Health Centres - Stalevo
How does it work?
Stalevo tablets contain three active ingredients, levodopa, carbidopa and entacapone. These are all medicines used in Parkinson's disease to increase the level of dopamine in the brain.
Dopamine is a substance known as a neurotransmitter. Neurotransmitters are found in the brain and nervous system and are involved in transmitting messages between nerves. These messages allow the normal functioning of the body. The neurotransmitter dopamine is known to be reduced or absent in the brains of people with Parkinson's disease, and this is thought to be the cause of the disease symptoms.
When you take levodopa, it is converted into dopamine in the brain. This replaces the lost dopamine and therefore reduces some of the symptoms of the disease.
Levodopa is also converted into dopamine in the rest of the body, which can cause unwanted side effects such as nausea and palpitations. An extra medicine called a dopa-decarboxylase inhibitor is therefore usually combined with levodopa treatment to prevent this happening. Dopa-decarboxylase inhibitors include the medicines carbidopa (found with levodopa in Sinemet) and benserazide (found with levodopa in Madopar). They block the conversion of levodopa to dopamine outside the brain and so prevent levodopa side effects on the rest of the body. (Carbidopa and benserazide cannot pass into the brain and so do not affect the conversion of levodopa to dopamine in the brain.)
Unfortunately levodopa treatment tends to become less effective over time, and patients tend to experience 'end-of-dose' deterioration, where the duration of benefit after each dose of levodopa becomes progressively shorter. Entacapone is used as an add-on treatment for Parkinson's disease because it prolongs the effect of levodopa.
Entacapone works by inhibiting the action of an enzyme in the body known as COMT. This enzyme normally breaks down levodopa that is left in the body after a dose so that the body can start to remove it. By stopping the action of this enzyme, entacapone increases the amount of levodopa that is available to pass into the brain with every dose of this medicine.
The three active ingredients have been combined in each tablet of this medicine to treat people with Parkinson's disease whose symptoms are not controlled by levodopa/carbidopa (Sinemet) or levodopa/benserazide (Madopar) alone, and who therefore need entacapone to increase the length of time the levodopa controls their symptoms. The medicine should make Parkinson's treatment simpler to remember and take, because all three active ingredients are contained in one tablet.
What is it used for?
Warning!
- This medicine can occasionally cause your blood pressure to drop when you move from a lying down or sitting position to sitting or standing, especially when you first start taking the medicine. This may make you feel dizzy or unsteady. To avoid this try getting up slowly. If you do feel dizzy, sit or lie down until the symptoms pass.
- As this medicine increases the level of dopamine in your brain more than levodopa alone it may cause abnormal involuntary movements or muscle twitches (dyskinesia). Consult your doctor if you experience these symptoms, as they may indicate that your dose of this medicine needs reducing.
- Consult your doctor if you feel depressed or confused, or have strange or abnormal thoughts while you are taking this medicine.
- You should also let your doctor know if you lose your appetite, lose weight, or feel generally weak during treatment, particularly if this gets progressively worse within a relatively short period of time.
- This medicine can cause sleepiness and on rare occasions people have experienced a sudden onset of sleep during their daily activities. In some cases this occured without any warning signs. Although this is rare, you should exercise caution when driving or performing other potentially hazardous activities. People who have experienced sleepiness or an episode of sudden onset of sleep while taking this medicine should not drive or operate machinary. Caution should be observed when drinking alcohol or taking other medicines that cause drowsiness, as this may increase the risk of drowsiness.
- Pathological gambling, increased sex drive and hypersexuality have been reported in people taking medicines for Parkinson's disease such as this one, that increase dopamine activity in the brain. If you think this medicine is affecting you in this way, you should consult your doctor.
- You should have regular tests to monitor the function of your liver, blood, kidneys and heart while taking this medicine.
- This medicine may affect the results of certain laboratory tests, including those for testing sugar (glucose) levels in blood or urine. If you have diabetes ask your doctor for further information about this. Tell your doctor that you are taking this medicine if you have any blood or urine tests.
- If you have chronic open angle glaucoma you should have regular tests to monitor the pressure within your eye (intraocular pressure) while taking this medicine.
- This medicine may discolour your urine a reddish/brown. This is normal and not harmful.
Use with caution in
- Severely decreased kidney function and people having dialysis for kidney failure.
- Kidney disease.
- Mild to moderately decreased liver function.
- Liver disease.
- Severe lung disease.
-
Asthma.
- Severe disease involving the heart and blood vessels.
- People who have an abnormal heart rhythm following a previous heart attack.
- Disorders involving hormone producing glands (endocrine disorders).
-
Diabetes.
- History of convulsions, eg epilepsy.
- History of peptic ulcers.
- History of psychiatric illness.
-
Open angle glaucoma.
Not to be used in
- Severely decreased liver function.
-
Closed angle glaucoma.
- Tumour of the adrenal gland (phaeochromocytoma).
- History of a rare muscle disorder called non-traumatic rhabdomyolysis.
- History of a rare condition called the neuroleptic malignant syndrome.
- People who have taken a monoamine-oxidase inhibitor antidepressant (MAOI) in the last 14 days.
-
Breastfeeding.
- Rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency (Stalevo tablets contain sucrose).
- This medicine is not recommended for children and adolescents under 18 years of age, as there is no information regarding its safety and efficacy in this age group.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- The safety of this medicine for use during pregnancy has not been established. It is not recommended for use in pregnancy unless considered essential by your doctor. Seek medical advice from your doctor.
- This medicine passes into breast milk and women taking this medicine should therefore not breastfeed. Seek medical advice from your doctor.
Label warnings
- This medicine should be swallowed whole not chewed.
- This medicine may colour the urine reddish-brown.
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