You can help reduce mix-ups with all of the carbidopa/levodopa products for Parkinson’s disease.
About 90,000 people in the US are diagnosed with Parkinson’s each year. Carbidopa/levodopa will usually be used first for treatment...since it’s the most effective option for tremor, rigidity, or slow movement.
Use this chart to see how carbidopa/levodopa products stack up.
Expect that most patients will start with a generic immediate-release (IR) form of carbidopa/levodopa. Most controlled-release (CR) products aren’t absorbed as well...and may take longer to kick in.
Double-check that you pick the right product and strength from your computer and shelf. Multiple forms are available, including IR tabs...ODTs...ER tabs...ER caps...and a triple-scored tab (Dhivy).
Don’t auto-sub between products...they’re not considered equivalent.
And some patients may prefer one generic manufacturer over another for a variety of reasons (pill size, tablet scoring, dye allergy, etc).
Be aware that ER capsules (Crexont, Rytary) are not interchangeable due to different formulations and dosages.
For example, Rytary capsules may be opened and the beads sprinkled on food...but Crexont capsules should NOT be opened.
Take note of when a different formulation of carbidopa/levodopa is prescribed and confirm with the pharmacist that this was intentional.
Ensure patients get a consultation with the pharmacist...to go over important info about side effects, administration, etc.
For instance, levodopa should be taken with food when starting, to ease nausea. But food, especially protein, slows absorption, so switching to an empty stomach may improve efficacy...especially as disease advances.
Expect some patients may have trouble opening child-resistant Rx bottles...or operating a pill cutter. Discuss risks of easy-open caps if children are in the home or visit...and ensure concerns are addressed.
See our resources, Drugs for Parkinson's Disease and Parkinson’s Disease Therapy for more formulations and dispensing tips.
- Pringsheim T, Day GS, Smith DB, et al. Dopaminergic Therapy for Motor Symptoms in Early Parkinson Disease Practice Guideline Summary: A Report of the AAN Guideline Subcommittee. Neurology. 2021 Nov 16;97(20):942-957.
- Zimmerman KM, Whitmire N. Parkinson’s disease and other movement disorders. In: Zeind CS, Carvalho MG, editors. Applied Therapeutics: the Clinical Use of Drugs. 11th ed. Philadelphia, PA: Wolters Kluwer Health, 2018:1246-72.
- Chart: Drugs for Parkinson’s Disease
- Algorithm: Parkinson's Disease Therapy