1. About co-careldopa
Co-careldopa 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.
Co-careldopa is a mixture of the medicines levodopa and carbidopa. These are both used for Parkinson's disease.
It is available on prescription only. It comes as tablets, including slow-release tablets that get the medicine into your body gradually.
Co-careldopa can sometimes be used as a gel that goes through a tube into your small intestine. You will need to have surgery to have the tube fitted.
Your specialist may recommend Duodopa gel if your symptoms are difficult to manage and tablets are no longer working.
2. Key facts
- Co-careldopa helps with motor symptoms. It does not help with non-motor symptoms such as depression or losing your sense of smell.
- It works best if you take it 30 to 60 minutes before a meal.
- The most common side effects of co-careldopa are feeling sick or dizzy, problems sleeping and uncontrollable jerking movements.
- 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-careldopa
Co-careldopa can be taken by adults (aged 18 and above). It is sometimes prescribed for children to treat a movement disorder called dystonia.
It is not suitable for some people. To make sure co-careldopa is safe for you, tell your doctor if you:
- have had an allergic reaction to co-careldopa, levodopa, carbidopa or any other medicines in the past
- 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 a 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 lung disease or asthma
- have problems with your adrenal glands (including phaeochromocytoma), liver or kidneys
- are pregnant, trying to get pregnant or breastfeeding
Co-careldopa can affect the results of blood tests and urine tests. Remind your doctor that you're taking co-careldopa if you need to have any tests.
4. How and when to take it
Doses vary from person to person. Always follow the instructions from your doctor or specialist nurse.
You will usually start with 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-careldopa suddenly. If you need to stop taking this medicine, your doctor or specialist will reduce your dose gradually. This is to prevent withdrawal symptoms.
For co-careldopa gel, this will be given under specialist care. Follow the instructions from your doctor or your specialist nurse.
You will be prescribed standard-release tablets or slow-release (called "prolonged" or "controlled" release) tablets, or a combination of both.
Standard-release tablets work fairly quickly. You'll usually take these tablets several times a day, depending on your dose.
Slow-release tablets get the medicine into your body gradually. This means you do not have to take them as often.
The tablets come in different strengths. The medicine packet will show the amount of carbidopa followed by the amount of levodopa (both in milligrams).
How to take the tablets
Take your co-careldopa at the same time each day. This is important to help control your symptoms.
Slow-release tablets are taken once or twice a day. You'll usually take standard-release tablets 3 or 4 times a day. Your doctor may recommend taking your co-careldopa more often, if you need it to control your symptoms.
It's best to take your medicine 30 to 60 minutes before you eat a meal. This is because taking it together with too much protein stops your body from absorbing the medicine properly.
Swallow the tablets whole, with a drink of water. Do not crush or chew the slow-release tablets.
If you find swallowing tablets difficult, talk to your pharmacist, doctor or specialist nurse.
What if I forget to take it?
If you forget to take a tablet, take it as soon as you remember, unless it's nearly time for your next dose. In this case, 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?
Accidentally taking 1 or 2 extra tablets is unlikely to harm you, but talk to your doctor, specialist nurse or a pharmacist if you are concerned.
Urgent advice: Contact 111 for advice now if:
You take too many co-careldopa tablets and have:
- muscle spasms or uncontrolled movements
- a fast, slow or uneven heartbeat
5. Side effects
Like all medicines, co-careldopa can cause side effects. However, many people have no side effects or only minor ones.
Some people notice that their pee, sweat or saliva turns a reddish colour. This is normal with co-careldopa and is not dangerous.
Common side effects
These common side effects happen in more than 1 in 100 people.
Keep taking the medicine, but talk to your doctor or pharmacist if these side effects bother you or don't go away:
- loss of appetite, feeling or being sick (nausea or vomiting)
- feeling dizzy 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-careldopa for a long time or at a high dose.
Serious side effects
It is possible to have serious side effects with co-careldopa.
Some of these side effects are rare and happen in less than 1 in 1,000 people. Others are more common.
Talk to 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-careldopa 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
Urgent advice: Contact 111 for advice now if you:
- have unexpected infections, mouth ulcers, bruising or bleeding gums – these can be caused by a blood problem
- feel lightheaded or faint
Immediate action required: Call 999 or go to A&E now if you:
- have chest pain or problems breathing
- have a fast heartbeat (palpitations)
- have a seizure or fit
- have blood in your vomit
- have black poo – this can be a sign of bleeding in your stomach
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to co-careldopa.
Immediate action required: Call 999 or go to A&E if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in your chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
These are warning signs of a serious allergic reaction. A serious allergic reaction is an emergency.
These are not all the side effects of co-careldopa. For a full list, see the leaflet inside your medicine packet.
You can report any suspected side effect to the UK safety scheme.
6. How to cope with side effects
What to do about:
- loss of appetite, feeling or being sick (nausea or vomiting) – having a low-protein snack (such as a plain biscuit or cracker) 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, take small sips of water to avoid dehydration.
- feeling dizzy – if you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so you do not faint, then sit until you feel better. Do not drive, cycle, or use tools or machines if you feel dizzy or tired. Do not drink alcohol as it may make you feel worse.
- problems sleeping (insomnia) – avoid big meals, smoking, or drinking alcohol, tea or coffee in the evening. 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 or your specialist nurse first.
- uncontrollable twitching, twisting or writhing movements (dyskinesias) – let your doctor or specialist nurse know as soon as possible
7. Pregnancy and breastfeeding
Co-careldopa is not generally recommended if you're pregnant or breastfeeding. This is because there's very little information about whether it's safe to use.
Speak to your doctor about the benefits and possible risks of taking co-careldopa. They will be able to help you decide on the best treatment for you and your baby.
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-careldopa.
Tell your doctor, specialist nurse or a pharmacist if you're taking any of these medicines before you start taking co-careldopa:
- iron supplements
- tranylcypromine, phenelzine and isocarboxazid (for depression), or selegiline (for Parkinson's disease)
- medicines for psychosis or schizophrenia, such as amisulpride, aripiprazole, haloperidol or risperidone
- anti-sickness medicines, such as metoclopramide or prochlorperazine
- medicines for high blood pressure (hypertension), such as atenolol, ramipril or amlodipine
- medicines that make you sleepy, give you a dry mouth, or make it difficult to pee (called "anticholinergic" side effects), including antihistamines, antidepressants and medicines for an overactive bladder
Many medicines have these anticholinergic effects, so check with a pharmacist if you're not sure. They can affect how much co-careldopa your body takes in and stop it from working properly.
Mixing co-careldopa with herbal remedies and supplements
There's very little information about taking herbal remedies and supplements with co-careldopa. Not enough research has been done to know whether they can affect your medicine.
Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.
9. Common questions
How does it work?
Co-careldopa 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 and 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-careldopa work together to help your symptoms.
Levodopa – this is changed into dopamine in your brain, allowing your nerves to send messages to your muscles and improve the way you move.
Carbidopa – this stops levodopa from being changed into dopamine in the rest of your body. This 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 1st dose. However, it can take up to a week for co-careldopa to have its full effect.
Talk to your specialist if you do not see any change after taking co-careldopa for 2 weeks.
How long will I take it for?
You will probably take co-careldopa 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.
Is it safe to take for a long time?
Many people take co-careldopa 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 dose.
If you take co-careldopa 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 doctor or specialist nurse if this happens as you may need a lower dose.
What will happen if I stop taking it?
If you stop taking co-careldopa, your symptoms will return unless you are taking other medicines for Parkinson's disease.
You must not stop taking co-careldopa 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 your dose gradually. This will help prevent withdrawal symptoms.
When is co-careldopa gel used and who is it for?
Co-careldopa gel (brand name Duodopa) is used to treat "advanced" Parkinson's disease. Parkinson's disease is called advanced when symptoms are harder to treat and start to affect day-to-day life.
If your specialist wants you to try co-careldopa gel, they will usually give it to you for a few days to see if it helps. They will put a tube down your nose so the gel can go into your stomach.
If your symptoms improve, and you and your specialist agree to continue using the gel, you will need surgery.
A tube will be put in through the skin near your belly button and gently pushed through into your small intestine. Usually the tube is fitted using a permanent connector (called a PEG or percutaneous endoscopic gastrostomy).
You can have the gel as a single dose, given over 10 to 30 minutes (called a "bolus" dose), followed by a continuous dose given gradually through the day ("basal" dose). You will have a break of about 8 hours overnight.
Your doctor or specialist nurse will show you how to use the gel and how to keep your tube and PEG clean. You will have regular check-ups to see how it's working for you.
Can I drink alcohol with co-careldopa?
Drinking alcohol while taking co-careldopa tablets can make you feel sleepy or tired.
It's best to stop drinking alcohol when you start taking co-careldopa, until you know how the medicine affects you.
Is there any food or drink I need to avoid?
You can eat and drink normally while taking co-careldopa.
However, it is best to avoid taking co-careldopa at the same time as meals containing lots of protein (such as meat, eggs, cheese, beans or lentils). This can reduce the amount of co-careldopa your body takes in, meaning that your medicine will not work properly.
Are there similar medicines to co-careldopa?
Co-careldopa contains levodopa and carbidopa. These can be mixed with other Parkinson's medicines to treat your symptoms.
Benserazide: this is mixed with levodopa to make co-beneldopa (brand name Madopar). This comes as capsules or soluble tablets and works in the same way as co-careldopa.
Entacapone: this can be mixed with co-careldopa (brand names Stalevo, Sastravi or Stanek). This combination can help if the effects of co-careldopa are "wearing off" and it's no longer working for you on its own.
Will it affect my contraception?
But if co-careldopa makes you vomit, your contraceptive pills may not protect you from pregnancy. Look on the pill packet to find out what to do.
Will it affect my fertility?
There's no firm evidence to suggest that taking co-careldopa 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 that co-careldopa makes them sleepy or makes them fall asleep suddenly.
If this happens to you, do not drive, cycle or operate 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 DVLA and your car insurance company promptly.
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
- surgery (for some people)
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 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.