1. About co-beneldopa
Co-beneldopa is used to treat the main symptoms of Parkinson's disease. It can help with shaking (tremors), slowness and stiffness. These are called motor symptoms because they affect the way you move.
It is a mixture of levodopa and benserazide. These medicines are both used for Parkinson's disease.
Co-beneldopa is only available on prescription. It comes as tablets that dissolve (dispersible tablets) and capsules.
2. Key facts
- Co-beneldopa helps with Parkinson's symptoms that affect your movements.
- Take it 30 minutes before or 60 minutes after a meal. This is because food can stop your body from absorbing the medicine properly.
- Possible side effects of co-beneldopa include twitching, twisting or writhing movements (dyskinesias). Your doctor may change your dose to help if this happens.
- Co-beneldopa can take up to 3 weeks to reach its full effect.
- Do not stop taking this medicine suddenly. If you need to stop taking it, your doctor or specialist nurse will reduce your dose gradually.
3. Who can and cannot take co-beneldopa
Adults aged 25 and older can take co-beneldopa.
However, it is not suitable for everyone. To make sure co-beneldopa is safe for you, tell your doctor if you:
- have ever had an allergic reaction to co-beneldopa, levodopa, benserazide or any other medicine
- have glaucoma
- have ever had a mental health condition, including depression or psychosis
- have ever had skin cancer (melanoma) or have symptoms such as unusual moles or lumps on your skin
- have had a stroke or heart attack, or you have heart problems such as irregular heartbeats (arrhythmia)
- have had a stomach ulcer, or a hole (perforation) or bleeding in your stomach
- have diabetes, an overactive thyroid (hyperthyroidism) or Cushing's syndrome
- have problems with your liver, kidneys or adrenal glands
- have lung disease or asthma
- are pregnant, trying to get pregnant or are breastfeeding
Co-beneldopa can affect the results of blood tests and urine tests. Remind your doctor that you're taking co-beneldopa if you need to have any tests.
4. How and when to take co-beneldopa
Co-beneldopa comes as:
- standard capsules
- slow-release (or prolonged release) capsules
- tablets that dissolve in a drink (dispersible tablets)
You will be prescribed either a slow-release capsule or standard capsule, a dissolvable tablet or a combination of these. Always follow the instructions from your doctor or specialist nurse.
The tablets and standard capsules start to work right away. You'll usually take these 3 or 4 times a day, depending on your dose.
Slow-release capsules get the medicine into your body gradually. This helps to reduce the symptoms of your condition over longer periods of time. If your condition causes sleep problems, for instance, taking slow-release co-beneldopa capsules at night can help. This means you may not have to take them as often.
Take your co-beneldopa at the same time each day. This is important to help control your symptoms. Delays can cause symptoms to return.
Doses vary from person to person.
Co-beneldopa capsules and tablets come in different strengths. The information on the medicine packet shows the amount of levodopa and the amount of benserazide (both in milligrams) it contains.
You will usually start on a low dose. Your doctor or specialist nurse will increase your dose gradually until your symptoms are under control. It's best to take the lowest dose that controls your symptoms. This helps reduce your chance of side effects.
Do not stop taking co-beneldopa suddenly. If you need to stop taking this medicine, your doctor or specialist nurse will reduce your dose gradually. This is to prevent withdrawal symptoms.
How to take co-beneldopa capsules
Swallow the capsules whole, with a drink of water. Do not crush or chew the slow-release capsules. This is because they have a coating that lets the medicine into your system gradually.
Do not take your medicine with a meal. This is because food reduces the amount of medicine that is absorbed into your body. It's best to take your medicine at least 30 minutes before or 60 minutes after eating.
How to take co-beneldopa tablets that dissolve in a drink
Put the tablets in a small glass of water and stir well until the tablets have dissolved. Drink the mixture within 30 minutes.
If you do not like the taste, try mixing the tablets with diluted fruit squash instead. However, do not use orange juice.
Do not take your medicine with a meal, as taking it with food stops your body absorbing the medicine properly. It's best to take your medicine at least 30 minutes before or 60 minutes after eating.
What if I forget to take it?
If you forget to take your co-beneldopa, leave out the missed dose and take your next dose as usual.
Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten dose.
If you often forget doses, it may help to set an alarm to remind you. You could also ask a pharmacist for other ways to help you remember to take your medicine.
What if I take too much?
Taking 1 extra capsule or tablet as a one-off is unlikely to harm you, but talk to your doctor, specialist nurse or pharmacist if you are concerned.
Immediate action required: Call 999 or go to A&E now if:
you've taken more than your prescribed dose of co-beneldopa and you have:
- muscle spasms or uncontrolled movements
- a fast, slow or irregular heartbeat
5. Side effects
Like all medicines, co-beneldopa can cause side effects. However, many people have no side effects or only minor ones.
Some people notice that their pee, saliva or tongue turns a reddish colour. This is normal with co-beneldopa and is not dangerous.
Keep taking the medicine, but talk to your doctor, pharmacist or specialist nurse if these side effects bother you or do not go away:
- loss of appetite, feeling or being sick (nausea or vomiting)
- change in the way things taste
- dizziness when you get up from sitting or lying down
- problems sleeping (insomnia)
- uncontrollable twitching, twisting or writhing movements (dyskinesias)
Dyskinesias are more likely if you've been taking co-beneldopa for a long time or at a high dose. Talk to your doctor about reviewing your medicine if this starts to happen.
Serious side effects
It is possible to have serious side effects with co-beneldopa.
Tell your doctor or specialist nurse if you:
- start gambling, binge eating or shopping uncontrollably or have an unusually high sex drive – these are signs of impulse control disorder
- have cravings for larger doses of co-beneldopa than you need to control your symptoms – these are signs of dopamine dysregulation syndrome
- feel unusually sleepy or suddenly fall asleep during the day
- have strange or unusual thoughts, including thinking things that are not true (delusions)
- see things that are not there (hallucinations)
- have mood changes, including anxiety or depression
- are thinking about hurting yourself
- keep getting infections, bruising, mouth ulcers and bleeding gums – these can be caused by a blood problem
- feel lightheaded or you faint
Immediate action required: Call 999 or go to A&E now if:
- you have black poo or blood in your vomit – this can be a sign of bleeding in your stomach
- you have a fast heartbeat (palpitations)
- you have a seizure or fit
Immediate action required: Call 999 and ask for an ambulance now if:
- you have chest pain or problems breathing
If you need to go to A&E take the medicine packet, information leaflet and any remaining medicine with you.
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to co-beneldopa.
Immediate action required: Call 999 now if:
- your lips, mouth, throat or tongue suddenly become swollen
- you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
- your throat feels tight or you're struggling to swallow
- your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
- you suddenly become very confused, drowsy or dizzy
- someone faints and cannot be woken up
- a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)
You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.
These can be signs of a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of co-beneldopa. For a full list, see the leaflet inside your medicines packet.
You can report any suspected side effect using the Yellow Card safety scheme.
6. How to cope with side effects of co-beneldopa
What to do about:
- loss of appetite, feeling or being sick (nausea or vomiting) – having a biscuit or cracker (or some other plain snack) with your medicine may help if you're feeling or being sick. If you lose your appetite, eat when you would usually expect to be hungry. It may help to eat smaller meals, more often than usual. If you are being sick, have frequent small sips of water often to avoid dehydration.
- change in the way things taste – talk to your specialist nurse or doctor if this lasts for more than a week and is bothering you.
- dizziness when you get up from sitting or lying down – try getting up very slowly, or stay sitting down until you feel better. If you still feel dizzy, lie down so you do not faint, then sit up for a while until you feel OK again. Do not drive, cycle, or operate machinery if you feel dizzy. Do not drink alcohol as it may make you feel worse.
- problems sleeping (insomnia) – avoid big meals, smoking, or drinking alcohol in the evening. Reduce tea and coffee and other drinks that contain caffeine. Try not to watch TV or use your mobile phone before going to bed, and relax for an hour before bedtime. Do not take any sleep remedies, including herbal medicines, without talking to a pharmacist, specialist nurse or doctor first.
- uncontrollable twitching, twisting or writhing movements (dyskinesias) – let your doctor or specialist nurse know as soon as possible. They may need to adjust your dose or medicine.
7. Pregnancy and breastfeeding
Co-beneldopa and pregnancy
Co-beneldopa is not often used in pregnancy. This is because there is little information about how the medicine may affect your baby. However, your doctor may advise you to take it if they think the benefits of taking the medicine outweigh any risks.
If you become pregnant while taking co-beneldopa, speak to your doctor as soon as possible.
Co-beneldopa and breastfeeding
Co-beneldopa passes into breast milk in very small amounts. It is very unlikely to cause any problems in your baby.
However, co-beneldopa may make breastfeeding more difficult as it can reduce the amount of milk that your body makes. It is likely to affect milk production less if you have already been breastfeeding for a while, and it may not affect it at all.
Your doctor will be able to talk to you about your options and whether it's OK for you to breastfeed while on co-beneldopa.
If you notice that your baby is not feeding as well as usual, or if you have any other concerns about your baby, talk to your health visitor, midwife or doctor as soon as possible.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
8. Cautions with other medicines
There are some medicines that do not mix well with co-beneldopa.
Tell your doctor, specialist nurse or pharmacist if you're taking any of these medicines before starting co-beneldopa:
- antidepressants such as tranylcypromine, phenelzine or isocarboxazid
- anti-sickness medicines, such as metoclopramide or prochlorperazine
- medicines for psychosis or schizophrenia, such as amisulpride, aripiprazole, haloperidol or risperidone
- medicines for high blood pressure, such as atenolol, ramipril or amlodipine
- medicines for an overactive bladder
- any other medicines that make you sleepy, give you a dry mouth or make it difficult to pee
Taking painkillers with co-beneldopa
Mixing co-beneldopa with herbal remedies and supplements
There can be a problem taking iron supplements with co-beneldopa.
Apart from this, there's very little information about taking herbal remedies and supplements with co-beneldopa. Not enough research has been done to know whether they can affect your medicine.
Important: Medicine safety
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
9. Common questions about co-beneldopa
How does co-beneldopa work?
Co-beneldopa works by increasing the amount of dopamine in your brain. Dopamine is an important chemical which sends nerve messages from your brain to your muscles.
With Parkinson's disease, you have less dopamine so it's harder for your brain to send these messages. This can give you the shakes, as well as making your muscles stiff and your movements slow.
The 2 ingredients in co-beneldopa work together to help ease your symptoms.
This is changed into dopamine in your brain, allowing your nerves to send messages to your muscles and improve the way you move.
This stops levodopa from being changed to dopamine in the rest of your body. This also reduces the risk of side effects such as sickness and a fast heartbeat.
How long does it take to work?
You may notice an improvement after taking your first dose. However, it can take up to 3 weeks for co-beneldopa to have its full effect.
Talk to your specialist if your symptoms do not improve after taking co-beneldopa for at least 3 to 4 weeks.
How long will I take it for?
You will probably take co-beneldopa for a long time. You can keep taking this medicine as long as it's controlling your symptoms and you're not having any serious side effects.
Can I take it for a long time?
Many people take co-beneldopa safely for many months or years.
However, it does not work as well over time and you may notice the effects "wearing off". This is when the benefits wear off before the next dose, so there are times when you are stiff or slow. Speak to your doctor or specialist nurse if this happens. They may need to change your medicine.
If you take co-beneldopa for several years, or at a high dose, you can get uncontrolled movements (called dyskinesias). These can include twitching, twisting or writhing movements. Speak to your doctor or specialist nurse as soon as possible if this happens because they may need to change your medicine.
What will happen if I stop taking it?
If you stop taking co-beneldopa, your symptoms will return unless you are taking other medicines for Parkinson's disease.
You must not stop taking co-beneldopa suddenly. This can lead to serious withdrawal symptoms, such as stiff muscles, a high temperature and confusion.
If you need to stop taking this medicine, your doctor or specialist nurse will reduce the dose gradually. This will help prevent withdrawal symptoms.
Can I drink alcohol with it?
Drinking alcohol while taking co-beneldopa may make you feel sleepy, tired or dizzy.
It's best to stop drinking alcohol, until you see how the medicine affects you.
Is there any food or drink I need to avoid?
Apart from being careful about alcohol, you can eat and drink normally while taking co-beneldopa.
However, it is best to avoid taking co-beneldopa at the same time as meals containing lots of protein (such as meat, eggs, cheese, beans or lentils). Too much protein can reduce the amount of co-beneldopa your body takes in, meaning that your medicine will not work properly.
Are there similar medicines to co-beneldopa?
Co-beneldopa contains levodopa and benserazide. These can be mixed with other Parkinson's medicines to treat your symptoms.
This is mixed with levodopa to make co-careldopa (brand names Sinemet, Caramet, Apodespan and Lecado). This comes as tablets and works in the same way as co-beneldopa.
Entacapone or opicapone
These medicines can be given with co-beneldopa. This can help if the effects of co-beneldopa are wearing off and it is no longer working for you on its own.
Will it affect my contraception?
But if co-beneldopa makes you sick (vomit), your contraceptive pills may not protect you from pregnancy. Look on the pill packet to find out what to do.
Read more about what to do if you're on the pill and you're being sick.
Will it affect my fertility?
There's no clear evidence to suggest that taking co-beneldopa will reduce fertility in either men or women.
However, speak to a pharmacist or your doctor before taking it if you're trying to get pregnant.
Can I drive or ride a bike?
Some people find co-beneldopa can make them feel dizzy or sleepy, or makes them fall asleep suddenly. If this happens to you, do not drive, cycle or use tools or machinery.
Speak to your doctor. They will tell you when you can start driving again once these side effects stop.
If you've been diagnosed with Parkinson's disease, you must tell the Driver and Vehicle Licensing Agency (DVLA) and your car insurance company as soon as possible.
What else can help with symptoms of Parkinson's disease?
There's currently no cure, but there are treatments for Parkinson's disease to help relieve the symptoms and maintain your quality of life.
These treatments include:
- supportive therapies, such as physiotherapy or speech therapy
- a type of surgery called deep brain stimulation
You may not need any treatment during the early stages of Parkinson's disease, as symptoms are usually mild. But you may need regular appointments with your specialist so your condition can be monitored.
A care plan will usually be agreed with your healthcare team and your family or carers. This will outline the treatments and help that you need now and what you're likely to need in the future. This will need to be reviewed regularly.
Regular exercise is particularly important, as it helps relieve muscle stiffness, improves mood and relieves stress. Find out more about living with Parkinson's disease, including advice on staying active.
What to do when co-beneldopa stops working
Co-beneldopa becomes less effective over time. This is because it cannot stop you from losing the cells in your brain that make dopamine (the chemical that helps to control your body's movements).
Because of this, your symptoms may start to return. For instance, you may start to feel stiff or slow between taking your medicine.
Although increasing the dose is an option, it can increase the chance of involuntary movements (dyskinesias).
If this happens, your doctor or specialist nurse may change:
- the amount of medicine you take
- how often you take it
- the medicine you take and start you on another
Keeping a diary is also helpful to show when your medicine is wearing off or when you get dyskinesias.