What Is It Like to Take Levodopa for Parkinson’s Disease?
Levodopa alleviates Parkinson’s symptoms and is considered one of the most important medications for Parkinson’s disease. Here’s what it’s like to take it.
carbidopa / levodopa
Used for Parkinson's Disease
Used for Parkinson's Disease
Carbidopa / levodopa (Sinemet) is a first-choice option for Parkinson's disease (PD) in adults. It's also used to treat adults with conditions that cause PD symptoms, like shakiness and slowed movement. This medication helps raise and keep dopamine levels high in the brain to help with movement. But it's usually taken multiple times per day to relieve PD symptoms. Immediate-release tablets are available as brand name Sinemet and generic. Extended-release tablets and orally disintegrating tablets are generic only. Side effects can include movement problems, nausea, and possible hallucinations.
What is Carbidopa / levodopa (Sinemet)?
What is Carbidopa / levodopa (Sinemet) used for?
- Parkinson's disease (PD)
- Parkinsonism (conditions that cause people to have PD symptoms, like slowness, stiffness, and tremors)
How Carbidopa / levodopa (Sinemet) works
Carbidopa / levodopa (Sinemet) is a combination of two medications. Carbidopa and levodopa work together to raise dopamine levels in the brain. This helps relieve symptoms of Parkinson's disease (PD).
- Levodopa is a dopamine replacement. Levodopa travels to the brain, where it gets turned into dopamine. By restoring dopamine levels in the brain, levodopa helps relieve PD symptoms.
- Carbidopa is a dopa decarboxylase inhibitor. Dopa decarboxylase is a protein that breaks down levodopa before it can reach the brain. Blocking this protein lets more levodopa reach the brain and turn into dopamine. This means more levodopa and dopamine stay in the brain longer. This helps improve PD symptoms.
When does Carbidopa / levodopa (Sinemet) start working?Time passed since treatment started:
Drug facts
| Common Brands | Sinemet |
|---|---|
| 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 Carbidopa / levodopa (Sinemet)
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
- Involuntary movements (dyskinesia or dystonia)
- Nausea
Less Common Side Effects
- Vomiting
- Diarrhea
- Dry mouth
- Back or shoulder pain
- Confusion
- Headache
- Weakness
- Dizziness
- Hallucinations
- Unusual dreams
- Shortness of breath
- Dark-colored saliva, sweat, or urine
- Changes in blood pressure
Carbidopa / levodopa (Sinemet) 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
- Depression and thoughts of suicide
- 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
- Withdrawal symptoms after stopping or lowering the dose suddenly: very high fevers, confusion, irregular pulse, sweating, muscle stiffness, changes in blood pressure
When do Carbidopa / levodopa (Sinemet) possible side effects begin and end?
Time passed since treatment started:
M
H
D
W
M
Y
Nausea
Uncontrolled movements (dyskinesia)
Seek immediate medical care if you experience this side effect.
If a line continues to the right, you'll likely keep experiencing this side effect once it starts.
The following Carbidopa / levodopa (Sinemet) 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
$9.000
GoodRx discount
$9.00
Pros and cons of Carbidopa / levodopa (Sinemet)
Pros
- First-choice option for treating PD symptoms
- Available in many forms: immediate-release (IR) tablets, extended-release (ER) tablets, and orally disintegrating tablets (ODTs)
- Might work within 1 hour
Cons
- Usually need to take many times per day to control PD symptoms
- Can make you very sleepy and possibly fall asleep suddenly
- Can darken the color of your saliva, sweat, and urine
Pharmacist tips for Carbidopa / levodopa (Sinemet)
- If you were taking levodopa by itself, stop taking it at least 12 hours before starting carbidopa / levodopa (Sinemet). For example, take your last levodopa dose before bedtime and then start carbidopa / levodopa (Sinemet) the next morning. This helps lower your risk of side effects from too much levodopa.
- You can take carbidopa / levodopa (Sinemet) with or without food. Food can help lower the risk of stomach upset from the medication. But try to avoid eating high-protein foods, like meat, milk, cheese, or nuts, too close to the medication. These foods can make your body take longer to absorb the medication and it might not work as well.
- For the immediate-release tablets: Follow your prescriber's instructions on how to take the immediate-release tablets. Some strengths have a score line, meaning that they can be cut in half there with a pill splitter. This might be needed for your dose or for people who have trouble swallowing it whole. Check with your prescriber first to see if this is a good option for you.
- For the extended-release tablets: Swallow the extended-release tablet whole. Don't crush or chew them. This could cause too much medication to enter your body at once and raise your risk of side effects.
- For the orally disintegrating tablets (ODTs): Only take out the ODT from the bottle when you're ready to take the medication. Carefully remove the tablet from the bottle with dry hands, and place it on your tongue. The tablet will dissolve on your tongue in a few seconds, so you don’t need to take it with water. Once dissolved, swallow it along with your saliva.
- Carbidopa / levodopa (Sinemet) can make you very sleepy. Some people might even fall asleep suddenly with or without warning. Don't drive or do anything that needs your full attention until you know how the medication makes you feel. If you feel too sleepy or fall asleep suddenly, tell your care team.
- You might have more trouble controlling your body's movements after starting carbidopa / levodopa (Sinemet). This is called dyskinesia. It's more common to happen for people who've been taking this medication for a while (like years). If this bothers you too much, let your prescriber know. They might need to lower your dose.
- Tell your care team if your tongue becomes red or sore or if you have cracks at the corners of your mouth. Also let them know if you feel any numbness or tingling. Carbidopa / levodopa (Sinemet) might lower your vitamin B6 levels and cause these symptoms. Your care team can check your vitamin levels with a blood test and suggest a vitamin B6 supplement if needed.
- Carbidopa / levodopa (Sinemet) can turn your urine, sweat, and saliva a dark color (e.g., red, brown, black). This is harmless, but it can stain your clothing.
- Don't take carbidopa / levodopa (Sinemet) at the same time as iron supplements or multivitamins with iron. Try to space them out as much as possible. Iron can lower how much of carbidopa / levodopa (Sinemet) your body absorbs. This might make it work less well.
- Tell your care team if your PD symptoms get worse while taking carbidopa / levodopa (Sinemet). It's common for the medication to not work as well over time. This might lead to more "off" time. Your prescriber can adjust your dose or recommend other treatment options to manage your PD better.
- Don't suddenly lower your dose or stop taking carbidopa / levodopa (Sinemet) without talking to your prescriber. This might cause high fever, confusion, and stiff muscles. If you want to stop the medication, tell your prescriber. They can help decide if it's right for you and tell you how to lower the dose and stop in a safe way.
Risks and warnings for Carbidopa / levodopa (Sinemet)
Carbidopa / levodopa (Sinemet) 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
Carbidopa / levodopa (Sinemet) can sometimes make you fall asleep suddenly, even if you didn't feel tired beforehand. This can happen while eating, talking, or even driving, which can be dangerous.
Because of this risk, avoid driving or doing anything that requires your focus until you know how carbidopa / levodopa (Sinemet) affects you. This is extra important if you often feel sleepy or have ever fallen asleep suddenly before. Also avoid taking medications that make you sleepy since they can make this worse.
Let your prescriber know if you feel very sleepy during the daytime while taking carbidopa / levodopa (Sinemet). Also tell them if you fall asleep in the middle of activities that need your full attention.
High fevers and confusion when lowering the dose or stopping too suddenly
Although rare, stopping carbidopa / levodopa (Sinemet) or lowering your dose too fast can cause side effects. These can look similar to symptoms of neuroleptic malignant syndrome (NMS). It can cause very high fever, confusion, an irregular pulse, sweating, muscle stiffness, and changes in blood pressure.
Don't stop taking carbidopa / levodopa (Sinemet) or lower your dose without talking to your prescriber first. They can make sure it's the right choice and slowly lower your dose in a safe way.
Hallucinations and changes in behavior and thoughts
- Risk factors: History of certain mental health conditions
Carbidopa / levodopa (Sinemet) can raise the risk of hallucinations. They might come with confusion, trouble sleeping, or a lot of dreaming. These symptoms can happen shortly after starting the medication, and they might go away after your dose is lowered. Tell your care team if you or your loved ones notice you're hallucinating while taking carbidopa / levodopa (Sinemet).
Carbidopa / levodopa (Sinemet) can also raise the risk of having abnormal thinking and behavior. This can include paranoia, delusions, aggression, agitation, and confusion. Call your care team if you notice these changes while taking this medication.
Because it can worsen psychosis, you shouldn't take carbidopa / levodopa (Sinemet) if you have certain mental health conditions. Also, some mental health medications, like haloperidol (Haldol), can make PD symptoms worse. They could also make carbidopa / levodopa (Sinemet) work less well. Let your prescriber know about any mental health problems you have.
Difficulty controlling impulsive behavior
Carbidopa / levodopa (Sinemet) can sometimes make people act more impulsively. Some examples include having strong sexual or gambling urges, having urges to spend a lot of money, and binge eating. These behaviors can be hard to control.
Tell your care team if you or someone close to you notices you start having these urges while you're taking carbidopa / levodopa (Sinemet). In particular, tell them if the urges start to have a negative impact on your life. Your prescriber will also ask you about these behaviors during follow-up visits, since you might not notice them yourself.
Risk of depression and thoughts of suicide
Tell your prescriber if you feel depressed or have suicidal thoughts while taking carbidopa / levodopa (Sinemet). If you start thinking about hurting yourself, call 988 for the National Suicide Prevention Lifeline or call 911 right away.
Low vitamin B6 levels and seizures
- Risk factors: Taking a high dose of carbidopa / levodopa (Sinemet)
Taking carbidopa / levodopa (Sinemet) might 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 skin rash, swollen tongue, and numbness and tingling in the hands and feet. More seriously, it can lead to depression, confusion, and 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 carbidopa / levodopa (Sinemet). They'll likely check again every so often during treatment. If you notice new symptoms like a sore tongue, cracked corners of your mouth, or numbness and tingling, tell your care team right away. They might suggest taking a vitamin B6 supplement to keep your levels in a safe range.
Caution use in people with a history of heart attack and arrhythmia
Before starting carbidopa / levodopa (Sinemet), tell your prescriber if you've had a heart attack and have a history of irregular heartbeats (arrhythmias). This medication can affect your heart rhythm. So your care team might want to keep an eye on your heart function as your dose gets adjusted.
Caution use in people with a history of stomach ulcers
If you've had stomach ulcers before, carbidopa / levodopa (Sinemet) might raise your risk of bleeding in your stomach or gut. Tell your prescriber or care team if you have a history of ulcers or frequent stomach pain before starting this medication. They’ll check your digestive health more closely. They can make sure the medication isn't causing gut irritation or bleeding.
Higher eye pressure in people with glaucoma
If you have glaucoma, taking carbidopa / levodopa (Sinemet) might cause the pressure inside your eye to rise. High eye pressure can be dangerous if it isn't managed.
Tell your prescriber and care team if you have glaucoma. They'll want you to see your eye specialist periodically for eye exams while you're taking carbidopa / levodopa (Sinemet). They'll check your eye pressure to make sure it's within a safe range during treatment.
Caution use in people with phenylketonuria (PKU) - orally disintegrating tablets only
The carbidopa / levodopa orally disintegrating tablets (ODT) contain phenylalanine. Phenylalanine is a component of the artificial sweetener aspartame. If you have a genetic condition called phenylketonuria (PKU), the ODTs can be dangerous for you.
If you have PKU, tell your prescriber before starting this medication. They can choose a safer option for you.
Carbidopa / levodopa (Sinemet) dosage
The average cost for 270 tablets of 25mg/100mg of Carbidopa / levodopa (Sinemet) is $24.00 with a free GoodRx coupon. This is 0.00% off the average retail price of $24.00. 
Tablet
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 10mg/100mg | 90 tablets | $9.00 | $0.10 |
| 25mg/100mg | 270 tablets | $24.00 | $0.09 |
| 25mg/250mg | 90 tablets | $23.94 | $0.27 |
Typical dosage for Carbidopa / levodopa (Sinemet)
Your dose will depend on how the medication works for you and how well you tolerate it. Your prescriber will slowly raise your dose until your PD symptoms are controlled.
- Brand name Sinemet and generic immediate-release tablets: The typical starting dose is 25 mg/100 mg (carbidopa/levodopa) swallowed by mouth 3 times per day.
- Generic orally disintegrating tablets: The typical starting dose is 25 mg/100 mg (carbidopa/levodopa) by mouth 3 times per day. Let the tablet dissolve on the tongue before swallowing.
- Generic extended-release tablets: The typical starting dose is 50 mg/200 mg (carbidopa/levodopa) swallowed by mouth 2 times per day. Take the doses at least 6 hours apart. The dose might be different if you're switching from the immediate-release tablets.
More on Carbidopa / levodopa (Sinemet) dosage
How much does Carbidopa / levodopa (Sinemet) cost?
To access savings, use a GoodRx coupon and pay just a fraction of the retail price.
Carbidopa / levodopa (Sinemet) 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 Carbidopa / levodopa (Sinemet) will not be safe for you to take.
- Currently take or have taken a nonselective monoamine oxidase inhibitor (MAOI) within 2 weeks
- Narrow-angle glaucoma
What are alternatives to Carbidopa / levodopa (Sinemet)?
There are a number of medications that your doctor can prescribe in place of Carbidopa / levodopa (Sinemet). Compare a few possible alternatives below.
News about Carbidopa / levodopa (Sinemet)
Parkinson’s Disease Treatments: Medication, Therapy, and More
Treatment for Parkinson’s disease aims to lower symptoms and keep strength and functionality. It involves medications, physical therapy, and mental health support.
Carbidopa / Levodopa Dosages for Adults: Your GoodRx Guide
Carbidopa / levodopa is a medication that treats Parkinson’s disease. Learn about the typical starting dosage, different formulations, and more.
Carbidopa / levodopa (Sinemet) images
