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Levodopa

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VOL: 101, ISSUE: 47, PAGE NO: 27

 GENERIC AND PROPRIETARY NAMES

- Co-beneldopa, Madopar, Madopar CR.

- Co-careldopa, Sinemet, Half Sinemet CR, Sinemet CR, Tilolec.

ACTION

- Replenishes depleted striatal dopamine. It is used in combination with the extracerebral dopa-decarboxylase inhibitors, benserazide or carbidopa, to reduce the peripheral conversion of levodopa to dopamine and limit side-effects.

CLASSIFICATION

- Dopaminergic drugs used in the treatment of Parkinsonism.

INDICATIONS

- Parkinsonism - but not drug-induced extrapyramidal symptoms.

CONTRAINDICATIONS

- Closed-angle glaucoma.

- Pregnancy and breastfeeding.

CAUTIONS

- Pulmonary disease.

- Peptic ulceration.

- Cardiovascular disease.

- Diabetes.

- Open-angle glaucoma.

- History of melanoma 

- Psychiatric illness.

SIDE-EFFECTS

- Drowsiness.

- Nausea and vomiting.

- Loss of appetite.

- Insomnia.

- Agitation.

- Postural hypotension.

- Dizziness.

- Tachycardia and arrhythmias.

- Discoloration of urine.

- Psychiatric symptoms.

- Headaches.

- Increased sweating.

- Change in sense of taste.

- Gastrointestinal bleeding.

INTERACTIONS

- Antidepressant medication such as monoamine-oxidase inhibitors (MAOIs) and tricyclics.

- Pyridoxine.

- Iron.

- Antipsychotic drugs.

- Bupropion (Zyban).

ADMINISTRATION

- Co-beneldopa is available as capsules, dispersible tablets and modified-release preparations.

- Co-careldopa is available as tablets and modified- release preparations.

NURSING CONSIDERATIONS

- Assess therapeutic response.

- Monitoring for side-effects, including mental state assessment and blood pressure measurement.

- Care should be taken to avoid confusion with the antihypertensive medication methyldopa.

- Levodopa can cause false results in urine tests for sugar and ketones.

PATIENT TEACHING

- Inform patients of the possibility of a sudden onset of excessive daytime sleepiness.

- Patients must not drive or operate machinery until they know how this drug affects them.

- Alcohol can add to the drowsiness caused by this drug.

- Inform patients that it may take several weeks to benefit from the full therapeutic effects.

- Patients should not stop taking levodopa suddenly without taking medical advice.

Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines

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