Formulary
Co-careldopa: Indications, Dosing, Side Effects and Interactions
Co-careldopa clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Co-careldopa: Indications, Dosing, Side Effects and Interactions
Co-careldopa clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Parkinson's disease**
- **Adult** (By Mouth): Initially 25/100 mg 3 times a day, then increased in steps of 12.5/50 mg once daily or on alternate days, alternatively increased in steps of 25/100 mg once daily or on alternate days, dose to be adjusted according to response; dose increased until 800 mg levodopa (with 200 mg carbidopa) daily in divided doses is reached, then maintenance up to 200/2000 mg daily in divided doses, adjusted according to response, when co-careldopa is used, the total daily dose of carbidopa should be at least 70 mg. A lower dose may not achieve full inhibition of extracerebral dopa-decarboxylase, with a resultant increase in side-effects.
**Parkinson's disease-alternative regimen**
- **Adult** (By Mouth): Initially 12.5/50 mg 3-4 times a day, alternatively initially 10/100 mg 3-4 times a day, then increased in steps of 12.5/50 mg once daily or on alternate days, adjusted according to response, alternatively increased in steps of 10/100 mg once daily or on alternate days, adjusted according to response, dose increased until 800 mg levodopa (with up to 200 mg carbidopa) daily in divided doses is reached, then maintenance up to 200/2000 mg daily in divided doses, adjusted according to response, when co-careldopa is used, the total daily dose of carbidopa should be at least 70 mg. A lower dose may not achieve full inhibition of extracerebral dopa-decarboxylase, with a resultant increase in side-effects.
**Parkinson's disease (patients not receiving levodopa/dopa-decarboxylase inhibitor preparations, expressed as levodopa)**
- **Adult** (By Mouth Using Modified-Release Tablets): Initially 100-200 mg twice daily, dose to be given at least 6 hours apart; dose adjusted according to response at intervals of at least 2 days.
**Parkinson's disease (patients transferring from immediate-release levodopa/dopa-decarboxylase inhibitor preparations)**
- **Adult** (By Mouth): 1 tablet twice daily, dose can be substituted for a daily dose of levodopa 300-400 mg in immediate-release Sinemet tablets (substitute Sinemet CR to provide approximately 10% more levodopa per day and extend dosing interval by 30-50%); dose and interval then adjusted according to response at intervals of not less than 3 days.
**Parkinson's disease (**
- **Adult** (By Mouth): for fine adjustment of Sinemet CR dose) (consult product literature).
**Parkinson's disease (patients not receiving levodopa/dopa-decarboxylase inhibitor therapy)**
- **Adult** (By Mouth): Initially 1 tablet twice daily, both dose and interval then adjusted according to response at intervals of not less than 3 days.
**Dopamine-sensitive dystonias including Segawa syndrome and dystonias related to cerebral palsy (dose expressed as levodopa) for co-careldopa**
- **Child 3 months-17 years** (By mouth): Initially 250 micrograms/kg 2-3 times a day, dose to be increased according to response every 2-3 days, increased if necessary up to 1 mg/kg 3 times a day, preparation containing 1:4 ratio of carbidopa:levodopa is to be used.
**Treatment of defects in tetrahydrobiopterin synthesis and dihydrobiopterin reductase deficiency (dose expressed as levodopa) for co-careldopa**
- **Neonate** (By mouth): Initially 250-500 micrograms/kg 4 times a day, dose to be increased every 4-5 days according to response, a preparation containing 1:4 carbidopa:levodopa to be administered; maintenance 2.5-3 mg/kg 4 times a day, at higher doses consider preparation containing 1:10 carbidopa:levodopa, review regularly (every 3-6 months).
- **Child** (By mouth): Initially 250-500 micrograms/kg 4 times a day, dose to be increased every 4-5 days according to response, a preparation containing 1:4 carbidopa:levodopa to be administered; maintenance 2.5-3 mg/kg 4 times a day, at higher doses consider preparation containing 1:10 carbidopa:levodopa, review regularly (every 3-6 months in early childhood).
Cautions
For co-careldopa Acute stroke; Cushing's syndrome; diabetes mellitus; endocrine disorders; history of convulsions; history of myocardial infarction with residual arrhythmia; history of peptic ulcer; hyperthyroidism; open-angle glaucoma (monitor intra-ocular pressure); osteomalacia; phaeochromocytoma; psychiatric illness (avoid if severe and discontinue if deterioration); severe cardiovascular disease; severe pulmonary disease
Contraindications
For co-careldopa Angle-closure glaucoma; suspicious undiagnosed skin lesions or history of skin melanoma (risk of activation)
Side effects
For co-careldopa Rare or very rare Drowsiness; seizure; sudden onset of sleep (can occur without warning) Frequency not known Agranulocytosis; alertness decreased; alopecia; anaemia; angioedema; anxiety; appetite decreased; asthenia; cardiac disorder; chest pain; compulsions; confusion; constipation; delusions; dementia; depression; diarrhoea; dizziness; dopamine dysregulation syndrome; dry mouth; dyskinesia (may be dose-limiting); dysphagia; dyspnoea; eating disorders; euphoric mood; eye disorders; fall; focal tremor; gait abnormal; gastrointestinal discomfort; gastrointestinal disorders; gastrointestinal haemorrhage; haemolytic anaemia; hallucination; headache; Henoch-Schnlein purpura; hiccups; hoarseness; Horner's syndrome exacerbated; hypertension; hypotension; leucopenia; malaise; malignant melanoma; movement disorders; muscle complaints; nausea; neuroleptic malignant syndrome (on abrupt discontinuation); oedema; on and off phenomenon; oral disorders; palpitations; pathological gambling; postural disorders; psychotic disorder; respiration abnormal; sensation abnormal; sexual dysfunction; skin reactions; sleep disorders; suicidal ideation; sweat changes; syncope; taste bitter; teeth grinding; thrombocytopenia; trismus; urinary disorders; urine dark; vasodilation; vision disorders; vomiting; weight changes Side-effects, further information Also available as an intestinal gel-for specific side-effects consult product literature.
Pregnancy
For co-careldopa Use with caution-toxicity has occurred in animal studies.
Breast feeding
For co-careldopa May suppress lactation; present in milk-avoid.
Hepatic impairment
For co-careldopa Manufacturer advises use with caution in hepatic disease.
Renal impairment
For co-careldopa Use with caution. M
Medicinal forms
Solution,Tablet,Tablet,Gel
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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