Usual Adult Dose for Parkinson's Disease

50 mg orally once a day at bedtime

Use: As adjunctive treatment to levodopa/carbidopa in patients with Parkinson's disease (PD) experiencing "off" episodes

Renal Dose Adjustments

Mild/moderate renal impairment: No adjustment recommended
Severe renal impairment: Monitor for adverse reactions and discontinue if tolerability issues arise
End stage (CrCl less than 15 mL/min) renal impairment: Use should be avoided

Liver Dose Adjustments

Mild hepatic impairment (Child-Pugh A): No adjustment recommended
Moderate hepatic impairment (Child-Pugh B): 25 mg orally once daily at bedtime
Severe hepatic impairment (Child-Pugh C): Use should be avoided

Dose Adjustments

Dyskinesia:

• Because this drug potentiates the effects of levodopa, dose reduction of levodopa or other dopaminergic drugs may mitigate dyskinesia

• Upon discontinuation, monitor closely and adjust other dopaminergic therapies as needed

Precautions

CONTRAINDICATIONS:

• Concomitant use with non-selective monoamine oxidase (MAO-A and MAO-B) inhibitors
• Pheochromocytoma, paraganglioma, or other catecholamine secreting neoplasms

Dialysis

Data not available

Other Comments

Administration advice:

• Take orally once a day at bedtime
• Patients should not eat food for 1 hour before and for at least 1 hour after intake

• Store at a temperature below 30C (86F)

• This drug enhances the effects of levodopa; this drug has no antiparkinsonian effect of its own and must be administered with a levodopa/DOPA decarboxylase inhibitor (DDCI).

• Cardiovascular: Monitor for signs and symptoms of orthostatic hypotension, particularly during dose escalation
• Nervous System: Question patients about somnolence and drowsiness
• Psychiatric: Question patients about new or increased gambling urges, sexual urges, uncontrolled spending, binge or compulsive eating, or other urges

• Patients should be instructed to read the US FDA-approved patient labeling (Patient Information).
• Patients should understand that drug therapy for Parkinson's disease often causes dizziness, and drowsiness; patients should not drive a car or operate machinery or perform other potentially dangerous activities until it is determined how adding this drug affects their mental and/or motor performance.
• Patients should be instructed to report episodes of new or worsening dyskinesia (tremors and involuntary muscle movements), and new or worsening compulsive behaviors and/or unusual urges.
• Patients should be instructed to contact their healthcare provider before stopping this drug.