Madopar 62.5mg, 50 mg + 12.5 mg, capsules
Levodopa + Benserazide
Madopar is a combination medicine containing two active substances: levodopa and benserazide (in the form of hydrochloride).
Madopar is indicated for the treatment of Parkinson's disease.
Madopar 125 mg, 100 mg + 25 mg, capsules; Madopar, 200 mg + 50 mg, capsules; and Madopar HBS, 100 mg + 25 mg, capsules are also indicated for the symptomatic treatment of idiopathic (primary) or renal failure-related restless legs syndrome (RLS).
In larger quantities, levodopa penetrates the brain and is converted to dopamine, and there is no conversion of levodopa to dopamine in extracerebral tissues, which results in fewer side effects. Madopar can thus have a beneficial effect on Parkinson's disease symptoms. However, it does not cure the disease, as it does not eliminate the cause of dopamine deficiency in the brain. The causal treatment of the disease is currently impossible.
Before starting to take Madopar, the patient should discuss with their doctor or pharmacist if:
During the dose titration phase, it is necessary to periodically monitor liver, kidney, and cardiovascular function
and monitor blood counts.
During treatment with Madopar, depressionmay occur, which may be related to the underlying disease. Patients taking Madopar should be closely monitored for psychological changes and depression: with or without suicidal thoughts.
Patients taking Madopar may experience cognitive and behavioral disorders.
In rare cases, duringlevodopa treatment, sleepiness and/or sudden sleep attacksmay occur. Very rarely, reports of sleep attacks that can occur while performing daily activities, sometimes without warning or prior sleepiness, have been made. Therefore, during Madopar treatment, caution should be exercised when driving or operating machinery. Patients who have already experienced sleepiness or sleep attacks should not drive or operate machinery. If sleepiness or sleep attacks occur, the doctor should consider reducing the dose or discontinuing treatment.
Hypersensitivity reactionsmay occur in susceptible individuals.
In a small number of patients, cognitive and behavioral disorders may occur, which may be directly related to taking a higher dose of the medicine than recommended (a dose significantly exceeding the dose of the medicine required to treat motor impairment).
The patient should tell their doctor or pharmacist about all medicines they are currently taking or have recently taken, as well as any medicines they plan to take.
If the doctor has prescribed Madopar for patients taking non-selective MAOIs, there should be at least a two-week interval between the end of non-selective MAOI treatment and the start of Madopar.
Concomitant use of Madopar with selective MAO-B inhibitors, such as selegiline and rasagiline, or selective MAO-A inhibitors, such as moclobemide, is allowed.However, concurrent administration of selective MAO-A and MAO-B inhibitors is equivalent to non-selective MAOI inhibition and should be avoided.
Taking antacids and Madopar HBSreduces levodopa absorption and may decrease the effectiveness of the medicine.
Concurrent use of iron sulfate decreases the maximum levodopa concentration in the blood.
Metoclopramide increases the rate of levodopa absorption. Domperidone may affect increased levodopa absorption in the intestine.
When taking antihypertensive drugsand Madopar, it is necessary to regularly monitor blood pressure to adjust the doses of the medicines.
Neuroleptic drugs, opioids, and antihypertensive drugs containing reserpineinhibit the effect of Madopar.
Concurrent use of Madopar with anti-Parkinsonian drugs(amantadine, selegiline, bromocriptine, dopamine agonists, anticholinergic drugs, such as trihexyphenidyl) is allowed, but it should be noted that both the desired and undesired effects of the medicine may be enhanced. It is recommended not to suddenly discontinue anticholinergic drugswhen starting Madopar treatment, as the effect of levodopa occurs after some time.
Concurrent administration of antipsychotic drugs with drugs having dopamine receptor blocking properties may counteract the anti-Parkinsonian effect of Madopar. Levodopa may counteract the effect of antipsychotic drugs. Caution should be exercised when concurrently administering these drugs, and the patient should be closely monitored for decreased anti-Parkinsonian drug effects and worsening of Parkinson's disease symptoms.
Levodopa in Madopar may affect the results of laboratory tests for catecholamines, creatinine, uric acid, and glucosuria.
Patients taking Madopar may experience false-positive Coombs test resultsand false-positive ketone body presence in the urine.
In the case of general anesthesia using halothane, Madopar should be discontinued 12-48 hours before the procedure, as concurrent administration of Madopar and halothane may cause blood pressure fluctuations and/or cardiac arrhythmias.
Concurrent consumption of protein-rich meals may reduce the effect of the medicine in immediate-release forms, i.e., capsules and standard-release tablets, as well as oral suspension preparation tablets. There is no data available on the effect of food on the efficacy of Madopar in other pharmaceutical forms.
Madopar should not be used during pregnancy or in women of childbearing age who do not use effective contraception.
Before starting treatment, a pregnancy test is recommended to rule out pregnancy.
If a woman taking Madopar becomes pregnant, the medicine should be discontinued (after consulting a doctor).
Madopar should not be used during breastfeeding, as the active substances may pass into breast milk and harm the baby.
During Madopar treatment, sleepiness may occur, and in rare cases, sudden sleep attacks may occur. Therefore, when taking Madopar, caution should be exercised when driving or operating machinery. Patients who have already experienced sleepiness or sleep attacks during Madopar treatment should refrain from driving or operating machinery, as their impaired concentration may pose a risk of serious injury or death to themselves or others.
Madopar 250 mg tablets contain less than 1 mmol (23 mg) of sodium per tablet, which means the medicine is considered "sodium-free".
Madopar HBS contains soybean oil (a component of hydrogenated vegetable oil). Madopar HBS should not be used in patients with known hypersensitivity to peanuts or soy.
This medicine should always be taken according to the doctor's or pharmacist's recommendations. In case of doubts, the doctor or pharmacist should be consulted.
Dosing in Parkinson's disease:
Madopar should never be taken without a doctor's prescription.Under no circumstances should the dosage be changed without the doctor's consent.
Unpleasant gastrointestinal symptoms that occur mainly in the initial phase of treatment can usually be avoided by taking Madopar with a small, protein-poor meal or drink, or by gradually increasing the dose. Madopar HBS can be taken regardless of meals.
For effective treatment, it is essential to take the correct amount of medicine at the right time. The doctor determines the appropriate amount and frequency of medication individually and, in close cooperation with the patient, determines the best treatment schedule. Therefore, the doctor's instructions should be followed carefully. Generally, at the beginning of treatment, the doctor prescribes Madopar in smaller doses and gradually increases the dose. This approach helps the patient's body adapt to the medicine, thereby limiting side effects as much as possible.
Typically, the recommended dose of Madopar is:
In the early stages of Parkinson's disease, treatment usually starts with one Madopar 62.5 mg capsule (50 mg levodopa + 12.5 mg benserazide) three to four times a day.
Optimal therapeutic effectis usually achieved with a daily dose of Madopar equivalent to 300-800 mg levodopa + 75-200 mg benserazide, taken in at least 3 divided doses over a period of 4 to 6 weeks.
The average maintenance dosecorresponds to 1 Madopar 125 mg capsule, taken 3 to 6 times a day. The number of divided doses and their distribution throughout the day should be determined by the doctor individually for each patient, depending on their clinical condition. Madopar HBS and Madopar oral suspension preparation tablets can be administered instead of standard-release Madopar (capsules and tablets) to achieve optimal therapeutic effect.
Dosing in restless legs syndrome
In restless legs syndrome, the dosage depends on the severity of the disease, with optimal efficacy achieved through careful individual dose titration. Madopar is usually taken for a longer period. The dosage and duration of treatment are determined by the doctor.
The medicine should be taken about an hour before bedtime, preferably with a small amount of liquid and a snack. Taking Madopar capsules during a meal containing a lot of protein may reduce the absorption of the medicine and limit its effectiveness.
Typically, the recommended dose of Madopar is:
Idiopathic restless legs syndrome
Madopar is taken orally about an hour before bedtime. To avoid gastrointestinal side effects, it is best to take the medicine with a small meal.
RLS with sleep disturbances
In patients with RLS who complain of sleep disturbances, the recommended dose of Madopar is 62.5 mg - 125 mg. If symptoms persist, the dose of Madopar can be increased to 250 mg.
RLS with sleep disturbances and nocturnal symptoms
In patients with RLS who experience both sleep disturbances and nocturnal symptoms, one Madopar HBS capsule and one Madopar 125 mg capsule should be taken about an hour before bedtime. If this does not lead to sufficient alleviation of symptoms in the second part of the night, the dose can be increased to 2 Madopar HBS capsules.
RLS with sleep disturbances, nocturnal symptoms, and additional daytime symptoms
In such patients, an additional dose of 125 mg Madopar standard-release should be administered, taking care not to exceed the maximum daily dose of 500 mg Madopar.
Parkinson's disease:
All patients should have their dose carefully determined. Patients treated with other anti-Parkinsonian drugs may receive Madopar. As the patient's condition improves with Madopar treatment, the doses of these drugs can be reduced or gradually discontinued.
Madopar in the form of oral suspension preparation tabletsis particularly suitable for patients with dysphagia (swallowing disorders) or when rapid onset of action is desired.
Patients who experience large fluctuations in the effect of the medicine during the dayshould receive smaller doses more frequently throughout the day or switch to Madopar HBS.
Switching from standard-release Madopar to Madopar HBSshould be done from day to day, starting with the first morning dose. The same daily dose and distribution of doses as with standard-release Madopar should be maintained.
After 2-3 days, the dose can be gradually increased by about 50%. There is a possibility of temporary worsening of the condition.
Properties of Madopar HBScause the onset of its action to occur later than with standard-release preparations. The desired effect can be achieved faster by administering Madopar HBS with standard-release Madopar or oral suspension preparation tablets. This method may be particularly useful when administering the first morning dose, which usually should be larger than subsequent doses taken throughout the day. The dosing regimen for Madopar HBS is determined by the doctor individually, slowly, and with special caution, with intervals of at least 2-3 days between each dose change.
In patients with reduced motor function at night, positive effects are achieved by gradually increasing the last evening dose of Madopar HBS to 250 mg, taken directly before bedtime.
Excessive response (dyskinesia)after taking Madopar HBS is more beneficial to reduce by prolonging the interval between individual doses rather than reducing single doses.
If there is no satisfactory clinical response to Madopar HBS, it is recommended to return to previous treatment with standard-release Madopar or oral suspension preparation tablets.
Restless legs syndrome (RLS)
To avoid worsening of symptoms (i.e., early occurrence of RLS symptoms during the day, increased severity of symptoms, and involvement of other body parts), the maximum recommended daily dose of Madopar should not be exceeded.
If worsening of symptoms occurs, it is essential not to exceed the maximum daily dose. If worsening or rebound effect occurs, consideration should be given to additional treatment with reduced levodopa dose or gradual discontinuation of levodopa and replacement with another medicine.
Taking Madopar in the form of tablets, capsules, or HBS capsules
Madopar capsules and Madopar HBS capsules should always be swallowed whole, without chewing, washed down with a non-alcoholic beverage, and taken with a small amount of food. If the doctor has prescribed Madopar in the form of tablets, the prescribed amount can be crushed if necessary to facilitate swallowing.
Taking Madopar in the form of oral suspension preparation tablets
Oral suspension preparation tablets should be dissolved in a small amount of water (about 25-50 ml). The tablets should not be dissolved in fruit juices, milk, or hot beverages, as this reduces the effectiveness of Madopar. Within a few minutes, the tablet disintegrates completely, forming a white suspension. The suspension should be used within 30 minutes of preparation.
Before drinking the suspension, it should be well mixed.
If the patient feels that the effect of Madopar is too strong or too weak, they should consult their doctor.
In case of taking a higher dose of Madopar than recommended, the patient should immediately consult a doctor or pharmacist.
The most common symptoms of overdose may include cardiovascular symptoms (arrhythmias), psychiatric disorders (e.g., disorientation and insomnia), gastrointestinal symptoms (e.g., nausea and vomiting), and involuntary movements. If the patient has overdosed on Madopar with prolonged release (i.e., HBS capsules), the onset of symptoms may be delayed due to the slower absorption of the active substances from the gastrointestinal tract.
Madopar overdose requires immediate medical attention, if necessary in a hospital or intensive care unit. It is recommended to monitor the patient's vital functions and other parameters according to their clinical condition. Patients may require treatment for cardiovascular or central nervous system symptoms. It may be necessary to administer anti-arrhythmic drugs and/or respiratory stimulants or neuroleptics.
A double dose should not be taken to make up for a missed dose. Subsequent doses of the medicine should be taken according to the schedule established by the doctor.
Madopar should not be stopped abruptly. See section 2 Warnings and precautions.
In case of any further doubts regarding the use of this medicine, the doctor or pharmacist should be consulted.
Like all medicines, Madopar can cause side effects, although not everybody gets them.
The following side effects have been reported in clinical trials with Madopar in restless legs syndrome:
Common:may affect up to 1 in 10 people
The following side effects have been reported during post-marketing use of Madopar:
Frequency not known:cannot be estimated from the available data
The patient should inform their doctor if they exhibit any of these behaviors to discuss ways to control or limit these symptoms.
If any side effects worsen or any side effects not listed in the leaflet occur, the doctor or pharmacist should be informed.
If side effects occur, including any side effects not listed in this leaflet, the doctor, pharmacist, or nurse should be informed.
Side effects can be reported directly to the "national reporting system" (detailed information below). By reporting side effects, more information can be collected on the safety of the medicine.
Department of Adverse Reaction Monitoring of Medicinal Products, Medical Devices, and Biocidal Products
Jerozolimskie Avenue 181C
02-222 Warsaw
Phone: +48 22 49 21 301
Fax: +48 22 49 21 309
Website: https://smz.ezdrowie.gov.pl
Side effects can also be reported to the marketing authorization holder.
The medicine should be stored out of sight and reach of children.
Madopar HBS should be stored at a temperature not exceeding 30°C. The bottle should be kept tightly closed to protect it from moisture.
Madopar 62.5 mg, 50 mg + 12.5 mg, and Madopar 125 mg, 100 mg + 25 mg oral suspension preparation tablets should be stored at a temperature below 30°C. The bottle should be kept tightly closed to protect it from moisture.
Madopar 250 mg, 200 mg + 50 mg tablets should be stored at a temperature below 25°C. The bottle should be kept tightly closed to protect it from moisture.
Madopar 62.5 mg, 50 mg + 12.5 mg, and Madopar 125 mg, 100 mg + 25 mg capsules; Madopar, 200 mg + 50 mg, capsules: The bottle should be kept tightly closed to protect it from moisture.
Do not use this medicine after the expiration date stated on the packaging. The expiration date refers to the last day of the specified month.
Medicines should not be disposed of via wastewater or household waste. The patient should ask their pharmacist how to dispose of unused medicines. This will help protect the environment.
The package contains: 100 tablets, 100 oral suspension preparation tablets, or 100 capsules of Madopar, or 30 or 100 Madopar HBS capsules.
Madopar 62.5 mg, 50 mg + 12.5 mg, capsules; light blue-gray capsules containing 50 mg levodopa and 12.5 mg benserazide (in the form of hydrochloride).
Madopar 125 mg, 100 mg + 25 mg, capsules; light blue-pink capsules containing 100 mg levodopa and 25 mg benserazide (in the form of hydrochloride).
Madopar, 200 mg + 50 mg, capsules; light blue-brown capsules containing 200 mg levodopa and 50 mg benserazide (in the form of hydrochloride).
Madopar HBS, 100 mg + 25 mg, capsules; (Hydrodynamically Balanced System) green-light blue capsules with prolonged release containing 100 mg levodopa and 25 mg benserazide (in the form of hydrochloride).
Madopar 250 mg, 200 mg + 50 mg, tablets; pink tablets containing 200 mg levodopa and 50 mg benserazide (in the form of hydrochloride).
Madopar 62.5 mg, 50 mg + 12.5 mg, oral suspension preparation tablets; white or grayish-white, divisible tablets containing 50 mg levodopa and 12.5 mg benserazide (in the form of hydrochloride).
Madopar 125 mg, 100 mg + 25 mg, oral suspension preparation tablets; white or grayish-white, divisible tablets containing 100 mg levodopa and 25 mg benserazide (in the form of hydrochloride).
Not all pack sizes may be marketed.
Marketing authorization holder:
Roche Polska Sp. z o.o.
Domaniewska Street 28
02-672 Warsaw
Phone: 022 345 18 88
Fax: 022 345 18 74
Importer:
Roche Pharma AG
Emil-Barell-Strasse 1
79639 Grenzach-Wyhlen
Germany
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