Rytary
Rytary (carbidopa / levodopa) is a combination medication that's used to treat adults with symptoms of Parkinson's disease (PD), such as stiff muscles and slowed movement. It contains carbidopa (a decarboxylase inhibitor) and levodopa (a dopamine replacement) in an extended-release capsule. The typical dosage is one capsule by mouth three times a day. Common side effects include nausea, headache, and dizziness. This medication doesn't currently have a generic version, but you can get it under the brand name Rytary.
What is Rytary (carbidopa / levodopa)?
What is Rytary (carbidopa / levodopa) used for?
Parkinson's disease (PD)
Parkinsonism (conditions that cause people to have symptoms of PD, including tremors, slowness, and stiffness)
How Rytary (carbidopa / levodopa) works
Rytary (carbidopa / levodopa) is a combination medication. The two active ingredients work together to help bring up the dopamine levels in the brain. This helps relieve symptoms of Parkinson's disease (PD).
Levodopa is a dopamine replacement. Once you take levodopa, it travels into the brain where it turns into dopamine. When there's more dopamine in the brain, PD symptoms lessen.
Carbidopa is a dopa decarboxylase inhibitor. It stops dopa decarboxylase, a protein in the body that breaks down levodopa before levodopa can reach the brain. By blocking this protein, more levodopa can get to the brain and turn into dopamine. It helps both levodopa and dopamine reach and stay at higher levels in the brain. This enhances levodopa's ability to relieve PD symptoms.
Drug Facts
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What are the side effects of Rytary (carbidopa / levodopa)?
Common Side Effects
- Nausea (up to 20%)
- Dizziness (up to 19%)
- Headache (up to 17%)
- Trouble sleeping (up to 9%)
- Dry mouth (up to 7%)
- Unusual dreams (up to 6%)
- Constipation (up to 6%)
- Involuntary movements (dyskinesia, up to 5%)
- Anxiety (up to 5%)
- Vomiting (up to 5%)
- Drop in blood pressure when standing from a sitting or lying down position (up to 5%)
Serious Side Effects
- Withdrawal symptoms after stopping suddenly: confusion, very high fevers, sweating, muscle stiffness, changes in breathing, irregular pulse, changes in blood pressure
- Heart problems: chest pain that travels to the arm, neck, or jaw; shortness of breath; cold sweat
- Suicidal thoughts or behavior
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Falling asleep during daily activities
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
- Mood and behavior changes—anxiety, nervousness, confusion, hallucinations, irritability, hostility, thoughts of suicide or self-harm, worsening mood, feelings of depression
- New or worsening uncontrolled and repetitive movements of the face, mouth, or upper body
- Stomach bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds
- Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss
- Urges to engage in impulsive behaviors such as gambling, binge eating, sexual activity, or shopping in ways that are unusual for you
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Dark red or black saliva, sweat, or urine
- Dizziness
- Drowsiness
- Headache
- Nausea
Pros and cons of Rytary (carbidopa / levodopa)
Pros
Can provide more "on" time and less "off" time than immediate-release Sinemet (carbidopa / levodopa) in people with advanced PD
Available in 4 different strengths
Can open capsule and sprinkle contents onto applesauce if you have trouble swallowing pills whole
Cons
Usually need to take multiple times per day
Can make you very sleepy and cause you to fall asleep suddenly
Interacts with certain monoamine oxidase inhibitors (MAOIs) and iron
Pharmacist tips for Rytary (carbidopa / levodopa)
Take Rytary (carbidopa / levodopa) with or without food.
If you take the medication with food, avoid taking it with a high-fat, high-calorie meal (e.g., avocados, cheese, peanut butter). Otherwise, it can take 2 to 3 hours longer for your body to absorb the medication. Because of this, it might be a good idea to take your first dose of the day about 1 to 2 hours before eating.
Swallow Rytary (carbidopa / levodopa) capsules whole. Don't chew, cut, or crush the capsules.
If you have trouble swallowing the Rytary (carbidopa / levodopa) capsule whole, you can open it and sprinkle the medication onto applesauce. Twist open the capsule carefully. Then, sprinkle the medication from both halves of the capsule onto 1 to 2 tablespoons of applesauce. Eat the mixture right away. Don't save it to take later.
Rytary (carbidopa / levodopa) can make you very sleepy. It can also make you fall asleep suddenly, sometimes without any warning. Don't drive or do anything that you need full concentration for until you know how the medication makes you feel.
You might have more trouble controlling your body's movements (dyskinesia) after you start taking Rytary (carbidopa / levodopa). If this becomes bothersome, let your prescriber know so they can consider reducing your dose.
Avoid taking Rytary (carbidopa / levodopa) at the same time as iron-containing products. Separate when you take Rytary (carbidopa / levodopa) and iron products as far apart as you can. Iron and iron-containing medications, vitamins, and supplements can interfere with Rytary (carbidopa / levodopa). This interaction can lessen how much Rytary (carbidopa / levodopa) gets absorbed into your body, which can lead to worsening Parkinson's symptoms.
Frequently asked questions about Rytary (carbidopa / levodopa)
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What are the risks and warnings for Rytary (carbidopa / levodopa)?
Rytary (carbidopa / levodopa) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Sleepiness or falling asleep during activities
Risk factors: History of drowsiness | History of sleep problems | Taking sedatives or medications that make you drowsy
People who've taken medications that contain levodopa, such as Rytary (carbidopa / levodopa), have fallen asleep out of nowhere, even when they didn't feel sleepy beforehand. For example, people might fall asleep in the middle of a conversation or a meal. It's also happened while people were driving, which have sometimes led to accidents.
Because of this risk, avoid driving or doing things that you need complete focus for until you know how Rytary (carbidopa / levodopa) affects you. This is especially important if you normally feel sleepy or if you've fallen asleep suddenly in the past. Also avoid taking medications that make you sleepy (e.g., sedatives) while you're taking Rytary (carbidopa / levodopa). They can make you feel even sleepier.
Tell your prescriber if you feel very sleepy during the daytime or if you fall asleep during activities where you need to concentrate while you're taking Rytary (carbidopa / levodopa).
High fevers and confusion with treatment changes
Although rare, stopping Rytary (carbidopa / levodopa) or lowering your dose suddenly can cause withdrawal symptoms that look similar to those of neuroleptic malignant syndrome (NMS). Symptoms can include very high fevers, confusion, muscle stiffness, irregular pulse, changes in breathing, and changes in blood pressure.
Don't stop taking Rytary (carbidopa / levodopa) or lower your dose without talking to your prescriber first. They can instruct you on how to do this safely.
Heart problems
Risk factors: History of heart attack or heart disease | At risk for heart disease
Some people have had heart problems while they were taking Rytary (carbidopa / levodopa). In studies, these people had a history of heart disease or risk factors for heart disease (e.g., high blood pressure, high cholesterol).
Let your prescriber know before you start Rytary (carbidopa / levodopa) if you've had a heart attack in the past. Your prescriber might monitor your heart when you first start taking this medication or when your dose changes.
Get medical help right away if you have chest pain that travels to the arm, neck, or jaw; shortness of breath; or a cold sweat. These can be symptoms of a heart problem.
Hallucinations and changes in behavior and thoughts
Risk factors: History of certain mental health conditions
Rytary (carbidopa / levodopa) can raise the risk for hallucinations. Hallucinations can also happen with confusion, trouble sleeping, and lots of dreaming. Generally, these symptoms can appear shortly after you start taking Rytary (carbidopa / levodopa). And they might go away once your dose gets lowered. Let your prescriber know if you or your loved ones think that you're having hallucinations while you're taking Rytary (carbidopa / levodopa).
Rytary (carbidopa / levodopa) can also raise the risk for changes in behavior and thinking (psychosis). Symptoms can include paranoia, delusions, confusion, aggressive behavior, uneasiness, and less awareness of your surroundings. Contact your care team if you or your loved ones notice unusual behavior and thinking while you're taking this medication.
Because of the risk for worsening psychosis, you shouldn't take Rytary (carbidopa / levodopa) if you have certain mental health conditions. What's more, some medications that are used to treat these mental health conditions, such as haloperidol (Haldol) or perphenazine, can worsen your Parkinson's symptoms. They also might make Rytary (carbidopa / levodopa) work less well.
Difficulty controlling impulsive behavior
Medications for Parkinson's disease that make dopamine levels go up, like Rytary (carbidopa / levodopa), can cause people to behave more impulsively. These behaviors can include strong sexual or gambling urges, urges to spend a lot money, and binge eating. It can be hard to control these urges.
Let your prescriber know if any urges start to have a negative impact on your life while you're taking Rytary (carbidopa / levodopa). You might not realize that you have these urges during treatment, so your prescriber might ask you if you've recently had these behaviors at your next visit.
Stomach bleeding in people who've had a stomach ulcer
Rytary (carbidopa / levodopa) might raise the risk of stomach bleeding if you've had certain kinds of stomach ulcers before. Get medical help right away if you vomit blood or coffee-ground bits; have bloody or black, tarry stool; or stomach cramps. These can be symptoms of stomach bleeding.
Rise in eye pressure in people with glaucoma
Rytary (carbidopa / levodopa) might raise the pressure inside the eye in people with glaucoma. Let your optometrist or ophthalmologist know that you're taking Rytary (carbidopa / levodopa). They'll need to check your eye pressure more often while you're taking the medication to make sure that your glaucoma doesn't get worse.
Rytary (carbidopa / levodopa) dosage forms
Typical dosing for Rytary (carbidopa / levodopa)
Your Rytary (carbidopa / levodopa) dose will depend on whether you've taken certain medications for Parkinson's before.
People who've never taken levodopa before
Days 1 through 3: The typical starting dose is 23.75 mg/95 mg (carbidopa/levodopa) by mouth three times per day.
Day 4 and onward: The dose can be raised to 36.25 mg/145 mg (carbidopa/levodopa) by mouth three times per day.
People switching from immediate-release Sinemet (carbidopa / levodopa) to Rytary (carbidopa / levodopa): The dose depends on your previous carbidopa/levodopa regimen. Your prescriber will work with you to find the right starting dose of Rytary (carbidopa / levodopa) for you.
Your prescriber will adjust your Rytary (carbidopa / levodopa) dose depending on how the medication works for you.
How much does Rytary (carbidopa / levodopa) cost?
Rytary (carbidopa / levodopa) contraindications
Currently take or have taken nonselective monoamine oxidase inhibitors (MAOIs) in the past 2 weeks
What are alternatives to Rytary (carbidopa / levodopa)?
Parkinson's disease (PD)
Parkinsonism (conditions that cause people to have symptoms of PD, including tremors, slowness, and stiffness)
Parkinson's disease (PD)
Parkinsonism (conditions that cause people to have signs and symptoms of PD, including slowness, stiffness, shakiness, and imbalance)
What is the latest news about Rytary (carbidopa / levodopa)?
Rytary (carbidopa / levodopa) images
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References
Best studies we foundAmneal Pharmaceuticals LLC. (2018). Amneal announces patent litigation settlement agreement with Actavis concerning Rytary®. PRNewswire.
Amneal Pharmaceuticals LLC. (2019). Rytary- carbidopa and levodopa capsule, extended release [package insert]. DailyMed.
Centers for Disease Control and Prevention. (2024). Heart disease risk factors.
Fiedorowicz, J. G., et al. (2004). The role of monoamine oxidase inhibitors in current psychiatric practice. Journal of Psychiatric Practice.
Gandhi, K. R., et al. (2023). Levodopa (L-dopa). StatPearls.
Hauser, R. A., et al. (2018). Onset and duration of effect of extended-release carbidopa-levodopa in advanced Parkinson's disease. Neuropsychiatric Disease and Treatment.
Leyden, E., et al. (2023). Carbidopa. StatPearls.
MedlinePlus. (2024). Secondary parkinsonism.
Mittur, A., et al. (2017). Pharmacokinetics of Rytary®, an extended-release capsule formulation of carbidopa-levodopa. Clinical Pharmacokinetics.
Parkinson’s Foundation. (n.d.). Managing “off” time in Parkinson’s.
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