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Other strengths and forms by Incepta Pharmaceuticals Ltd.
Indications & Uses
Twindopa is indicated for:
Pharmacology
Levodopa is the metabolic precursor of dopamine. It crosses the blood-brain barrier and is converted to dopamine in the brain. Carbidopa is a dopa decarboxylase (DDC) inhibitor. It reduces the breakdown of levodopa to dopamine outside the brain, so more levodopa reaches the brain.
Levodopa: As the precursor of dopamine, levodopa does cross the blood-brain barrier and is presumably converted to dopamine in the brain. This is thought to be how levodopa relieves the symptoms of Parkinson's disease.
Carbidopa: When levodopa is taken by mouth, it is rapidly decarboxylated to dopamine in tissues outside the brain. Because of this, only a small portion of a given dose reaches the central nervous system unchanged. Carbidopa inhibits the decarboxylation of levodopa in the peripheral tissues, which makes more levodopa available for delivery to the brain.
Dosage Reference
Reference Information Only
Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.
Adults:
100/10 mg tablet: You can start with one tablet three or four times a day. Some patients may need the dose raised step by step to reach the best dose of carbidopa. Increase by one tablet every day or every other day until a total of eight tablets (two tablets q.d.s.) is reached.
250/25 mg tablet: The starting dose is one half taken once or twice daily. This may not give many patients the best amount of carbidopa, so if needed, add one-half every day or every other day until the best response is reached. For most patients taking more than 1500 mg of Levodopa a day, the suggested starting dose is one tablet of 250/25 mg three or four times a day.
100/25 mg tablet: When Levodopa 100 mg & Carbidopa 25 mg tablet is used, start with 1 tablet, 3 times a day. This schedule gives 75 mg of carbidopa per day. The dose can be raised by 1 tablet every day or every other day, as needed, until 8 tablets of Levodopa 100 mg & Carbidopa 25 mg a day is reached.
50/12.5 mg tablet: One tablet three or four times a day.
Maintenance dose: Treatment should be individualized and adjusted to the response wanted. When more levodopa is required, the 250/25 mg tablet should be used instead, at one tablet three or four times a day. If needed, the 250/25 mg dose may be raised by half to one tablet every other day, up to a maximum of eight tablets a day. Experience with a total daily dose greater than 200 mg Carbidopa is limited.
Side Effects
The side effects seen most often with Carbidopa-Levodopa come from the central action of dopamine in the brain. Reducing the dose usually eases these reactions. The most common ones are dyskinesias (choreiform, dystonic and other involuntary movements) and nausea. Across the body as a whole, people may have syncope, chest pain or anorexia. Heart and circulation effects include palpitation, orthostatic effects (with hypotensive episodes), hypertension and phlebitis. In the gastrointestinal tract, the reported effects are vomiting, gastrointestinal bleeding, development of duodenal ulcer, diarrhoea and dark saliva. Blood effects include leukopenia, haemolytic and non-haemolytic anaemia, thrombocytopenia and agranulocytosis. Hypersensitivity reactions include angioedema, urticaria, pruritus and Henoch-Schonlein purpura. Nervous system effects are dizziness, somnolence, paresthesia, delusions, hallucinations and paranoid ideation. Depression can occur, with or without the development of suicidal tendencies. Dementia, dream abnormalities, agitation, confusion and increased libido are also reported. Dyspnea is the respiratory effect. On the skin, Carbidopa-Levodopa can cause alopecia, rash and dark sweat. In the urogenital system, it can cause dark urine.
Cautions & Contraindications
Warnings & Precautions
Carbidopa-Levodopa isn't recommended for treating extrapyramidal reactions caused by medicines. It can be given to patients who are already taking Levodopa alone, but the Levodopa must be stopped at least 12 hours before Carbidopa-Levodopa is started. These patients may develop dyskinesias, because Carbidopa lets more Levodopa reach the brain and so more dopamine is formed. If dyskinesias occur, the dose may need to be reduced. All patients should be watched carefully for depression with suicidal tendencies. Patients with past or current psychoses should be treated with caution. Give Carbidopa-Levodopa cautiously to patients with severe cardiovascular or pulmonary disease, bronchial asthma, renal, hepatic or endocrine disease, or a history of peptic ulcer disease or of convulsions. Take care with patients who have a history of myocardial infarction and who have atrial, nodal or ventricular arrhythmia. In these patients, cardiac function should be monitored with particular care during the first dosing and titration period. Patients with chronic wide-angle glaucoma may be treated with Carbidopa-Levodopa, but with caution. The intraocular pressure must be well controlled, and the patient should be monitored carefully for changes in intraocular pressure during therapy.
Contraindications
Carbidopa-Levodopa tablet must not be given to people who are allergic to carbidopa or levodopa, or to those who have narrow-angle glaucoma. Levodopa may activate a malignant melanoma, so the tablet should also not be used in anyone with a skin lesion that looks suspicious and hasn't been diagnosed, or in anyone who has had melanoma before.
Pregnancy & Breastfeeding
We don't know how CarbidopaLevodopa affects human pregnancy. But both Levodopa and the combination of Carbidopa and Levodopa have caused visceral and skeletal malformations in rabbits. So for women who could become pregnant, the doctor needs to weigh the expected benefits of the medicine against the possible harm if pregnancy occurs.
It's not known whether Carbidopa passes into human milk. Many medicines do pass into breast milk, and there is a chance of serious adverse reactions in infants. For this reason, a decision should be made either to stop nursing or to stop Carbidopa-Levodopa, taking into account how important the medicine is to the mother.
⚠️ Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
Use in Special Populations
Use in children: Nobody has established whether Carbidopa-Levodopa is safe or effective in infants and children, so it isn't recommended for anyone below the age of 18 years.
Storage
Keep Levodopa + Carbidopa in a cool, dry place and away from light.
Drug Interactions
Common questions about Twindopa 100 mg+25 mg
What is Twindopa 100 mg+25 mg Tablet?
Twindopa 100 mg+25 mg Tablet is a medicine that contains Levodopa + Carbidopa. It is made by Incepta Pharmaceuticals Ltd. It belongs to the Antiparkinson drugs group of medicines.
What is Twindopa used for?
Twindopa is used for: Parkinson's Disease, Stroke.
What are the side effects of Twindopa?
The side effects seen most often with Carbidopa-Levodopa come from the central action of dopamine in the brain. Reducing the dose usually eases these reactions.
Can I take Twindopa during pregnancy or while breastfeeding?
We don't know how CarbidopaLevodopa affects human pregnancy. But both Levodopa and the combination of Carbidopa and Levodopa have caused visceral and skeletal malformations in rabbits. Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
How should I store Twindopa?
Keep Levodopa + Carbidopa in a cool, dry place and away from light.
Can I take other medicines with Twindopa?
Some medicines can interact with Levodopa + Carbidopa, for example: Ferrous Gluconate, Isoniazid, Risperidone, Levodopa, Phenytoin, Ferrous Sulphate. Tell your doctor or pharmacist about every medicine you take.
Is there a cheaper medicine with the same ingredient?
Twindopa is already among the lowest-priced brands of Levodopa + Carbidopa at this strength.
Do I need a prescription for Twindopa?
Twindopa is a prescription (Rx) medicine. Take it as your doctor advises.