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carbidopa / levodopa ER
Used for Parkinson's Disease
Used for Parkinson's Disease
Rytary (carbidopa / levodopa) is a combination medication that helps treat adults with symptoms of Parkinson's disease (PD). It raises the dopamine levels in the brain to improve symptoms like stiff muscles and slowed movement. Rytary (carbidopa / levodopa) is an extended-release capsule. The typical dosage is taken by mouth three times a day. Common side effects include nausea, headache, and dizziness.
What is Rytary (carbidopa / levodopa)?
What is Rytary (carbidopa / levodopa) used for?
- Parkinson's disease (PD)
- Parkinsonism (conditions that cause people to have PD symptoms, 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. Levodopa 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 it 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 helps relieve PD symptoms.
When does Rytary (carbidopa / levodopa) start working?Time passed since treatment started:
Drug facts
| Common Brands | Rytary |
|---|---|
| Drug Class | Dopa decarboxylase inhibitor / Dopamine replacement |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | Lower-cost generic available |
| Availability | Prescription only |
Side effects of Rytary (carbidopa / levodopa)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
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 you get up (up to 5%)
Rytary (carbidopa / levodopa) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Falling asleep suddenly or feeling very sleepy
- Hallucinations: seeing things that aren't there, hearing sounds that aren't real, feeling unreal sensations
- Abnormal thinking or behavior: confusion; trouble sleeping; paranoia; delusions; aggression; agitation; strong urges to gamble, shop, or eat
- Heart problems: chest pain that travels to the arm, neck, or jaw; shortness of breath; cold sweat
- Low vitamin B6: depression, confusion, swollen or sore tongue, cracked corners of your mouth, skin irritation, numbness or tingling in the hands or feet, seizure
- Suicidal thoughts or behavior
- Withdrawal symptoms after stopping suddenly: confusion, very high fevers, sweating, muscle stiffness, changes in breathing, irregular pulse, changes in blood pressure
The following Rytary (carbidopa / levodopa) 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
- Low vitamin B6 level—swollen or sore tongue, cracks at the corners of the mouth, rash, pain, tingling, or numbness in the hands or feet, irritability, confusion, feelings of depression, unusual weakness or fatigue, seizures
- 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 these to your care team if they continue or are bothersome):
- Dark red or black saliva, sweat, or urine
- Dizziness
- Drowsiness
- Headache
- Nausea
Get your GoodRx coupon
$239.40
GoodRx discount
$194.55
Pros and cons of Rytary (carbidopa / levodopa)
Pros
- Can provide more "on" time and less "off" time than immediate-release 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 Rytary (carbidopa / levodopa) 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 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 needs your full attention 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. They might decide to lower your dose to help.
- Speak with your care team if your tongue gets sore or red, or if you notice cracks at the corners of your mouth. Also tell them if you have numbness, tingling, or feel confused. These can be signs of low vitamin B6, which is possible with Rytary (carbidopa / levodopa). Your care team can check your levels with a blood test and recommend a vitamin B6 supplement you need one.
- Avoid taking Rytary (carbidopa / levodopa) at the same time as iron products. This includes multivitamins with iron in them and iron supplements. Take Rytary (carbidopa / levodopa) and your iron as far apart as you can. Iron can lessen how much Rytary (carbidopa / levodopa) gets absorbed into your body. This might make the medication work less well at managing your PD symptoms.
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.
Avoid driving or doing things that you need complete focus for until you know how Rytary (carbidopa / levodopa) affects you. This is very important if you normally feel sleepy or if you've fallen asleep suddenly in the past. Also avoid taking medications that make you sleepy like sedatives. They can make you feel even sleepier.
Tell your prescriber if you feel very sleepy during the daytime while taking Rytary (carbidopa / levodopa). Also tell them if you suddenly doze off while doing things that need your focus. Your prescriber can help decide if it's safe for you to keep taking the medication.
High fevers and confusion with treatment changes
Although rare, stopping Rytary (carbidopa / levodopa) or lowering your dose suddenly can cause withdrawal symptoms. They can 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 tell you how to do this safely.
Heart problems
- Risk factors: History of heart attack and irregular heart rhythm (arrhythmia) | History of 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 of 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 you're having hallucinations while you're taking Rytary (carbidopa / levodopa).
Rytary (carbidopa / levodopa) can also raise the risk of changes in behavior and thinking (psychosis). Symptoms can include paranoia, delusions, confusion, aggressive behavior, uneasiness, and less awareness of your surroundings. Tell 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 PD 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.
Low vitamin B6 levels and seizures
- Risk factors: Taking a high dose of Rytary (carbidopa / levodopa)
Taking Rytary (carbidopa / levodopa) can lower your vitamin B6 levels. The risk of vitamin B6 deficiency is greater if you're taking a higher dose of the medication.
Low vitamin B6 can cause a rash, a swollen tongue, or numbness and tingling in your hands and feet. In serious cases, it can lead to depression, confusion, or even seizures. These seizures might not get better with usual anti-seizure medications. And they might only improve when given extra vitamin B6.
Your care team will check your vitamin levels with blood tests before you start Rytary (carbidopa / levodopa). They'll also check again periodically during treatment. Tell your care team if you notice symptoms of low vitamin B6. These include a sore tongue, cracked corners of your mouth, or numbness and tingling. Your care team might suggest a vitamin B6 supplement to keep your levels up.
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
The average cost for 90 capsules of 48.75mg/195mg of of Rytary (carbidopa / levodopa) is $278.93 with a free GoodRx coupon. This is 21.16% off the average retail price of $353.80. 
Capsule
Capsule| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 23.75mg/95mg of | 90 capsules | $250.44 | $2.78 |
| 36.25mg/145mg of | 60 capsules | $194.55 | $3.24 |
| 48.75mg/195mg of | 90 capsules | $278.93 | $3.10 |
| 61.25mg/245mg of | 120 capsules | $438.61 | $3.66 |
Typical dosage for Rytary (carbidopa / levodopa)
Your Rytary (carbidopa / levodopa) dose will depend on whether you've taken certain Parkinson's medications 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 carbidopa / levodopa (Sinemet) 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 dose depending on how the medication works for you.
How much does Rytary (carbidopa / levodopa) cost?
To access savings, use a GoodRx coupon and pay just a fraction of the retail price.
Rytary (carbidopa / levodopa) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Rytary (carbidopa / levodopa) will not be safe for you to take.
- Currently take or have taken nonselective monoamine oxidase inhibitors (MAOIs) in the past 2 weeks
What are alternatives to Rytary (carbidopa / levodopa)?
There are a number of medications that your doctor can prescribe in place of Rytary (carbidopa / levodopa). Compare a few possible alternatives below.
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