Levodopa, benserazide (Madopar)
How does it work?
Madopar capsules and dispersible tablets contain the active ingredients levodopa and benserazide. This combination of medicines is also sometimes known as co-beneldopa. Co-beneldopa is also available without a brand name, ie as the generic medicine. It is used in Parkinsons disease to increase the levels of dopamine in the brain.
Dopamine is a substance known as a neurotransmitter. Neurotransmitters are found the brain and nervous system and are involved in transmitting messages between nerves. These messages help to perform certain functions the body. The neurotransmitter dopamine is known to be reduced or absent in the brains of people with Parkinson's disease, and this is thought to be the cause of the disease's symptoms.
When you take levodopa, it is converted into dopamine in the brain. This replaces the lost dopamine and therefore reduces some of the symptoms of the disease.
Levodopa is also converted into dopamine in the rest of the body, which can cause unwanted side effects such as nausea and palpitations. Benserazide is used in combination with the levodopa to prevent this happening. Benserazide is a type of medicine called a dopa-decarboxylase inhibitor. It blocks the conversion of levodopa to dopamine in the body and so prevents these side effects. (Benserazide cannot pass into the brain and so does not affect the conversion of levodopa to dopamine in the brain.)
The combination of levodopa and benserazide is therefore effective in the treatment of Parkinson's disease, while minimising the side effects caused by levodopa on the rest of the body.
Madopar dispersible tablets start to work more quickly than Madopar capsules. The tablets may be swallowed whole or dispersed in at least 25ml water per tablet. They may be taken in dilute orange squash (but not orange juice) if preferred.
What is it used for?
- This medicine can occasionally cause your blood pressure to drop when you move from a lying down or sitting position to sitting or standing, especially when you first start taking the medicine. This may make you feel dizzy or unsteady. To avoid this try getting up slowly. If you do feel dizzy, sit or lie down until the symptoms pass.
- This medicine can cause sleepiness and on rare occasions people have experienced a sudden onset of sleep during their daily activities. In some cases this can occur without any warning signs. Although this is rare, you should exercise caution when driving or performing other potentially hazardous activities. People who have experienced sleepiness or an episode of sudden onset of sleep while taking this medicine should not drive or operate machinery. Caution should be observed when drinking alcohol or taking other medicines that cause drowsiness, as this may increase the risk of drowsiness.
- As this medicine increases the level of dopamine in your brain more than levodopa alone it may cause abnormal involuntary movements or muscle twitches (dyskinesia). Consult your doctor if you experience these symptoms, as they may indicate that your dose of this medicine needs reducing.
- Consult your doctor if you feel depressed or confused, or have strange or abnormal thoughts while you are taking this medicine.
- Pathological gambling, increased sex drive and hypersexuality have been reported in people taking medicines for Parkinson's disease such as this one, which increase dopamine activity in the brain. If you think this medicine is affecting you in this way, you should consult your doctor.
- This medicine may cause a reddish discolouration of your urine and other body fluids, such as sweat and saliva. This is normal and not harmful.
- If your symptoms start to improve while taking this medicine, make sure you resume your normal activities gradually. Try not to do too much too quickly as you may risk injury.
- You should have regular tests to monitor the function of your liver, blood, kidneys and heart while taking this medicine.
- This medicine may affect the results of certain laboratory tests, including those for testing glucose levels in blood or urine. If you have diabetes ask your doctor for further information about this. Tell your doctor that you are taking this medicine if you have any blood or urine tests.
- If you have chronic open angle glaucoma you should have regular tests to monitor the pressure within your eye (intraocular pressure) while taking this medicine.
- You should not suddenly stop taking this medicine unless your doctor tells you otherwise.
Use with caution in
- Liver disease.
- Kidney disease.
- Lung disease.
- Disease involving the heart and blood vessels (cardiovascular disease).
- History of heart attack.
- History of irregular heart beats (arrhythmias).
- Disorders involving hormone producing glands (endocrine disorders).
- History of convulsions, eg epilepsy.
- History of peptic ulcers.
- History of psychiatric illness.
- Open angle glaucoma.
- Softening of the bones due to lack of vitamin D in the body (osteomalacia).
Not to be used in
- People under 25 years of age.
- Severe liver disease.
- Severe kidney disease.
- Severe heart disease.
- Severe disease involving hormone producing glands (endocrine disease).
- Closed angle glaucoma.
- History of skin cancer (malignant melanoma).
- Suspicious skin lesions of unknown cause.
- Severe psychotic illness.
- People who have taken a monoamine-oxidase inhibitor antidepressant (MAOI) in the last 14 days.
This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine should not be used during pregnancy as it may be harmful to an unborn baby. Women who could get pregnant should use effective contraception to prevent pregnancy while taking this medicine. Seek medical advice from your doctor.
- This medicine may pass into breast milk, therefore mothers taking this medicine must not breastfeed. Discuss with your doctor.
- This medication may cause your urine to become a little red in colour.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
- Difficulty performing voluntary movements, resulting in jerky or involuntary movements or muscle twitches (dyskinesia).
- Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain.
- Mood changes, strange or abnormal thoughts or depression.
- Awareness of your heartbeat (palpitations).
- Irregular heart beats.
- A drop in blood pressure that occurs when going from lying down to sitting or standing, which results in dizziness and lightheadedness (postural hypotension).
- Loss of appetite.
- Dry mouth.
- Weakness or loss of strength (asthenia).
- Difficulty in sleeping (insomnia).
- Sleepiness (somnolence).
- Suddenly falling asleep.
- False perceptions of things that are not really there (hallucinations).
- Bleeding or ulceration in the stomach or intestines.
- Disturbances in the normal numbers of blood cells in the blood.
- Inability to resist impulses to gambling (pathological gambling).
- Increased sex drive (libido) and excessive interest or involvement in sexual activity (hypersexuality).
- Visual disturbances.
- Difficulty in breathing (dyspnoea).
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.
This medicine should not be taken at the same time as, or within two weeks of taking non-selective monoamine oxidase inhibitors (MAOIs), for example the antidepressants phenelzine, isocarboxazid and tranylcypromine, and the antibiotic linezolid. In addition it should not be taken in combination with BOTH a selective monoamine oxidase type A inhibitor, eg moclobemide, AND a selective monoamine oxidase type B inhibitor, eg selegiline or rasagiline, though it can be used with either of these on their own.
There may be an increased risk of dizziness when moving from a lying or sitting position to sitting or standing (postural hypotension) if this medicine is taken with other medicines that can have this effect, for example medicines to treat high blood pressure (antihypertensives). Your doctor may need to adjust the dose of your blood pressure medicine.
Iron reduces the absorption of this medicine from the gut. For this reason, if you are taking iron supplements such as ferrous sulphate, you should take them two to three hours before or after this medicine.
The following medicines may reduce the effect of levodopa:
- antipsychotic medicines, eg chlorpromazine, prochlorperazine, haloperidol, flupentixol (equally levodopa may oppose the effect of these medicines)
- benzodiazepines, eg diazepam
Tricyclic antidepressants, eg amitriptyline, imipramine, may decrease the therapeutic effects of this medicine, and may also rarely increase the risk of a dangerous rise in blood pressure (hypertensive crisis).
Anticholinergic medicines, eg procyclidine, atropine, hyoscine, propantheline, orphenadrine, benzhexol, may decrease the absorption of this medicine from the gut and reduce its therapeutic effect.
This medicine can be used with other medicines for Parkinsons disease, eg anticholinergics, amantadine, dopamine agonists or COMT inhibitors, however, both the desired effects and side effects of treatment may be intensified. Your doctor may need to adjust the dose of one or more of your medicines to get the correct balance to control your symptoms with minimum side effects.
Other medicines containing the same active ingredients
Co-beneldopa tablets are also available without a brand name, ie as the generic medicine.