Stalevo 150 Tablets
It is used to treat Parkinson's disease.
Drug Class
Anti-Parkinson's agent
Pharmacologic Class
Dopamine precursor, decarboxylase inhibitor, catechol-O-methyltransferase (COMT) inhibitor
Pregnancy Category
Category C
FDA Approved
Jun 2003
DEA Schedule
Not Controlled
Overview
What is this medicine?
Stalevo is a medication used to treat Parkinson's disease. It combines three medicines: levodopa, which helps replace a chemical called dopamine in the brain; carbidopa, which helps more levodopa get to the brain; and entacapone, which helps levodopa work longer. This combination helps reduce 'off' times (when symptoms return) and improve motor control in people with Parkinson's.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided to you and follow the instructions closely. You can take this medication with or without food. Swallow the tablet whole - do not chew, break, or crush it.
If you take an iron supplement or a multivitamin that contains iron, consult your doctor or pharmacist about how to take it with this medication. Iron may reduce the absorption of this medication in your body.
Your diet can also affect how well your body absorbs this medication. Diets high in protein, fat, or calories, as well as eating acidic foods, may reduce absorption. Discuss your diet with your doctor, especially if you plan to make any changes.
Do not stop taking this medication suddenly without consulting your doctor, as this may increase your risk of side effects. If you need to stop taking this medication, your doctor will instruct you on how to gradually discontinue it.
Continue taking this medication even when you are not experiencing symptoms. Keeping a diary of your symptoms can be helpful. Take this medication at the same time every day, as directed by your doctor or healthcare provider, even if you feel well.
Storing and Disposing of Your Medication
Store this medication at room temperature in a dry place, away from the bathroom. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so. If you have questions about disposing of medications, consult your pharmacist. You may also want to check if there are any drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it is close to the time for your next dose, skip the missed dose and resume your regular schedule. Do not take two doses at the same time or take extra doses.
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided to you and follow the instructions closely. You can take this medication with or without food. Swallow the tablet whole - do not chew, break, or crush it.
If you take an iron supplement or a multivitamin that contains iron, consult your doctor or pharmacist about how to take it with this medication. Iron may reduce the absorption of this medication in your body.
Your diet can also affect how well your body absorbs this medication. Diets high in protein, fat, or calories, as well as eating acidic foods, may reduce absorption. Discuss your diet with your doctor, especially if you plan to make any changes.
Do not stop taking this medication suddenly without consulting your doctor, as this may increase your risk of side effects. If you need to stop taking this medication, your doctor will instruct you on how to gradually discontinue it.
Continue taking this medication even when you are not experiencing symptoms. Keeping a diary of your symptoms can be helpful. Take this medication at the same time every day, as directed by your doctor or healthcare provider, even if you feel well.
Storing and Disposing of Your Medication
Store this medication at room temperature in a dry place, away from the bathroom. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so. If you have questions about disposing of medications, consult your pharmacist. You may also want to check if there are any drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it is close to the time for your next dose, skip the missed dose and resume your regular schedule. Do not take two doses at the same time or take extra doses.
Lifestyle & Tips
- Take Stalevo exactly as prescribed by your doctor. Do not stop taking it suddenly without consulting your doctor, as this can lead to serious side effects.
- Take Stalevo with or without food, but be aware that high-protein meals may reduce its absorption. If you experience nausea, taking it with a low-protein snack may help.
- Do not crush or chew the tablets; swallow them whole.
- Be aware of potential side effects like dizziness or lightheadedness, especially when standing up quickly. Rise slowly from a sitting or lying position.
- Report any new or worsening involuntary movements (dyskinesia) to your doctor.
- Be aware of potential changes in behavior, such as increased gambling, shopping, or sexual urges. Discuss these with your doctor.
- Do not take iron supplements or multivitamins containing iron at the same time as Stalevo. Separate doses by at least 2-3 hours.
- Your urine, sweat, or saliva may turn dark (red, brown, or black). This is a harmless side effect of entacapone.
- Avoid alcohol or other sedatives, as they can worsen drowsiness.
Available Forms & Alternatives
Available Strengths:
Generic Alternatives:
Dosing & Administration
Adult Dosing
Standard Dose:
Individualized based on patient's current levodopa/carbidopa regimen. Stalevo 150 contains Levodopa 150 mg, Carbidopa 37.5 mg, and Entacapone 200 mg. The maximum recommended daily dose of entacapone is 1600 mg (equivalent to 8 Stalevo 150 tablets). Dosing frequency is typically with each levodopa/carbidopa dose.
Condition-Specific Dosing:
initial_therapy:
Not recommended for initiation of levodopa therapy. Should be used to replace current levodopa/carbidopa and entacapone regimens.
dose_adjustment:
Adjustments should be made cautiously, considering the levodopa component. If more levodopa is needed, increase frequency or switch to a higher strength of Stalevo. If less levodopa is needed, decrease frequency or switch to a lower strength. Entacapone dose is fixed at 200 mg per tablet.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established
Adolescent:
Not established
Dose Adjustments
Renal Impairment:
Mild:
No specific dose adjustment recommended, but caution advised.
Moderate:
No specific dose adjustment recommended, but caution advised. Monitor for adverse effects.
Severe:
No specific dose adjustment recommended, but caution advised. Monitor for adverse effects, especially dyskinesia and nausea.
Dialysis:
Not well studied. Use with caution and monitor closely for adverse effects.
Hepatic Impairment:
Mild:
No specific dose adjustment recommended, but caution advised.
Moderate:
Use with caution. Consider reducing the entacapone dose or increasing the dosing interval. Monitor liver function tests.
Severe:
Contraindicated due to increased exposure to entacapone and potential for hepatotoxicity.
Pharmacology
Mechanism of Action
Stalevo combines three active ingredients: Levodopa, Carbidopa, and Entacapone. Levodopa is a metabolic precursor of dopamine that crosses the blood-brain barrier and is converted to dopamine in the brain, alleviating Parkinson's symptoms. Carbidopa is an aromatic L-amino acid decarboxylase (DDC) inhibitor that does not cross the blood-brain barrier. It inhibits the peripheral conversion of levodopa to dopamine, allowing more levodopa to reach the brain and reducing peripheral side effects. Entacapone is a selective and reversible catechol-O-methyltransferase (COMT) inhibitor. It inhibits the COMT enzyme, which is responsible for the peripheral metabolism of levodopa, thereby prolonging the half-life of levodopa and increasing its bioavailability to the brain.
Pharmacokinetics
Absorption:
Bioavailability:
Levodopa: ~30% (when given with carbidopa); Carbidopa: ~58%; Entacapone: ~35%
Tmax:
Levodopa: 2-2.5 hours; Carbidopa: 2-2.5 hours; Entacapone: 1 hour
FoodEffect:
Food delays and decreases the absorption of levodopa and entacapone. High-protein meals can reduce levodopa absorption.
Distribution:
Vd:
Levodopa: 0.9-1.6 L/kg; Carbidopa: 1.3 L/kg; Entacapone: 0.27 L/kg (at steady state)
ProteinBinding:
Levodopa: Not significant; Carbidopa: ~36%; Entacapone: ~98% (primarily to albumin)
CnssPenetration:
Levodopa: Yes; Carbidopa: No (does not cross BBB); Entacapone: Limited
Elimination:
HalfLife:
Levodopa: ~1.5 hours (with carbidopa); Carbidopa: ~2 hours; Entacapone: 2.4-3.5 hours
Clearance:
Levodopa: 0.3-0.8 L/kg/hr; Carbidopa: 0.4-0.7 L/kg/hr; Entacapone: 0.7 L/kg/hr
ExcretionRoute:
Levodopa: Urine (metabolites); Carbidopa: Urine (unchanged and metabolites); Entacapone: Primarily feces (90-95%), small amount in urine (10-20%)
Unchanged:
Levodopa: <1% (in urine); Carbidopa: ~30% (in urine); Entacapone: <0.2% (in urine)
Pharmacodynamics
OnsetOfAction:
Within 30-60 minutes (for levodopa effect)
PeakEffect:
1-2 hours after dose (for levodopa effect)
DurationOfAction:
Variable, typically 2-4 hours, prolonged by entacapone
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
New or worsening behavior or mood changes, including:
+ Depression
+ Thoughts of suicide
Hallucinations (seeing or hearing things that are not there)
Severe dizziness or fainting
Confusion
Vomiting blood or coffee ground-like material
Black, tarry, or bloody stools
Muscle pain or weakness, dark urine, or difficulty urinating
A new skin lump or growth
Changes in the color or size of a mole
Strong, uncontrollable urges (such as eating, gambling, sex, or spending money)
New or worsening trouble controlling body movements
Chest pain or pressure
Shortness of breath
Fever, chills, or sore throat
Unexplained bruising or bleeding
Feeling extremely tired or weak
Sudden, unexplained sleepiness, especially during activities like driving, eating, or talking
If you experience sudden sleepiness, do not drive or engage in activities that require alertness while taking this medication. Contact your doctor immediately if you experience sudden sleepiness or feel extremely sleepy.
Neuroleptic Malignant Syndrome (NMS)
NMS is a rare but potentially life-threatening condition that can occur when this medication is stopped abruptly or when the dose is lowered. If you experience any of the following symptoms, contact your doctor immediately:
Fever
Muscle cramps or stiffness
Dizziness
Severe headache
Confusion
Changes in thinking or behavior
Fast or irregular heartbeat
Excessive sweating
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people may not experience any side effects or may only have mild ones. If you experience any of the following side effects, contact your doctor if they bother you or do not go away:
Dizziness
Sleepiness
Fatigue
Weakness
Constipation
Diarrhea
Stomach pain
Upset stomach
Vomiting
Dry mouth
Headache
Trouble sleeping
* Back pain
This is not a comprehensive list of all possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
New or worsening behavior or mood changes, including:
+ Depression
+ Thoughts of suicide
Hallucinations (seeing or hearing things that are not there)
Severe dizziness or fainting
Confusion
Vomiting blood or coffee ground-like material
Black, tarry, or bloody stools
Muscle pain or weakness, dark urine, or difficulty urinating
A new skin lump or growth
Changes in the color or size of a mole
Strong, uncontrollable urges (such as eating, gambling, sex, or spending money)
New or worsening trouble controlling body movements
Chest pain or pressure
Shortness of breath
Fever, chills, or sore throat
Unexplained bruising or bleeding
Feeling extremely tired or weak
Sudden, unexplained sleepiness, especially during activities like driving, eating, or talking
If you experience sudden sleepiness, do not drive or engage in activities that require alertness while taking this medication. Contact your doctor immediately if you experience sudden sleepiness or feel extremely sleepy.
Neuroleptic Malignant Syndrome (NMS)
NMS is a rare but potentially life-threatening condition that can occur when this medication is stopped abruptly or when the dose is lowered. If you experience any of the following symptoms, contact your doctor immediately:
Fever
Muscle cramps or stiffness
Dizziness
Severe headache
Confusion
Changes in thinking or behavior
Fast or irregular heartbeat
Excessive sweating
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people may not experience any side effects or may only have mild ones. If you experience any of the following side effects, contact your doctor if they bother you or do not go away:
Dizziness
Sleepiness
Fatigue
Weakness
Constipation
Diarrhea
Stomach pain
Upset stomach
Vomiting
Dry mouth
Headache
Trouble sleeping
* Back pain
This is not a comprehensive list of all possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe dizziness or fainting
- New or worsening uncontrolled movements (dyskinesia)
- Hallucinations (seeing or hearing things that are not there)
- Unusual urges or behaviors (e.g., compulsive gambling, hypersexuality)
- Sudden onset of sleep during daily activities
- Severe nausea, vomiting, or diarrhea that persists
- Muscle stiffness, high fever, confusion (signs of Neuroleptic Malignant Syndrome-like reaction)
- Yellowing of skin or eyes, dark urine, persistent nausea (signs of liver problems)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain health conditions, including:
+ Glaucoma
+ Skin lumps or growths
+ A history of skin cancer
* If you have taken specific antidepressant medications, such as isocarboxazid, phenelzine, or tranylcypromine, within the last 14 days. Taking this medication too soon after these drugs can lead to severe high blood pressure.
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health problems with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions. Never start, stop, or change the dose of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain health conditions, including:
+ Glaucoma
+ Skin lumps or growths
+ A history of skin cancer
* If you have taken specific antidepressant medications, such as isocarboxazid, phenelzine, or tranylcypromine, within the last 14 days. Taking this medication too soon after these drugs can lead to severe high blood pressure.
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health problems with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions. Never start, stop, or change the dose of any medication without first consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. This will help ensure they have a complete understanding of your treatment plan.
Until you know how this medication affects you, avoid driving and other activities that require your full attention. To minimize the risk of dizziness or fainting, get up slowly from a sitting or lying position, and be cautious when climbing stairs.
Regular blood tests and other laboratory evaluations are crucial while taking this medication. Follow your doctor's instructions for scheduling these tests. Additionally, notify all your healthcare providers and laboratory personnel that you are taking this medication, as it may interfere with certain lab tests.
You may experience a decrease in the medication's effectiveness as the time approaches for your next dose. If this occurs and bothers you, discuss it with your doctor. It may take several months to feel the full benefits of this medication.
Before consuming alcohol, marijuana, or other forms of cannabis, or taking prescription or over-the-counter medications that can cause drowsiness, consult with your doctor.
You may notice a dark discoloration (red, brown, or black) in your saliva, urine, or sweat. Although this is harmless, it may stain your clothing.
If you experience diarrhea or vomiting, consult your doctor promptly. It is crucial to prevent dehydration and electrolyte imbalances.
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor. You and your doctor will need to discuss the potential benefits and risks of this medication to you and your baby.
Until you know how this medication affects you, avoid driving and other activities that require your full attention. To minimize the risk of dizziness or fainting, get up slowly from a sitting or lying position, and be cautious when climbing stairs.
Regular blood tests and other laboratory evaluations are crucial while taking this medication. Follow your doctor's instructions for scheduling these tests. Additionally, notify all your healthcare providers and laboratory personnel that you are taking this medication, as it may interfere with certain lab tests.
You may experience a decrease in the medication's effectiveness as the time approaches for your next dose. If this occurs and bothers you, discuss it with your doctor. It may take several months to feel the full benefits of this medication.
Before consuming alcohol, marijuana, or other forms of cannabis, or taking prescription or over-the-counter medications that can cause drowsiness, consult with your doctor.
You may notice a dark discoloration (red, brown, or black) in your saliva, urine, or sweat. Although this is harmless, it may stain your clothing.
If you experience diarrhea or vomiting, consult your doctor promptly. It is crucial to prevent dehydration and electrolyte imbalances.
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor. You and your doctor will need to discuss the potential benefits and risks of this medication to you and your baby.
Overdose Information
Overdose Symptoms:
- Severe dyskinesia
- Agitation, confusion
- Orthostatic hypotension
- Tachycardia
- Arrhythmias
- Nausea, vomiting
- Diarrhea
- Darkening of urine
What to Do:
Seek immediate medical attention or call a poison control center. In the US, call 1-800-222-1222. Treatment is supportive, including gastric lavage, activated charcoal, and careful monitoring of vital signs and cardiac rhythm. Administer antiarrhythmics if necessary.
Drug Interactions
Contraindicated Interactions
- Non-selective monoamine oxidase (MAO) inhibitors (e.g., phenelzine, tranylcypromine) - risk of hypertensive crisis. Discontinue MAOIs at least 2 weeks prior to Stalevo.
Major Interactions
- Selective MAO-B inhibitors (e.g., selegiline, rasagiline) - may be used cautiously, but levodopa dose reduction may be necessary.
- Antihypertensive agents - increased risk of orthostatic hypotension.
- Dopamine D2 receptor antagonists (e.g., phenothiazines, butyrophenones, metoclopramide) - may reduce the therapeutic effects of levodopa.
- Iron salts (ferrous sulfate, ferrous gluconate) - form chelates with levodopa and entacapone, reducing absorption.
- Reserpine, tetrabenazine - may deplete central catecholamine stores, reducing levodopa efficacy.
- Papaverine, phenytoin - may reduce the therapeutic effects of levodopa.
- Tricyclic antidepressants - rare reports of hypertension and dyskinesia.
Moderate Interactions
- Other drugs metabolized by COMT (e.g., isoproterenol, epinephrine, norepinephrine, dopamine, dobutamine, alpha-methyldopa, apomorphine) - entacapone may potentiate their effects.
- Warfarin - isolated cases of INR increase with entacapone.
Minor Interactions
- Antacids - may increase entacapone absorption slightly.
Monitoring
Baseline Monitoring
Liver Function Tests (ALT, AST, ALP, Bilirubin)
Rationale: Entacapone has been associated with rare cases of liver injury. Baseline assessment is important.
Timing: Prior to initiation of therapy
Renal Function (BUN, Creatinine)
Rationale: To assess kidney function, especially in patients with pre-existing renal impairment.
Timing: Prior to initiation of therapy
Complete Blood Count (CBC)
Rationale: Levodopa/carbidopa can rarely cause hemolytic anemia or leukopenia.
Timing: Prior to initiation of therapy
Cardiovascular Assessment (Blood Pressure, ECG)
Rationale: To assess for pre-existing cardiovascular conditions and risk of orthostatic hypotension.
Timing: Prior to initiation of therapy
Mental Status Examination
Rationale: To assess for baseline cognitive and psychiatric status, as these can be affected by therapy.
Timing: Prior to initiation of therapy
Routine Monitoring
Motor Fluctuations (wearing-off, dyskinesia)
Frequency: At each clinical visit, or as needed based on patient report
Target: Optimal motor control with minimal dyskinesia
Action Threshold: Increased 'off' time, new or worsening dyskinesia, or other motor complications warrant dose adjustment or re-evaluation of therapy.
Blood Pressure (especially orthostatic)
Frequency: Regularly, especially during dose titration and in patients at risk for hypotension
Target: Within patient's normal range, without symptomatic orthostasis
Action Threshold: Symptomatic orthostatic hypotension (dizziness, lightheadedness) or significant drop in BP (e.g., >20 mmHg systolic, >10 mmHg diastolic) upon standing.
Psychiatric Symptoms (hallucinations, delusions, impulse control disorders)
Frequency: At each clinical visit
Target: Absence of new or worsening psychiatric symptoms
Action Threshold: Emergence or worsening of psychiatric symptoms warrants dose reduction or discontinuation.
Liver Function Tests (ALT, AST)
Frequency: Periodically, especially if symptoms of liver dysfunction develop or if patient has pre-existing liver disease.
Target: Within normal limits
Action Threshold: Significant elevation (e.g., >3x ULN) warrants investigation and potential discontinuation.
Renal Function
Frequency: Periodically, especially in patients with renal impairment
Target: Stable renal function
Action Threshold: Significant decline in renal function may necessitate dose adjustment or re-evaluation.
Symptom Monitoring
- Orthostatic hypotension (dizziness, lightheadedness upon standing)
- Dyskinesia (involuntary movements)
- Nausea, vomiting, diarrhea
- Hallucinations, delusions, confusion
- Impulse control disorders (e.g., pathological gambling, hypersexuality, compulsive shopping, binge eating)
- Sleepiness, sudden onset of sleep
- Unusual urges or behaviors
- Darkening of urine, sweat, or saliva (harmless, due to entacapone metabolites)
- Abdominal pain, constipation
- Changes in mood or behavior
- Symptoms of liver dysfunction (e.g., persistent nausea, fatigue, dark urine, jaundice)
Special Patient Groups
Pregnancy
Category C. There are no adequate and well-controlled studies in pregnant women. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Levodopa has been shown to be teratogenic in animals.
Trimester-Specific Risks:
First Trimester:
Potential for teratogenicity based on animal studies. Use only if clearly needed.
Second Trimester:
Potential for adverse effects on fetal development. Use with caution.
Third Trimester:
Potential for adverse effects on fetal development and labor. Use with caution.
Lactation
Levodopa and carbidopa are excreted in human milk. It is unknown if entacapone is excreted in human milk. Due to the potential for serious adverse reactions in breastfed infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Infant Risk:
L3 (Moderate risk). Potential for central nervous system effects in the infant due to levodopa. Entacapone's effects are unknown but could theoretically affect infant's metabolism.
Pediatric Use
Safety and effectiveness in pediatric patients have not been established. Stalevo is not recommended for use in this population.
Geriatric Use
No overall differences in safety or effectiveness were observed between elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. Elderly patients may be more susceptible to certain adverse effects, such as orthostatic hypotension and hallucinations. Dose adjustments should be made cautiously.
Clinical Information
Clinical Pearls
- Stalevo is a fixed-dose combination and should not be used for initial levodopa therapy. It is intended for patients already on stable doses of levodopa/carbidopa and entacapone who experience 'wearing-off' phenomena.
- Patients should be advised about the harmless discoloration of urine, sweat, and saliva (reddish-brown to black) due to entacapone metabolites.
- Monitor for impulse control disorders (ICDs) such as pathological gambling, hypersexuality, and compulsive shopping, which can occur with dopaminergic therapies.
- Sudden onset of sleep without warning has been reported; advise patients to use caution when driving or operating machinery.
- Discontinuation of Stalevo should be gradual to avoid a symptom complex resembling Neuroleptic Malignant Syndrome (NMS), characterized by fever, muscle rigidity, altered mental status, and autonomic instability.
- Iron supplements should be taken at least 2-3 hours apart from Stalevo to avoid reduced absorption of levodopa and entacapone.
Alternative Therapies
- Dopamine agonists (e.g., pramipexole, ropinirole, rotigotine, apomorphine)
- MAO-B inhibitors (e.g., selegiline, rasagiline, safinamide)
- Amantadine
- Anticholinergics (e.g., benztropine, trihexyphenidyl)
- COMT inhibitors (e.g., opicapone, tolcapone - note: tolcapone has liver toxicity concerns)
Cost & Coverage
Average Cost:
Varies widely, typically $300-$1000+ per 30 tablets
Generic Available:
Yes
Insurance Coverage:
Tier 2 or 3 (Brand name, may require prior authorization)
General Drug Facts
If your symptoms or health condition do not improve or worsen over time, it is essential to contact your doctor for further evaluation and guidance. To ensure your safety and the effectiveness of your treatment, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it is a good idea to consult with your pharmacist for more information. If you have any questions or concerns about your medication, do not hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide detailed information about the overdose, including the type and amount of medication taken, as well as the time it was taken.