Carbidopa + Levodopa

Adults: Starting Dose for Patients Naive to Levodopa Therapy: For patients who have never taken levodopa before, the usual starting dose of RYTARY is 95 mg taken by mouth three times a day (TID) for the first 3 days. On the fourth day of treatment, the dose can be raised to 145 mg taken three times a day. Depending on how each patient responds and tolerates the medicine, the RYTARY dose may be increased further, up to a maximum recommended dose of 390 mg three times a day. If more frequent dosing is needed and tolerated, the schedule can be changed from three times a day to as often as five times a day. Patients should be kept on the lowest dose that controls symptoms while limiting side effects such as dyskinesia and nausea. The maximum recommended daily dose of RYTARY is 2450 mg. Converting from Immediate Release Carbidopa Levodopa to RYTARY: Doses of other carbidopa and levodopa products are not interchangeable with RYTARY on a 1:1 basis. To convert a patient from immediate release carbidopa-levodopa to RYTARY, first calculate the patient's current total daily dose of levodopa. The starting total daily dose of RYTARY is then chosen using the conversion guide below. After conversion, any combination of the four RYTARY strengths can be used to reach an optimal dose. The dose and dosing frequency should be adjusted as necessary to maintain patient tolerance and sufficient symptom control. Any other Parkinson's disease medicines the patient is taking should be kept stable while the RYTARY dose is being adjusted. In clinical trials, RYTARY was given in divided doses three to five times a day. The maximum recommended total daily dose of RYTARY is 612.5 mg / 2,450 mg. For patients already being treated with carbidopa and levodopa together with a catechol-O-methyl transferase (COMT) inhibitor such as entacapone, the initial total daily levodopa dose shown in the conversion guide may need to be increased. RYTARY has not been studied in combination with other levodopa products. Conversion Guide from Immediate Release Carbidopa Levodopa to RYTARY: Total daily levodopa dose with immediate release levodopa-carbidopa of 400 mg to 549 mg corresponds to a total daily levodopa dose with RYTARY of 855 mg, given as 3 capsules of RYTARY95 mg taken TID. 550 mg to 749 mg corresponds to 1140 mg, given as 4 capsules of RYTARY95 mg taken TID. 750 mg to 949 mg corresponds to 1305 mg, given as 3 capsules of RYTARY145 mg taken TID. 950 mg to 1249 mg corresponds to 1755 mg, given as 3 capsules of RYTARY195 mg taken TID. Equal to or greater than 1250 mg corresponds to 2340 mg or 2205 mg, given as 3 capsules of RYTARY245 mg taken TID.