediatric cerebral palsy
▶Child 2–17 years:(consult product literature)
DOSE EQUIVALENCE AND CONVERSION
▶Important: information is specific to each individual
preparation.lCONTRA-INDICATIONSGeneralised disorders of muscle
activity.infection at injection site.myasthenia gravis
lCAUTIONSAtrophy in target muscle.chronic respiratory
disorder.excessive weakness in target muscle.history of
aspiration.history of dysphagia.inflammation in target258 Movement disorders BNFC 2018 – 2019
Nervous system4