Stalevo 200 Tablets
It is used to treat Parkinson's disease.
Drug Class
Anti-Parkinson's agent
Pharmacologic Class
Dopamine precursor, DOPA 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, carbidopa, and entacapone. Levodopa helps replace a natural substance in your brain called dopamine, which is low in Parkinson's disease. Carbidopa helps more levodopa get to your brain and reduces side effects. Entacapone helps levodopa work longer in your body, which can reduce 'off' times (when your symptoms return).
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 with your prescription 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 in relation to 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 taper off gradually.
Continue taking this medication even when you are not experiencing symptoms. Keeping a diary of your symptoms can be helpful in tracking your progress. 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 your 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 your medication, 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 make up for a missed one.
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription 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 in relation to 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 taper off gradually.
Continue taking this medication even when you are not experiencing symptoms. Keeping a diary of your symptoms can be helpful in tracking your progress. 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 your 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 your medication, 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 make up for a missed one.
Lifestyle & Tips
- Take Stalevo exactly as prescribed by your doctor. Do not stop taking it suddenly, as this can lead to serious side effects.
- You can take Stalevo with or without food. However, taking it with a high-protein meal may reduce its effectiveness. If you experience nausea, taking it with a low-protein snack may help.
- Do not crush, chew, or split the tablets; swallow them whole.
- Be aware that your urine, sweat, or saliva may turn reddish-brown or dark. This is a harmless effect of the medication.
- Stand up slowly from a sitting or lying position to avoid dizziness or lightheadedness (orthostatic hypotension).
- Report any new or worsening involuntary movements (dyskinesias) 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.
Available Forms & Alternatives
Available Strengths:
Generic Alternatives:
Dosing & Administration
Adult Dosing
Standard Dose:
Individualized, based on patient's response and tolerance. For Stalevo 200 (Carbidopa 50 mg / Levodopa 200 mg / Entacapone 200 mg), the maximum recommended daily dose of entacapone is 1600 mg (equivalent to 8 tablets of Stalevo 200).
Dose Range:
1 - 8 mg
Condition-Specific Dosing:
conversionFromLevodopaCarbidopa:
Patients currently treated with levodopa/carbidopa may be switched to Stalevo with a dose that provides approximately 10% to 30% more levodopa than previously administered, while ensuring the entacapone dose does not exceed 1600 mg/day.
doseAdjustment:
Doses should be adjusted to achieve optimal therapeutic response, typically by adjusting the levodopa component. The maximum daily dose of entacapone is 1600 mg.
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 use with caution.
Moderate:
No specific dose adjustment recommended, but use with caution.
Severe:
No specific dose adjustment recommended, but use with caution. Monitor for adverse effects.
Dialysis:
Not extensively studied; entacapone is highly protein bound and unlikely to be significantly removed by dialysis. Use with caution.
Hepatic Impairment:
Mild:
Use with caution. Dose reduction may be necessary.
Moderate:
Use with caution. Dose reduction may be necessary due to increased AUC and Cmax of entacapone.
Severe:
Use with caution. Dose reduction may be necessary. Monitor for adverse effects.
Pharmacology
Mechanism of Action
Stalevo combines three active ingredients: Levodopa, Carbidopa, and Entacapone. Levodopa is a metabolic precursor of dopamine, which crosses the blood-brain barrier and is converted to dopamine in the brain, alleviating Parkinson's symptoms. Carbidopa is a peripheral DOPA decarboxylase inhibitor that prevents the peripheral conversion of levodopa to dopamine, allowing more levodopa to reach the brain and reducing peripheral side effects. Entacapone is a reversible and selective catechol-O-methyltransferase (COMT) inhibitor that prevents the peripheral breakdown of levodopa by COMT, thereby increasing the bioavailability and prolonging the half-life of levodopa in the plasma, leading to more sustained levodopa levels in the brain.
Pharmacokinetics
Absorption:
Bioavailability:
Levodopa: ~30% (when co-administered with carbidopa); Carbidopa: ~50%; Entacapone: ~35% (oral)
Tmax:
Levodopa: ~0.5-2 hours; Carbidopa: ~2-4 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: ~1.1 L/kg; Entacapone: ~20 L
ProteinBinding:
Levodopa: Not significantly protein bound; Carbidopa: ~36%; Entacapone: >98% (primarily to albumin)
CnssPenetration:
Levodopa: Yes (after conversion to dopamine); Carbidopa: Limited; Entacapone: Limited
Elimination:
HalfLife:
Levodopa: ~1-2 hours (with carbidopa/entacapone); Carbidopa: ~2 hours; Entacapone: ~0.4-0.7 hours (initial), ~2.4 hours (terminal)
Clearance:
Not available
ExcretionRoute:
Levodopa: Urine (metabolites); Carbidopa: Urine (metabolites); Entacapone: Primarily fecal (90-95%), minor renal (10-20%)
Unchanged:
Levodopa: <1% (urine); Carbidopa: ~30% (urine); Entacapone: <0.2% (urine)
Pharmacodynamics
OnsetOfAction:
Variable, typically within 30-60 minutes for levodopa effect
PeakEffect:
Variable, generally corresponds to peak plasma levodopa levels
DurationOfAction:
Dependent on levodopa half-life, typically 2-5 hours, extended 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
Skin lumps or growths
Changes in mole color or size
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 fall asleep during activities 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 suddenly or when the dose is lowered. If you experience any of the following symptoms, contact your doctor right away:
Fever
Muscle cramps or stiffness
Dizziness
Severe headache
Confusion
Changes in thinking
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 notice any of the following side effects or any other unusual symptoms, contact your doctor:
Dizziness
Sleepiness
Fatigue
Weakness
Constipation
Diarrhea
Stomach pain
Upset stomach
Vomiting
Dry mouth
Headache
Trouble sleeping
* Back pain
This is not an exhaustive list of 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
Skin lumps or growths
Changes in mole color or size
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 fall asleep during activities 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 suddenly or when the dose is lowered. If you experience any of the following symptoms, contact your doctor right away:
Fever
Muscle cramps or stiffness
Dizziness
Severe headache
Confusion
Changes in thinking
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 notice any of the following side effects or any other unusual symptoms, contact your doctor:
Dizziness
Sleepiness
Fatigue
Weakness
Constipation
Diarrhea
Stomach pain
Upset stomach
Vomiting
Dry mouth
Headache
Trouble sleeping
* Back pain
This is not an exhaustive list of 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 or persistent diarrhea
- New or worsening involuntary movements (dyskinesias)
- Hallucinations, delusions, or confusion
- Excessive daytime sleepiness or sudden onset of sleep
- Uncontrolled urges (e.g., gambling, shopping, eating, sexual urges)
- Severe dizziness or fainting spells
- Unexplained muscle pain, tenderness, or weakness (rhabdomyolysis)
- Signs of liver problems (e.g., yellowing of skin/eyes, dark urine, persistent nausea/vomiting)
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 and its symptoms.
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 within 14 days of 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 consulting your doctor first.
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 and its symptoms.
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 within 14 days of 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 consulting your doctor first.
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.
To minimize the risk of accidents, avoid driving and engaging in activities that require your full attention until you understand how this medication affects you. Additionally, to reduce the likelihood of dizziness or fainting, get up slowly from a sitting or lying position, and exercise caution when navigating stairs.
Regular blood tests and other laboratory evaluations are crucial while taking this medication. Follow your doctor's instructions for scheduling these tests, and be sure to notify all healthcare providers and laboratory personnel that you are taking this drug, as it may interfere with certain lab results.
You may experience a decrease in the medication's effectiveness as the time approaches for your next dose. If this occurs and causes you concern, discuss it with your doctor. It may take several months to realize the full benefits of this medication.
Before consuming alcohol, using marijuana or other cannabis products, or taking prescription or over-the-counter medications that may cause drowsiness, consult with your doctor.
You may notice a dark discoloration (red, brown, or black) in your saliva, urine, or sweat while taking this medication. Although this is harmless, it may stain your clothing.
If you experience diarrhea or vomiting, consult your doctor promptly to prevent dehydration and electrolyte imbalances.
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor. It is crucial to discuss the potential benefits and risks of this medication to both you and your baby.
To minimize the risk of accidents, avoid driving and engaging in activities that require your full attention until you understand how this medication affects you. Additionally, to reduce the likelihood of dizziness or fainting, get up slowly from a sitting or lying position, and exercise caution when navigating stairs.
Regular blood tests and other laboratory evaluations are crucial while taking this medication. Follow your doctor's instructions for scheduling these tests, and be sure to notify all healthcare providers and laboratory personnel that you are taking this drug, as it may interfere with certain lab results.
You may experience a decrease in the medication's effectiveness as the time approaches for your next dose. If this occurs and causes you concern, discuss it with your doctor. It may take several months to realize the full benefits of this medication.
Before consuming alcohol, using marijuana or other cannabis products, or taking prescription or over-the-counter medications that may cause drowsiness, consult with your doctor.
You may notice a dark discoloration (red, brown, or black) in your saliva, urine, or sweat while taking this medication. Although this is harmless, it may stain your clothing.
If you experience diarrhea or vomiting, consult your doctor promptly to prevent dehydration and electrolyte imbalances.
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor. It is crucial to discuss the potential benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Severe dyskinesias
- Agitation
- Confusion
- Insomnia
- Orthostatic hypotension
- Nausea, vomiting
- Tachycardia
- Arrhythmias
What to Do:
Seek immediate medical attention. Call 911 or your local emergency number. For poison control, call 1-800-222-1222.
Drug Interactions
Contraindicated Interactions
- Non-selective monoamine oxidase (MAO) inhibitors (e.g., phenelzine, tranylcypromine) - risk of hypertensive crisis. Discontinue MAO inhibitors at least 2 weeks prior to initiating Stalevo.
Major Interactions
- Iron salts (ferrous sulfate, gluconate) - form chelates with levodopa and entacapone, reducing absorption. Administer Stalevo at least 2-3 hours before or after iron preparations.
- Dopamine D2 receptor antagonists (e.g., phenothiazines, butyrophenones, metoclopramide, risperidone) - may antagonize the effects of levodopa.
- Antihypertensive agents - additive hypotensive effects, monitor blood pressure.
- Isoniazid - may reduce the efficacy of levodopa.
- Papaverine - may reduce the efficacy of levodopa.
Moderate Interactions
- Tricyclic antidepressants (TCAs) - rare reports of hypertension and dyskinesia. Use with caution.
- Other COMT inhibitors (e.g., tolcapone) - concomitant use is not recommended.
- Drugs metabolized by COMT (e.g., isoproterenol, epinephrine, norepinephrine, dopamine, dobutamine, alpha-methyldopa, apomorphine) - entacapone may increase their systemic exposure. Use with caution.
- Antacids - may increase entacapone absorption.
Minor Interactions
- High-protein diet - may reduce levodopa absorption and efficacy.
Monitoring
Baseline Monitoring
Blood pressure (sitting and standing)
Rationale: To assess for orthostatic hypotension, a common side effect of dopaminergic therapy.
Timing: Prior to initiation of therapy.
Heart rate
Rationale: To assess for cardiovascular effects.
Timing: Prior to initiation of therapy.
Liver function tests (ALT, AST, bilirubin)
Rationale: Although rare, entacapone has been associated with liver enzyme elevations. Baseline assessment is prudent.
Timing: Prior to initiation of therapy.
Renal function (BUN, creatinine)
Rationale: To assess baseline kidney function, especially in patients with pre-existing renal impairment.
Timing: Prior to initiation of therapy.
Mental status and psychiatric history
Rationale: To assess for pre-existing psychiatric conditions that may be exacerbated by dopaminergic therapy (e.g., psychosis, impulse control disorders).
Timing: Prior to initiation of therapy.
Routine Monitoring
Blood pressure (sitting and standing)
Frequency: Regularly, especially during dose titration and if symptoms of orthostatic hypotension occur.
Target: Maintain within patient's normal range, avoid symptomatic hypotension.
Action Threshold: Symptomatic orthostatic hypotension or significant drop (e.g., >20 mmHg systolic, >10 mmHg diastolic) upon standing.
Motor fluctuations (e.g., 'wearing-off' time, dyskinesias)
Frequency: At each clinical visit.
Target: Optimal motor control with minimal dyskinesia.
Action Threshold: Increased 'off' time, troublesome dyskinesias, or other motor complications requiring dose adjustment.
Mental status, mood, and behavior (e.g., hallucinations, delusions, impulse control disorders)
Frequency: At each clinical visit.
Target: Stable mental state.
Action Threshold: New or worsening psychiatric symptoms.
Liver function tests (ALT, AST)
Frequency: Periodically, especially if symptoms of liver dysfunction develop or if there is a history of liver disease.
Target: Within normal limits.
Action Threshold: Significant or persistent elevation above normal limits.
Symptom Monitoring
- Orthostatic hypotension (dizziness, lightheadedness upon standing)
- Nausea, vomiting, diarrhea, abdominal pain
- Dyskinesias (involuntary movements)
- Hallucinations, delusions, confusion, psychosis
- Impulse control disorders (e.g., pathological gambling, hypersexuality, compulsive shopping, binge eating)
- Sleep disturbances (insomnia, somnolence, sudden onset of sleep)
- Urine discoloration (reddish-brown, harmless)
- Diarrhea (can be severe and persistent, requiring discontinuation)
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.
Trimester-Specific Risks:
First Trimester:
Potential for developmental toxicity observed in animal studies at high doses.
Second Trimester:
Potential for developmental toxicity observed in animal studies at high doses.
Third Trimester:
Potential for developmental toxicity observed in animal studies at high doses.
Lactation
Levodopa is excreted into human milk. It is unknown if carbidopa or entacapone are excreted into human milk. Because of 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:
Risk of adverse effects on the infant (e.g., suppression of lactation, potential for motor abnormalities, CNS effects).
Pediatric Use
The safety and effectiveness of Stalevo in pediatric patients have not been established. Use is not recommended.
Geriatric Use
No specific dose adjustment is generally required based on age alone. However, elderly patients may be more sensitive to the adverse effects of Stalevo, particularly orthostatic hypotension, hallucinations, and dyskinesias. Monitor closely for these effects.
Clinical Information
Clinical Pearls
- Stalevo is designed to reduce 'wearing-off' periods in Parkinson's patients by extending the duration of levodopa's effect.
- Patients should be advised that their urine, sweat, or saliva may turn reddish-brown or dark, which is a harmless effect of entacapone.
- Severe, persistent diarrhea can occur with entacapone and may necessitate discontinuation of the drug. Patients should report this symptom immediately.
- Impulse control disorders (e.g., pathological gambling, hypersexuality) can occur with dopaminergic therapies, including Stalevo. Patients and caregivers should be counselled on this risk.
- Sudden onset of sleep without warning has been reported. Patients should be cautioned about driving or operating machinery.
- Avoid abrupt discontinuation of Stalevo due to the risk of a neuroleptic malignant syndrome-like syndrome (NMS-like syndrome).
Alternative Therapies
- Dopamine agonists (e.g., pramipexole, ropinirole, rotigotine, apomorphine)
- MAO-B inhibitors (e.g., selegiline, rasagiline, safinamide)
- Other COMT inhibitors (e.g., tolcapone, opicapone)
- Amantadine
- Anticholinergics (e.g., benztropine, trihexyphenidyl)
- Adenosine A2A receptor antagonists (e.g., istradefylline)
Cost & Coverage
Average Cost:
Check current market data per 30 tablets
Generic Available:
Yes
Insurance Coverage:
Tier 2 or 3 (Brand), Tier 1 (Generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication, including the amount taken and the time it happened, to facilitate prompt and effective treatment.