syndopa
Generic Name
Levodopa + Carbidopa
Manufacturer
Sun Pharmaceutical Industries Ltd.
Country
India
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| syndopa 250 mg tablet | ৳ 10.03 | ৳ 100.30 |
Description
Overview of the medicine
Syndopa 250 mg is a combination medicine used to treat Parkinson's disease. It contains Levodopa and Carbidopa. Levodopa converts to dopamine in the brain to reduce symptoms, while Carbidopa prevents the breakdown of Levodopa in the bloodstream, allowing more of it to reach the brain.
Uses & Indications
Dosage
Adults
Dosage is highly individualized. Usually started with 1 tablet of Syndopa Plus (Levodopa 100 mg + Carbidopa 25 mg) three times daily. For Syndopa 250 mg, the initial dose may be 1/2 tablet once or twice daily, gradually increasing based on patient response to a maximum of 8 tablets (2000 mg Levodopa, 200 mg Carbidopa) per day.
Elderly
Elderly patients may require lower initial doses and slower titration due to increased sensitivity to side effects.
Renal_impairment
No dosage adjustment is generally required for mild to moderate renal impairment, but caution is advised in severe renal disease.
How to Take
Take orally, with or without food. Taking it with food may reduce gastrointestinal upset, but high protein meals can reduce absorption. Do not crush or chew the tablet. Maintain a consistent dosing schedule.
Mechanism of Action
Levodopa, a metabolic precursor of dopamine, crosses the blood-brain barrier and is converted to dopamine by dopa decarboxylase. Carbidopa, an aromatic amino acid decarboxylase inhibitor, does not cross the blood-brain barrier but inhibits peripheral decarboxylation of levodopa, thus increasing the amount of levodopa available to the brain and reducing gastrointestinal side effects.
Pharmacokinetics
Onset
Clinical effects usually begin within 30-60 minutes after administration.
Excretion
Both levodopa and carbidopa, along with their metabolites, are primarily excreted in the urine.
Half life
The plasma half-life of levodopa when administered with carbidopa is approximately 1.5 to 3 hours.
Absorption
Levodopa is rapidly absorbed from the gastrointestinal tract, but absorption can be variable and reduced by food. Carbidopa significantly increases the bioavailability of levodopa.
Metabolism
Levodopa is extensively metabolized primarily by decarboxylation and O-methylation. Carbidopa is also metabolized, mainly into two inactive metabolites.
Side Effects
Contraindications
- Known hypersensitivity to levodopa, carbidopa, or any component of the formulation
- Narrow-angle glaucoma
- Concurrent use of non-selective monoamine oxidase (MAO) inhibitors
- Suspicious undiagnosed skin lesions or history of melanoma
Drug Interactions
Iron salts
May reduce levodopa absorption.
Metoclopramide
May reduce levodopa bioavailability.
Antihypertensive drugs
Additive hypotensive effect.
Pyridoxine (Vitamin B6)
Alone, it can reverse levodopa effects, but carbidopa in Syndopa prevents this interaction.
Non-selective MAO inhibitors
May cause hypertensive crisis. Discontinue MAOIs at least 2 weeks before starting Syndopa.
Antipsychotics (Dopamine D2 receptor antagonists)
May reduce the efficacy of levodopa.
Storage
Store below 30°C in a dry place, away from direct sunlight and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include dyskinesias, agitation, confusion, insomnia, orthostatic hypotension, and sometimes cardiac arrhythmias. Management is symptomatic and supportive, including general supportive measures and hospitalization if necessary. Gastric lavage may be useful.
Pregnancy & Lactation
Pregnancy Category C. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Levodopa is excreted in breast milk; therefore, caution should be exercised when administered to a nursing mother.
Side Effects
Contraindications
- Known hypersensitivity to levodopa, carbidopa, or any component of the formulation
- Narrow-angle glaucoma
- Concurrent use of non-selective monoamine oxidase (MAO) inhibitors
- Suspicious undiagnosed skin lesions or history of melanoma
Drug Interactions
Iron salts
May reduce levodopa absorption.
Metoclopramide
May reduce levodopa bioavailability.
Antihypertensive drugs
Additive hypotensive effect.
Pyridoxine (Vitamin B6)
Alone, it can reverse levodopa effects, but carbidopa in Syndopa prevents this interaction.
Non-selective MAO inhibitors
May cause hypertensive crisis. Discontinue MAOIs at least 2 weeks before starting Syndopa.
Antipsychotics (Dopamine D2 receptor antagonists)
May reduce the efficacy of levodopa.
Storage
Store below 30°C in a dry place, away from direct sunlight and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include dyskinesias, agitation, confusion, insomnia, orthostatic hypotension, and sometimes cardiac arrhythmias. Management is symptomatic and supportive, including general supportive measures and hospitalization if necessary. Gastric lavage may be useful.
Pregnancy & Lactation
Pregnancy Category C. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Levodopa is excreted in breast milk; therefore, caution should be exercised when administered to a nursing mother.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from manufacturing date
Availability
Available in pharmacies
Approval Status
Approved globally for Parkinson's disease
Patent Status
Off-patent, generic versions available
WHO Essential Medicine
YesClinical Trials
Levodopa/carbidopa combination therapy has been extensively studied and is a cornerstone in the management of Parkinson's disease, with numerous clinical trials demonstrating its efficacy and safety profile over decades.
Lab Monitoring
- Regular monitoring of blood pressure, especially for orthostatic hypotension
- Periodic monitoring of complete blood count (CBC), liver function tests, and renal function tests, particularly during prolonged therapy.
Doctor Notes
- Individualize dosage carefully, titrating slowly to achieve optimal symptom control with minimal side effects.
- Educate patients on potential motor fluctuations and strategies for managing them (e.g., timing of doses relative to meals).
- Monitor for psychiatric side effects and impulse control disorders, especially in patients with a history of these conditions.
- Counsel patients against abrupt discontinuation due to risk of serious withdrawal symptoms.
Patient Guidelines
- Take the medicine regularly as prescribed by your doctor; do not stop abruptly.
- Be aware of potential side effects, especially dizziness or lightheadedness when standing up.
- Report any new or worsening symptoms, particularly involuntary movements or changes in mood/behavior, to your doctor.
- Avoid high-protein meals if you experience reduced effectiveness of the medication.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose to catch up.
Driving Precautions
Syndopa can cause drowsiness, sudden sleep onset, dizziness, and dyskinesia, which may impair your ability to drive or operate machinery. Patients should be warned not to drive or engage in activities where impaired alertness could put them or others at risk.
Lifestyle Advice
- Engage in regular, light exercise as tolerated to help manage Parkinson's symptoms.
- Maintain a balanced diet and adequate hydration.
- Ensure sufficient sleep and manage stress effectively.
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