Indications

Twindopa Tablet is indicated for the treatment of Parkinson’s disease and Parkinsonian syndromes. It is effective in relieving many of the cardinal symptoms of parkinsonism, particularly rigidity and bradykinesia. Twindopa Tablet is also beneficial in managing tremor, dysphagia, sialorrhea, and postural instability associated with Parkinson’s disease and related syndromes. In addition, administration of Levodopa plus Carbidopa prior to physiotherapy has been shown to enhance motor recovery following stroke.

রেজিস্টার্ড চিকিৎসকের পরামর্শ অনুযায়ী ঔষধ সেবন করুন

Pharmacology

Twindopa Tablet contains Levodopa and Carbidopa. Levodopa is the metabolic precursor of dopamine that crosses the blood–brain barrier and is converted to dopamine in the brain, thereby helping to alleviate the symptoms of Parkinson’s disease. When administered alone, Levodopa is rapidly decarboxylated to dopamine in extracerebral tissues, limiting the amount that reaches the central nervous system. Carbidopa is a dopa decarboxylase inhibitor that prevents the peripheral conversion of Levodopa to dopamine, increasing the availability of Levodopa in the brain and reducing peripheral adverse effects.

Dosage & Administration

Dosage should be individualized according to patient response and tolerance.

• Therapy may be initiated with one tablet three or four times daily.

• Dose titration may be required, with increases of one tablet daily or every other day until optimal response is achieved.

• When using Levodopa 100 mg and Carbidopa 25 mg tablets, the usual starting dose is one tablet three times daily, providing 75 mg of Carbidopa per day.

• Dosage may be increased gradually up to a maximum of eight tablets per day if necessary.

• When higher doses of Levodopa are required, Levodopa 250 mg and Carbidopa 25 mg tablets may be substituted.

• Experience with daily Carbidopa doses exceeding 200 mg is limited.

Drug Interactions

• Symptomatic postural hypotension may occur when Carbidopa-Levodopa is combined with antihypertensive medicines; dose adjustment may be required.

• Rare cases of hypertension and dyskinesia have been reported with concomitant use of tricyclic antidepressants.

• Iron salts such as ferrous sulphate or ferrous gluconate may reduce the bioavailability of Carbidopa and Levodopa.

• Dopamine-2 receptor antagonists, isoniazid, phenytoin, and papaverine may reduce therapeutic effectiveness.

• Concomitant use with selegiline may be associated with severe orthostatic hypotension.

Contraindications

Twindopa Tablet is contraindicated in patients with known hypersensitivity to Carbidopa or Levodopa, in patients with narrow-angle glaucoma, and in those with suspicious undiagnosed skin lesions or a history of malignant melanoma.

Side Effects

Common adverse effects are related to the central dopaminergic activity and include dyskinesias such as choreiform and dystonic movements, as well as nausea. These reactions are often dose-related and may be reduced by adjusting the dosage.

Pregnancy & Lactation

The effects of Carbidopa-Levodopa on human pregnancy are not well established. Animal studies have shown fetal abnormalities; therefore, the potential benefits should be weighed against possible risks. It is not known whether Carbidopa is excreted in human milk. A decision should be made to discontinue breastfeeding or the medicine, considering the importance of therapy to the mother.

রেজিস্টার্ড চিকিৎসকের পরামর্শ অনুযায়ী ঔষধ সেবন করুন

Precautions & Warnings

• Not recommended for drug-induced extrapyramidal reactions.

• Levodopa should be discontinued at least 12 hours before initiating Carbidopa-Levodopa therapy.

• Patients should be monitored for dyskinesias, depression, suicidal tendencies, and psychotic symptoms.

• Use with caution in patients with cardiovascular, pulmonary, renal, hepatic, endocrine diseases, peptic ulcer disease, or seizure disorders.

• Careful monitoring is advised in patients with a history of myocardial infarction or glaucoma.

Use in Special Populations

Safety and effectiveness in children and adolescents below 18 years of age have not been established; use in this population is not recommended.

Therapeutic Class

Antiparkinson drugs

Storage Conditions

Store in a cool and dry place, protected from light.