Adults: Adults: The best daily dose of levodopa has to be worked out for each patient by careful titration. Patients should be told to take only 1 tablet per dose. The maximum recommended daily dose of entacapone is 2,000 mg. Levodopa + Carbidopa + Entacapone is usually meant for patients who are already treated with matching doses of standard release levodopa/DDC inhibitor and entacapone. Method of administration: each tablet is taken by mouth, with or without food. One tablet contains one treatment dose, and it may only be taken as a whole tablet. How to transfer patients taking levodopa/DDC inhibitor (carbidopa or benserazide) preparations and entacapone tablets to this combination: Patients who are already on entacapone and standard release levodopa/carbidopa, in doses equal to the strengths of the combination tablets, can be moved straight over to the matching tablets. For example, a patient taking one tablet of 100 mg/25 mg levodopa/carbidopa with one tablet of entacapone 200 mg four times daily can take one Levodopa + Carbidopa + Entacapone 100 tablet four times daily in place of the usual levodopa/carbidopa and entacapone doses. If the patient's current levodopa/carbidopa and entacapone doses don't equal Levodopa + Carbidopa + Entacapone 100 tablets (or the 50, 150 or 200 tablets), the dose should be titrated carefully to get the best clinical response. At the start, the dose should be set to match the total daily dose of levodopa the patient is currently using, as closely as possible. For patients on entacapone and standard release levodopa/benserazide, the levodopa/benserazide is stopped the previous night and the combination tablet is started the next morning. The starting dose should give either the same amount of levodopa or slightly more (5 to 10%). How to transfer patients not currently treated with entacapone: In some patients with Parkinson's disease and end-of-dose motor fluctuations, who are not stabilized on their current standard release levodopa/DDC inhibitor treatment, starting this combination at doses matching the current treatment may be considered. However, a direct switch from levodopa/DDC inhibitor is not recommended for patients who have dyskinesias or whose daily levodopa dose is above 800 mg. In these patients it is advisable to bring in entacapone first as a separate treatment (entacapone tablets), adjust the levodopa dose if necessary, and only then switch to Levodopa + Carbidopa + Entacapone. Entacapone increases the effects of levodopa. So it may be necessary, particularly in patients with dyskinesia, to reduce the levodopa dose by 10 to 30% within the first days to first weeks after starting treatment. The daily levodopa dose can be lowered by extending the gaps between doses, by reducing the amount of levodopa per dose, or both, depending on the patient's clinical condition. Dose adjustment during the course of the treatment: When more levodopa is needed, a higher frequency of doses and/or a different strength of the tablet should be considered, within the dose recommendations. When less levodopa is needed, the total daily dose should be reduced, either by taking it less often (extending the time between doses) or by using a lower strength at each dose. If other levodopa products are used together with this tablet, the maximum dose recommendations should be followed. Discontinuation of therapy: If treatment with levodopa/carbidopa/entacapone is stopped and the patient is moved to levodopa/DDC inhibitor therapy without entacapone, the doses of other antiparkinsonian treatments, especially levodopa, need to be adjusted so that the parkinsonian symptoms stay sufficiently controlled.
