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Drug

Carbidopa/Levodopa

Common brand names:

Parcopa, Sinemet, Sinemet CR

Levodopa is required by the brain to produce dopamine, an important neurotransmitter. People with Parkinson’s disease have depleted levels of dopamine, leading to debilitating symptoms. Levodopa is given to increase production of dopamine, which in turn reduces the symptoms of Parkinson’s disease. When taken by mouth, most levodopa is broken down by the body before it reaches the brain. Sinemet® combines levodopa with carbidopa, a drug that prevents the breakdown, allowing levodopa to reach the brain to increase dopamine levels.

Summary of Interactions with Vitamins, Herbs, & Foods

  • Negative Interactions

    2
    • Carbidopa

      Iron

      Reduces Effectiveness

      Iron supplements taken with carbidopa may interfere with the action of the drug.

      Iron
      Carbidopa
      ×
      1. Campbell NR, Hasinoff BB. Iron supplements: A common cause of drug interactions. Br J Clin Pharmacol 1991;31:251-5.
    • Carbidopa-Levodopa

      Iron

      Reduces Effectiveness

      Iron supplements taken with carbidopa interfere with the action of the drug. People taking carbidopa should not supplement iron without consulting the prescribing physician.

      Iron
      Carbidopa-Levodopa
      ×
      1. Campbell NR, Hasinoff BB. Iron supplements: A common cause of drug interactions. Br J Clin Pharmacol 1991;31:251-5.
  • Supportive Interactions

    5
    • Carbidopa

      Vitamin B3 (Niacin)

      Replenish Depleted Nutrients

      This interaction is based on this drug belonging to a drug class. While this drug may differ from the text and references below, drugs within this class work in a similar way and this interaction is applicable to drugs within the same class.

      A study in animals has found that carbidopa inhibits an enzyme involved in the synthesis of niacin in the body. In addition, there is evidence that niacin synthesis is decreased in people taking carbidopa and other drugs in its class, raising the concern that people taking these drugs could be at risk of niacin deficiency, even if not frankly deficient. Further studies will be required determine if niacin supplementation is appropriate in people taking carbidopa.

      Vitamin B3 (Niacin)
      Carbidopa
      ×
      1. Bender DA, Smith WR. Inhibition of kynurenine hydrolase by benserazide, carbidopa and other aromatic hydrazine derivatives: evidence for sub-clinical iatrogenic niacin deficiency. Biochem Soc Trans 1978;6:120-2.
      2. Bender DA, Earl CJ, Lees AJ. Niacin depletion in Parkinsonian patients treated with L-dopa, benserizide and carbidopa. Clin Sci 1979;56:89-93.
    • Carbidopa-Levodopa

      Vitamin B3 (Niacin)

      Replenish Depleted Nutrients

      A study in animals has found that carbidopa inhibits an enzyme involved in the synthesis of niacin in the body. In addition, there is evidence that niacin synthesis is decreased in people taking carbidopa and other drugs in its class. Further studies are needed to determine whether niacin supplementation is appropriate in people taking carbidopa.

      Vitamin B3 (Niacin)
      Carbidopa-Levodopa
      ×
      1. Bender DA, Smith WR. Inhibition of kynurenine hydrolase by benserazide, carbidopa and other aromatic hydrazine derivatives: evidence for sub-clinical iatrogenic niacin deficiency. Biochem Soc Trans 1978;6:120-2.
      2. Bender DA, Earl CJ, Lees AJ. Niacin depletion in Parkinsonian patients treated with L-dopa, benserizide and carbidopa. Clin Sci 1979;56:89-93.
    • Carbidopa

      Vitamin B6

      Replenish Depleted Nutrients

      Test tube, animal, and preliminary human studies suggest that carbidopa may cause depletion of vitamin B6. However, the use of carbidopa with levodopa reduces the vitamin B6-depleting effects of levodopa. More research is needed to determine whether vitamin B6 supplementation is advisable when taking carbidopa.

      Vitamin B6
      Carbidopa
      ×
      1. Bender DA. Inhibition in vitro of the enzymes of the oxidative pathway of tryptophan metabolism and of nicotinamide nucleotide synthesis by benserazide, carbidopa and isoniazid. Biochem Pharmacol 1980;29:707-12.
      2. Bender DA. Effects of benserazide, carbidopa and isoniazid administration on tryptophan-nicotinamide nucleotide metabolism in the rat. Biochem Pharmacol 1980;29:2099-2104.
      3. Bender DA, Earl CJ, Lees AJ. Niacin depletion in Parkinsonian patients treated with L-dopa, benserizide and carbidopa. Clin Sci 1979;56:89-93.
      4. Trovato A, Nuhlicek DN, Midtling JE. Drug-nutrient interactions. Am Family Phys 1991;44:1651-8.
    • Carbidopa

      Vitamin C

      Support Medicine

      A combination of levodopa/carbidopa and vitamin C may be useful for people with Parkinson’s disease whose motor complications are not effectively managed with conventional drug treatment. This combination was administered to people with Parkinson’s disease for 16.8 months in an unblinded, uncontrolled study. The researchers reported that participants who completed the study experienced substantial increases in the number of hours with good functional capacity and were able to reduce their intake of other anti-Parkinsonian drugs. However, 62% of the participants withdrew from the study, citing difficulty in performing voluntary movements as the main reason. Until more research is performed, this drug-nutrient combination must be viewed as preliminary.

      Vitamin C
      Carbidopa
      ×
      1. Linazasoro G, Gorospe A. [Treatment of complicated Parkinson disease with a solution of levodopa- carbidopa and ascorbic acid]. Neurologia 1995;10:220-3 [Article in Spanish].
    • Carbidopa-Levodopa

      Vitamin C

      Support Medicine

      Combining levodopa-carbidopa and vitamin C may be useful for people with Parkinson’s disease whose motor complications are not effectively managed with conventional drug treatment. This combination was administered to people with Parkinson’s disease in a preliminary study. The researchers reported several improvements in participants who completed the study; however, 62% of the participants withdrew from the study, most citing difficulty in performing normal movements. Until more research is performed, this drug-nutrient combination must be viewed as experimental.

      Vitamin C
      Carbidopa-Levodopa
      ×
      1. Linazasoro G, Gorospe A. [Treatment of complicated Parkinson disease with a solution of levodopa- carbidopa and ascorbic acid]. Neurologia 1995;10:220-3 [Article in Spanish].
  • Explanation Required

    3
    • Carbidopa

      5-HTP

      Needs Explanation

      5-HTP and carbidopa have been reported to improve intention myoclonus (a neuromuscular disorder) in some human cases but not others. Several cases of scleroderma-like illness have been reported in patients using carbidopa and 5-HTP for intention myoclonus.

      5-HTP
      Carbidopa
      ×
      1. Van Woert MH, Rosenbaum D, Howieson J, Bowers MB Jr. Long-term therapy of myoclonus and other neurologic disorders with L-5-hydroxytryptophan and carbidopa. N Engl J Med 1977;296:70-5.
      2. Magnussen I, Dupont E, Engbaek F, de Fine Olivarius B. Post-hypoxic intention myoclonus treated with 5-hydroxytryptophan and an extracerebral decarboxylase inhibitor. Acta Neurol Scand 1978;57:289-94.
      3. Growdon JH, Young RR, Shahani BT. L-5-hydroxytryptophan in treatment of several different syndromes in which myoclonus is prominent. Neurology 1976;26:1135-40.
      4. Sternberg EM, Van Woert MH, Young SN, et al. Development of a scleroderma-like illness during therapy with L-5-hydroxytryptophan and carbidopa. N Engl J Med 1980;303:782-7.
      5. Joly P, Lampert A, Thromine E, Lauret P. Development of pseudobullous morphea and scleroderma-like illness during therapy with L-5-hydroxytryptophan and carbidopa. J Am Acad Dermatol 1991;25:332-3.
      6. Auffranc JC, Berbis P, Fabre JF, et al. Sclerodermiform and poikilodermal syndrome observed during treatment with carbidopa and 5-hydroxytryptophan. Ann Dermatol Verereol 1985;112:691-2.
    • Carbidopa-Levodopa

      5-HTP

      Needs Explanation

      Several cases of scleroderma-like illness have been reported in patients using carbidopa and 5-HTP (5-Hydroxytryptophan). People taking carbidopa should not supplement 5-HTP without consulting the prescribing physician.

      5-HTP
      Carbidopa-Levodopa
      ×
      1. Sternberg EM, Van Woert MH, Young SN, et al. Development of a scleroderma-like illness during therapy with L-5-hydroxytryptophan and carbidopa. N Engl J Med 1980;303:782-7.
      2. Joly P, Lampert A, Thromine E, Lauret P. Development of pseudobullous morphea and scleroderma-like illness during therapy with L-5-hydroxytryptophan and carbidopa. J Am Acad Dermatol 1991;25:332-3.
      3. Auffranc JC, Berbis P, Fabre JF, et al. Sclerodermiform and poikilodermal syndrome observed during treatment with carbidopa and 5-hydroxytryptophan. Ann Dermatol Verereol 1985;112:691-2.
    • Carbidopa-Levodopa

      Vitamin B6

      Needs Explanation

      Vitamin B6 supplementation above 5–10 mg per day reduces the effectiveness of levodopa. However, combining levodopa with carbidopa prevents this adverse effect, so vitamin B6 supplements may safely be taken with Sinemet® (carbidopa/levodopa).

      Vitamin B6
      Carbidopa-Levodopa
      ×
      1. Trovato A, Nuhlicek DN, Midtling JE. Drug-nutrient interactions. Am Family Phys 1991;44:1651-8.
The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a new supplement with your doctor or pharmacist.

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