LEVODOPA/CARBIDOPA/ENTACAPONA CINFA 75 mg/18.75 mg/200 mg FILM-COATED TABLETS

2. What you need to know before you take Levodopa/Carbidopa/Entacapone cinfa

Do not take Levodopa/Carbidopa/Entacapone cinfa if

• you are allergic to levodopa, carbidopa, or entacapone, or to any of the other ingredients of this medicine (listed in section 6).
• you have narrow-angle glaucoma (a condition of the eye).
• you have a tumor of the adrenal gland.
• you are taking certain medicines for depression (combinations of selective MAO-A and MAO-B inhibitors, or non-selective MAO inhibitors).
• you have ever had neuroleptic malignant syndrome (NMS – a rare reaction to medicines used to treat severe mental disorders).
• you have ever had non-traumatic rhabdomyolysis (a rare muscle disorder).
• you have severe liver disease.

Warnings and precautions

Consult your doctor or pharmacist before starting to take Levodopa/Carbidopa/Entacapone cinfa.

If you suffer or have ever suffered from:

• a heart attack or any other heart disease, including arrhythmias, or blood vessel disease.
• asthma or any other lung disease.
• any liver problem, as the dose you receive may need to be adjusted.
• any kidney disease or hormone-related disease.
• stomach ulcers or convulsions.
• prolonged diarrhea. Consult your doctor as it may be a sign of colon inflammation.
• any severe mental disorder, such as psychosis.
• open-angle glaucoma, as the dose may need to be adjusted and your intraocular pressure monitored.

Consult your doctor if you are taking:

• antipsychotics (medicines for treating psychosis).
• any medicine that may cause a drop in blood pressure when standing up from a chair or bed. You should be aware that Levodopa/Carbidopa/Entacapone may worsen these reactions.

Consult your doctor if, during treatment with Levodopa/Carbidopa/Entacapone:

• you notice great stiffness in the muscles or violent contractions, or if you suffer from tremors, agitation, confusion, fever, rapid pulse, or large fluctuations in blood pressure. If any of these circumstances occur, contact your doctor immediately.
• you feel depressed, have suicidal thoughts, or notice unusual changes in your behavior.
• you notice that you suddenly fall asleep, or you feel very drowsy. If this happens, you should not drive or operate tools or machinery (see also the section "Driving and using machines").
• you start to notice uncontrolled movements or they worsen. If this occurs, your doctor may need to adjust your medication dose.
• you suffer from diarrhea; it is recommended to monitor your weight to avoid excessive weight loss.
• you suffer from progressive loss of appetite, asthenia (weakness, exhaustion), and weight loss over a relatively short period. In these cases, a complete medical evaluation, including a liver function test, should be considered.
• you consider stopping treatment with Levodopa/Carbidopa/Entacapone cinfa; consult the section "If you stop taking Levodopa/Carbidopa/Entacapone cinfa".

Inform your doctor if you or your family/caregiver notice that you are developing desires or tendencies to behave in an unusual way for you or that you cannot resist the impulse, determination, or temptation to perform certain activities that may harm you or others. These behaviors are called impulse control disorders and may include addiction to gambling, eating, or excessive spending, and an abnormally high sexual impulse or concern with an increase in sexual thoughts or feelings. Your doctor may need to review your treatment.

Inform your doctor if you, or your family/caregiver, notice that you are developing symptoms similar to addiction, leading to a desire for high doses of levodopa/carbidopa/entacapone and other medicines used to treat Parkinson's disease.

During prolonged treatment with Levodopa/Carbidopa/Entacapone, your doctor may perform regular blood tests.

If you need to undergo surgery, you should inform your doctor that you are taking this medicine.

It is not recommended to use Levodopa/Carbidopa/Entacapone for the treatment of extrapyramidal symptoms (e.g., involuntary movements, agitation, muscle stiffness, and muscle contractions) caused by other medicines.

Children and adolescents

Experience with the use of Levodopa/Carbidopa/Entacapone in patients under 18 years is limited. Therefore, it is not recommended for administration in children or adolescents.

Other medicines and Levodopa/Carbidopa/Entacapone cinfa

Inform your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines.

Do not take this medicine if you are taking certain medicines for depression (combinations of selective MAO-A and MAO-B inhibitors, or non-selective MAO inhibitors).

Levodopa/Carbidopa/Entacapone may increase the effect and also the side effects of certain medicines. These include:

• medicines used to treat depression, such as moclobemide, amitriptyline, desipramine, maprotiline, venlafaxine, and paroxetine
• rimiterol and isoprenaline, used to treat respiratory diseases
• adrenaline, used for severe allergic reactions
• noradrenaline, dopamine, and dobutamine, used to treat heart diseases and low blood pressure
• alpha-methyldopa, used to treat high blood pressure
• apomorphine, used to treat Parkinson's disease

Certain medicines may reduce the effects of Levodopa/Carbidopa/Entacapone. These medicines are:

• dopamine antagonists used to treat mental disorders, nausea, and vomiting
• phenytoin, used to prevent convulsions
• papaverine, used to relax muscles

Levodopa/Carbidopa/Entacapone may interfere with the absorption of iron in the gut. Therefore, you should not take Levodopa/Carbidopa/Entacapone at the same time as iron supplements. If you take any of them, you should wait at least 2 or 3 hours before taking the other.

Taking Levodopa/Carbidopa/Entacapone cinfa with food and drinks

This medicine can be taken with or without food.

It is possible that in some patients, Levodopa/Carbidopa/Entacapone may not be absorbed well if taken with protein-rich foods (meat, fish, dairy products, cereals, and nuts) or shortly after eating them.

Consult your doctor if you think this is happening in your case.

Pregnancy, breastfeeding, and fertility

If you are pregnant or breastfeeding, think you may be pregnant, or are planning to have a baby, consult your doctor or pharmacist before using this medicine.

You should not breastfeed while taking this medicine.

Driving and using machines

Levodopa/Carbidopa/Entacapone may cause drowsiness and sudden episodes of sleep. If this happens, you should not drive or operate machinery until these episodes and/or drowsiness have disappeared.

Levodopa/Carbidopa/Entacapone cinfa 75 mg/18.75 mg/200 mg contains lactose

This medicine contains lactose. If your doctor has told you that you have an intolerance to some sugars, consult them before taking this medicine.

3. How to take Levodopa/Carbidopa/Entacapone cinfa

Always take this medicine exactly as your doctor or pharmacist has told you. If you are not sure, consult your doctor or pharmacist.

Adults and elderly patients:

• Your doctor will tell you exactly how many Levodopa/Carbidopa/Entacapone tablets to take each day.
• The tablets should not be broken or divided into smaller pieces.
• Take only one tablet at a time.
• Depending on how you respond to treatment, your doctor may adjust your dose up or down.
• If you are taking Levodopa/Carbidopa/Entacapone tablets of 50 mg/12.5 mg/200 mg, 75 mg/18.75 mg/200 mg, 100 mg/25 mg/200 mg, 125 mg/31.25 mg/200 mg, or 150 mg/37.5 mg/200 mg, do not take more than 10 tablets per day.

Talk to your doctor or pharmacist if you think the effect of this medicine is too strong or too weak, or if you experience possible side effects.

If you take more Levodopa/Carbidopa/Entacapone cinfa than you should

In case of overdose or accidental ingestion, consult your doctor or pharmacist immediately or call the Toxicology Information Service, telephone: 91 562 04 20, indicating the medicine and the amount taken.

You may feel dizzy or agitated, your heart rate may be slower or faster than normal, or the color of your skin, tongue, eyes, or urine may change.

If you forget to take Levodopa/Carbidopa/Entacapone cinfa

Do not take a double dose to make up for forgotten doses.

If it is more than 1 hour until the next dose:

Take a tablet as soon as you remember, and the next one at the usual time.

If it is less than 1 hour until the next dose:

Take a tablet as soon as you remember, wait 1 hour, and take another tablet then. Then, continue as usual.

There should always be an interval of 1 hour between tablets of this medicine to avoid possible side effects.

If you stop taking Levodopa/Carbidopa/Entacapone cinfa

Do not stop taking this medicine unless your doctor tells you to. In that case, your doctor may need to adjust the dose of your other Parkinson's medicines, especially levodopa, to ensure sufficient control of your symptoms.

If you stop taking Levodopa/Carbidopa/Entacapone and other Parkinson's medicines suddenly, you may experience unwanted side effects.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. Many can be alleviated by adjusting the dose.

If you experience any of these symptoms during treatment with this medicine, contact your doctor immediately:

• Great stiffness or violent contractions of the muscles, tremors, agitation, confusion, fever, rapid pulse, or large fluctuations in blood pressure. These may be symptoms of neuroleptic malignant syndrome (NMS – a rare and severe reaction to medicines used to treat central nervous system disorders) or rhabdomyolysis (a rare and severe muscle disorder).
• Allergic reaction characterized by signs such as hives, itching, rash, and swelling of the face, lips, tongue, or throat. This reaction can cause difficulty breathing or swallowing.

Very common (may affect more than 1 in 10 people):

• uncontrolled movements (dyskinesias)
• feeling sick (nausea)
• brown-red discoloration of urine (harmless)
• muscle pain
• diarrhea
• urinary tract infections

Common (may affect up to 1 in 10 people):

• fainting or fainting due to low blood pressure, hypertension
• worsening of parkinsonian symptoms, dizziness, drowsiness
• vomiting; abdominal pain and discomfort; heartburn; dry mouth; constipation
• sleeplessness; hallucinations; confusion; abnormal dreams (with nightmares); fatigue
• changes in mental state, including memory problems, anxiety, and depression (possibly with suicidal thoughts)
• heart or blood vessel disorders (e.g., chest pain), irregular heart rhythms
• more frequent falls
• breathlessness
• increased sweating, rash
• muscle cramps, swelling of the legs
• blurred vision
• anemia
• decreased appetite, weight loss
• headache, joint pain
• urinary tract infections

Uncommon (may affect up to 1 in 100 people):

• heart attack
• intestinal bleeding
• changes in blood cell counts that can cause bleeding and abnormalities in liver function tests
• seizures
• feeling agitated
• psychotic symptoms
• colitis (inflammation of the colon)
• color changes different from those of urine (e.g., skin, nails, hair, sweat)
• difficulty swallowing
• inability to urinate

Frequency not known (cannot be estimated from the available data):

Desire for high doses of Levodopa/Carbidopa/Entacapone higher than those required to control motor symptoms, known as dopamine dysregulation syndrome.

Some patients experience severe abnormal involuntary movements (dyskinesias), mood changes, or other side effects after taking high doses of Levodopa/Carbidopa/Entacapone.

The following side effects have also been reported:

• hepatitis (inflammation of the liver)
• itching

You may experience the following side effects:

Inability to resist the impulse to perform an action that could be harmful, and which could include:

• a strong impulse to gamble excessively despite serious personal or family consequences
• an increased or altered interest in sex and a concerning behavior for you or others, such as an increased sexual desire
• excessive and uncontrolled shopping or spending
• eating excessively (eating large amounts of food in short periods) or compulsively (eating more food than usual and more than needed to satisfy hunger).

Inform your doctor if you experience any of these behaviors; they will discuss how to manage or reduce these symptoms.

Reporting of side effects

If you experience any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly through the Spanish Medicines Monitoring System for Human Use: https://www.notificaram.es. By reporting side effects, you can help provide more information on the safety of this medicine.

5. Storage of Levodopa/Carbidopa/Entacapone cinfa

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the carton after EXP. The expiry date is the last day of the month shown.

This medicine does not require any special storage conditions.

Discard the product 175 days after opening the package.

Medicines should not be disposed of via wastewater or household waste. Return the package and any unused medicine to a pharmacy for proper disposal. If you have any questions, ask your pharmacist. This will help protect the environment.

6. Container Content and Additional Information

Composition of Levodopa/Carbidopa/Entacapone cinfa

• The active ingredients are levodopa, carbidopa, and entacapone. Each coated tablet contains 75 mg of levodopa, 18.75 mg of carbidopa, and 200 mg of entacapone.
• The other components are: microcrystalline cellulose, anhydrous lactose, hydroxypropylcellulose, povidone (E-1201), colloidal anhydrous silica, magnesium stearate, titanium dioxide (E-171), hypromellose, glycerol (E-422), yellow iron oxide (E-172), polysorbate 80, and red iron oxide (E-172).

Product Appearance and Container Content

Biconvex, oval, light orange tablets, engraved with "75" on one side, smooth on the other.

Levodopa/Carbidopa/Entacapone cinfa 75 mg/18.75 mg/200 mg is available in HDPE bottles with child-resistant PP caps in packs of 100 tablets.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

Laboratorios Cinfa, S.A.

Carretera Olaz-Chipi, 10. Polígono Industrial Areta

31620 Huarte (Navarra) - Spain

Manufacturer

Teva Pharmaceutical Works Private

Pallagi út 13, 4042 Debrecen

Hungary

Or

Laboratorios Cinfa, S.A.

Carretera Olaz-Chipi, 10. Polígono Industrial Areta

31620 Huarte (Navarra) - Spain

Date of Last Revision of this Leaflet: October 2023

Detailed information on this medicinal product is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/

You can access detailed and updated information about this medicinal product by scanning the QR code included in the leaflet and packaging with your mobile phone (smartphone). You can also access this information at the following internet address: https://cima.aemps.es/cima/dochtml/p/79657/P_79657.html

QR code to: https://cima.aemps.es/cima/dochtml/p/79657/P_79657.html