Carbidopa/ levodopa ER
RYTARY
What it isExtended-release levodopa replacement paired with carbidopa’s peripheral AADC inhibition; Parkinson disease.
Why this oneIt combines immediate- and extended-release beads to smooth motor fluctuations and reduce "off" time in Parkinson disease; it is not interchangeable mg-for-mg with IR Sinemet.
What limits itDyskinesia, nausea, orthostasis, and hallucinations can limit use; conversion from other levodopa products requires retitration.
FDA-approved for
- Parkinson disease (2015)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Parkinson's disease / parkinsonism (levodopa-naive) | Adults | 23.75 mg/95 mg TID x3 days | 36.25 mg/145 mg TID (day 4); up to 97.5 mg/390 mg TID | 612.5 mg/2,450 mg per day |
| Parkinson's disease (converting from IR carbidopa-levodopa) | Adults | Per conversion table (Table 1) | Individualized, 3-5 times daily | 612.5 mg/2,450 mg per day |
Renal Undefined
Hepatic Undefined
Dosing frequency may be increased from TID up to 5 times daily; not interchangeable 1:1 with other carbidopa-levodopa products
Instructions
- Swallow whole with or without food; do not chew, divide or crush
- May open capsule and sprinkle contents on 1-2 tbsp applesauce, consume immediately
- High-fat/high-calorie meal may delay levodopa absorption ~2 h
- Taper at discontinuation; avoid sudden discontinuation/rapid dose reduction
- Evaluate vitamin B6 levels before and during treatment; supplement if low
Contraindications
- Currently taking a nonselective monoamine oxidase (MAO) inhibitor (e.g., phenelzine and tranylcypromine) or have recently (within 2 weeks) taken a nonselective MAO inhibitor
Cautions
- Falling asleep during activities of daily living / somnolence
- Withdrawal-emergent hyperpyrexia and confusion
- Cardiovascular ischemic events
- Hallucinations/psychosis
- Impulse control/compulsive behaviors
- May cause or exacerbate dyskinesia
- Vitamin B6 deficiency and seizures
- Peptic ulcer disease (GI hemorrhage risk)
- May increase intraocular pressure in glaucoma
Adverse reactions
- Nausea
- Dizziness
- Headache
- Insomnia
- Abnormal dreams
- Dry mouth
- Dyskinesia
- Anxiety
- Constipation
- Vomiting
- Orthostatic hypotension
Pregnancy No adequate human data; animal studies show developmental toxicity including teratogenicity — may cause fetal harm
Lactation Levodopa detected in human milk; may inhibit lactation (decreases prolactin); consider benefits vs risk
NO BOXED WARNINGS
Principal riskDyskinesia and motor fluctuation with cumulative exposure
Classes and tags
Clinical profile
Mechanism of action: Carbidopa/ levodopa ER ballicule
Open Carbidopa/ levodopa ER in the interactive console ↗
Memory aids: mascots and interaction avatars
