What May Interact With This Medication
Do not take this medicine with any of the following medications:
This medicine may also interact with the following medications:
This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.
The Efficacy Of Entacapone For Pd
Among the 14 studies, the motor complications, including the on and off phenomena were observed in 12 and 9 studies , respectively. Overall, forest plots of the motor complications between placebo and adjuvant therapy are shown in Figure . Based on the results of the heterogeneity test, the wearing-on and wearing-off phenomena were analyzed with a random-effects model . Compared with placebo, entacapone significantly increased patient on-time . Meanwhile, patients receiving entacapone had significantly reduced off-time .
Fig. 2.
Meta-analysis of the reduction of on-time and off-time . MD, mean difference.
UPDRS scores, including ADL, motor and UPDRS IIII was also assessed in 7 , 6 and 5 studies , respectively. Based on the results of heterogeneity test, a fixed-effects model was analyzed . Patients receiving entacapone had statistically significant reduction in the UPDRS ADL score and UPDRS motor score compared to those receiving placebo , while, there was no statistically significance for UPDRSI-III scores between entacapone and placebo . In the 8 studies that reported change in LD dose , patients receiving entacapone had greater reduction compared to placebo and was statistically significant .
Fig. 3.
Meta-analysis of the reduction of ADL , motor , UPDRS scores and levodopa dose . ADL, activities of daily living score UPDRS, Unified Parkinsons Disease Rating Scale MD, mean difference.
Diet & Lifestyle Advise
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Drink plenty of water to avoid headaches due to dehydration.
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Limit the consumption of sugar-containing food or food with too many calories but fewer nutrients as it may cause tooth decay.
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Engage in physical activity like dancing or exercising, which will boost the metabolism and make a person more energetic.
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Avoid intake of alcoholic beverages with CARBIDOPA+LEVODOPA+ENTACAPONE as it can make a person dehydrated and may affect their sleep. This can make it harder for a persons body to aid the CARBIDOPA+LEVODOPA+ENTACAPONE in fighting off infections.
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Stalevo Withdrawal And Dependence
There havent been studies done on whether Stalevo can cause drug dependence.
You should not suddenly stop taking Stalevo. Doing so could cause serious side effects. This could include a rare but life threatening group of symptoms thats similar to neuroleptic malignant syndrome. These symptoms can include:
- high or low blood pressure
- stiff or rigid muscles
- changes in consciousness
If you need to stop taking Stalevo, talk with your doctor. Theyll recommend a treatment plan to help you safely stop taking this drug. Typically, your doctor will gradually reduce your dosage over a period of time until its safe for you to completely stop treatment.
Stalevo is not known to interact with alcohol. However, both Stalevo and alcohol can cause:
- low blood pressure
Drinking alcohol while youre taking Stalevo may raise your risk for these side effects. These side effects can become serious.
If you drink alcohol, talk with your doctor about drinking while youre taking Stalevo. Your doctor may be able to recommend a safe amount for you to drink. Or they may recommend that you avoid alcohol during your treatment.
Main Reagents And Preparation
The main reagent, entacapone, is a product of the Orion Corporation. Indomethacin, TTX, bumetanide, and DPC were purchased from Sigma . All chemical reagents were dissolved in dimethyl sulfoxide , and the DMSO volume fraction did not exceed 0.1%. Preliminary experiments showed that the solvent did not alter basic electrophysiologic parameters. In addition, NaCl, KCl, MgSO4·7H2O, KH2PO4, NaHCO3, CaCl2·2H2O, and glucose were purchased from Sigma.
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How Does This Medication Work What Will It Do For Me
Entacapone belongs to a group of medications called catechol-O-methyl transferase inhibitors. It is used along with levodopa-carbidopa or levodopa-benserazide to treat Parkinson’s disease.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
Controlled Release Madopar And Sinemet
Controlled release preparations have the letters CR or HBS after the drug name.
These let the levodopa enter your body slowly instead of all at once. They can increase the time between doses.
They may be used when the dose of standard levodopa starts to wear off and the person taking it no longer feels the treatment is effective.
Controlled release options can sometimes reduce involuntary movements .
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Stalevo And Lab Tests
Stalevo may affect the results of certain lab tests. Lab tests with results that may not be accurate while youre taking Stalevo include:
- urine test to measure ketone levels
- tests to check for pheochromocytoma
If you have any of these tests done during your Stalevo treatment, tell the healthcare professional performing the test that youre taking Stalevo. This may help them more accurately interpret your lab results.
What Causes Parkinsons Disease
Parkinsons disease occurs when nerve cells in an area of the brain called the substantia nigra become impaired or die. These cells normally produce dopamine, a chemical that helps the cells of the brain communicate . When these nerve cells become impaired or die, they produce less dopamine. Dopamine is especially important for the operation of another area of the brain called the basal ganglia. This area of the brain is responsible for organizing the brains commands for body movement. The loss of dopamine causes the movement symptoms seen in people with Parkinsons disease.
People with Parkinsons disease also lose another neurotransmitter called norepinephrine. This chemical is needed for proper functioning of the sympathetic nervous system. This system controls some of the bodys autonomic functions such as digestion, heart rate, blood pressure and breathing. Loss of norepinephrine causes some of the non-movement-related symptoms of Parkinsons disease.
Scientists arent sure what causes the neurons that produce these neurotransmitter chemicals to die.
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Clinical Evidence With Carbidopa/levodopa/entacapone
In the first section we discussed the evidence for the use of entacapone. Entacapone has a similar pharmacokinetic profile to levodopa, and taken together increases levodopas half-life and bioavailability. This approach leads to increasing the daily on time, decreasing the daily off time and the daily levodopa dose.610
A product that combines carbidopa, levodopa, and enta-capone in one tablet should have similar pharmacokinetic and efficacy profile. However, the initial step is to prove bio-equivalence between CL and entacapone taken separately and combined in one tablet. Four bioequivalence studies tested CLE at different doses . There were 40 healthy volunteers per study. They used an open, randomized, crossover and replicate design. They administered either the test drug or the reference drug after an overnight fast. Fifteen blood samples were drawn at the same point in time for up to 12 hours after drug administration. Plasma concentrations of levodopa, carbidopa, and entacapone were measured. To determine bioequivalence they calculated the area under the concentration-time curve from 0 up to 12 hours , Cmax, tmax, and the elimination half-life for levodopa, carbidopa, and entacapone separately. The bioequivalence criteria were met for all three components of all different CLE doses, the levodopa half-life for CLE being 1.7 hours .36
Quality Assessment And Data Extraction
The methodological quality of the identified studies was assessed using the validated Jadad Scale . This rating scale assesses inherent controllers of bias by using the following quality assessment criteria. Was the study described as randomized such as using the words randomly, random, and randomization? Was the study described as double blind? Was there a description of withdrawals and dropouts? One point was given for each satisfied criterion. Based on the Jadad Scale, studies with a total score of 5 points were considered to be of the highest quality, 0 points indicated lowest quality. The studies points < 3 deemed to have lower methodological quality.
The data from identified studies were extracted independently by 2 investigators and included the following: the name of the first author, year of the publication, age, gender, number of the study subjects, duration of PD, duration of patients follow-up, change in LD dose, change in on and off time, effect on UPDRS score , adverse events and withdrawals due to adverse events.
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Preparation Of The Main Reagents
The Krebs-Henseleit solution was prepared as follows: sodium chloride 117 mmol/L, potassium chloride 4.7 mmol/L, calcium chloride 2.5mmol/L, magnesium chloride 1.2 mmol/L, sodium bicarbonate 24.8 mmol/L, monopotassium phosphate 1.2 mmol/L, and glucose 11.1 mmol/L. For Cl–free K-HS, sodium gluconate, potassium gluconate, calcium gluconate, and magnesium gluconate were used to replace the sodium chloride, potassium chloride, calcium chloride, and magnesium chloride, respectively.
Stalevo And Herbs And Supplements
Stalevo may interact with supplements that contain iron. This is because supplements with iron may decrease the amount of levodopa your body absorbs, and Stalevo contains levodopa.
Therefore, taking your dose of Stalevo with a multivitamin or supplement that contains iron may cause your dose of Stalevo to be less effective.
If you need to take a multivitamin or supplement that contains iron while youre taking Stalevo, talk with your doctor about the best time to take each treatment.
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Measurement Of Extracellular Cl
This experiment utilized SIET . The noninvasive microelectrode used for measuring the Cl- concentration and flux was provided by Xuyue Sci. & Tech. Co., Ltd. The tip of the Cl– selective microelectrode was filled with a 15-25 m chloride selective liquid ion exchanger column and was subsequently filled with an approximately 10 mmol/L electrolyte solution column. The Cl– selective microelectrode must be calibrated before use only Nernstian Slope > 56 mV/decade electrodes can be used, and the distance between the Cl– electrode and cells must be controlled to approximately 30 m. The absolute concentration, flux direction, and flux rate difference before and after drug treatment were compared.
Over Time Will Stalevos Effects Begin To Wear Off Sooner
Its possible that Stalevos effects will wear off sooner the longer you take it. The drugs effects may also wear off sooner as your PD progresses . When a drugs effects begin to wear off and your PD symptoms return, its called an off period. Off periods may occur with Stalevo.
An off period typically happens before youre scheduled to take your next dose of the drug. During these times, symptoms that may return include rigid muscles and dyskinesia .
Talk with your doctor if you have concerns about experiencing off periods during your Stalevo treatment.
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Scope Aims And Objectives
These results coupled with bioequivalence studies lead to CLE approval by the US Food and Drug Administration in 2003 for substitution of carbidopa/levodopa and entacapone taken separately and for replacing CL in PD patients experiencing wearing-off signs and symptoms . The aim of this article is to review the evidence for safety, tolerability, efficacy and cost-effectiveness of CLE and its place in the treatment of PD.
Keep A Medicine And Symptoms Diary
Keeping a diary is a helpful way of monitoring your condition and keeping track of your medicines. A diary can be a useful way of letting your doctor know what problems youre experiencing, any changes in your condition from day to day or over a period of time, and how well your medicine is controlling your symptoms. It can also help remind you of things you want to discuss during your appointment that you may otherwise forget. You can also use it to record any embarrassing issues that you want help with but find difficult to ask about. Examples of diaries:
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Stay Safe With Your Medicines
Read all labels carefully.
- Tell all your health care providers about all the medicines and supplements you take.
- Know all the medicines and foods youâre allergic to.
- Review any side effects your medicines can cause. Most reactions will happen when you start taking something, but thatâs not always the case. Some reactions may be delayed or may happen when you add a drug to your treatment. Call your doctor right away about anything unusual.
- Use one pharmacy if possible. Try to fill all your prescriptions at the same location, so the pharmacist can watch for drugs that might interact with each other.
- You can use online tools to see if any of your medicines wonât work well together.
You have the right and responsibility to know what medications your doctor prescribes. The more you know about them and how they work, the easier it will be for you to control your symptoms. You and your doctor can work together to create and change a medication plan. Make sure that you understand and share the same treatment goals. Talk about what you should expect from medications so that you can know if your treatment plan is working.
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Medications To Avoid Or Use With Caution
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Before making any decisions about treatment of Parkinsons disease, you will want to learn about the different types of medications available for Parkinsons disease and discuss the pros and cons of each with your physician. It may help to know that there is no right answer, and if you try something that doesnt work for you, you can always adjust your plan.
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Why Is This Medication Prescribed
Entacapone is an inhibitor of catechol-O-methyltransferase . It is used in combination with levodopa and carbidopa to treat the end-of-dose ‘wearing-off’ symptoms of Parkinson’s disease. Entacapone helps the levodopa and carbidopa work better by allowing more of it to reach the brain, where it has its effects.
This medication is sometimes prescribed for other uses ask your doctor or pharmacist for more information.
Dopamine Agonist Withdrawal Syndrome
If you suddenly stop taking dopamine agonists, this can lead to dopamine agonist withdrawal syndrome, which can cause symptoms such as depression, anxiety or pain.
Any withdrawal from Parkinsons drugs needs to be done in a tapered way, under the supervision of a health professional.
Speak to your specialist for advice.
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How To Use Entacapone
Take this medication by mouth with or without food, usually with each prescribed dose of levodopa/carbidopa or as directed by your doctor.
Dosage is based on your medical condition, liver function, and response to therapy.
Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day. Do not suddenly stop taking this medication unless instructed to do so by your doctor. Doing so may cause your Parkinson’s symptoms to become much worse.
Tell your doctor if your condition persists or worsens .
Who Should Not Take This Medication
Do not take entacapone if you:
- are allergic to entacapone or any ingredients of the medication
- are taking or have taken a non-selective monoamine oxidase inhibitor within the last 2 weeks
- have a previous history of neuroleptic malignant syndrome or rhabdomyolysis
- have liver impairment
- have or have had skin lesions that may be melanoma
- have any condition where epinephrine, norepinephrine, isoprenaline or dopamine should not be given
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Dopaminergic Features And Their Treatment
Patients with PD usually present with features indicative of degeneration of nigrostriatal pathways. A useful clinical definition for PD is asymmetric onset of an akinetic rigid syndrome with resting tremor and a good response to levodopa. When applied by neurologists with an interest in movement disorders, this definition has a pathological correlation exceeding 98%. When treatment is considered appropriate, and this is a topic discussed in detail below, a variety of options is available. The use of dopaminergic drugs improves motor function, significantly reduces both the morbidity and mortality of PD, and improves quality of life.
Levodopa remains the drug most commonly used in PD. It is very effective in improving bradykinesia and rigidity, and in practice remains the gold standard against which other drugs are judged. Some studies, predominantly in vitro, have suggested that levodopa may be toxic. However, such data are conflicting, and some laboratory studies have suggested a growth factor-like effect for levodopa. Overall, the pre-clinical evidence for levodopa toxicity is not convincing and there are no data to indicate that any toxic action is of clinical relevance.
Table 1
Percentage of patients remaining on dopamine agonist monotherapy at years 14 and years 15 during treatment trials
Recording Of Rat Colon Smooth Muscle Contraction
The rats were killed and then distal colon was quickly removed. The luminal contents of the colon were washed with Krebs solution. The 1st to 4th segments of the distal colon were collected. Each segment was cut open along the mesentery border and spread evenly over silica gel with the apical membrane facing down. The samples were surrounded by ice-cold Krebs solution to maintain tissue activity. The entire colon was cut into 2-mm-wide, 1-1.5-cm-long strips along the longitudinal or circular muscles. Surgical sutures were used to tie a piece of thread to each end of the muscle strip and connect one end to a specimen support rod and the other end to a pressure transducer. The muscle strips were incubated in 10 mL of Krebs solution at a constant temperature under continuous gas ventilation . After applying 1g of resting muscle tension, the change in length was recorded by the pressure transducer. With 2000 mg of weight for calibration, intensity of muscle strip contraction was measured with mg as the basic unit. After the muscle strips were adapted in a water bath for 120 min, the autonomous contraction intensity was officially recorded.
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