Triple fixed-dose combination: dopamine precursor, peripheral decarboxylase inhibitor, and COMT inhibitor
ATC code: N04BA03 (Levodopa, decarboxylase inhibitor and COMT inhibitor)
Levodopa crosses the blood-brain barrier and is converted to dopamine in the substantia nigra and striatum, replenishing the dopamine deficit in Parkinson's. Carbidopa inhibits peripheral decarboxylase – more levodopa reaches the brain and dose-related nausea decreases. Entacapone reversibly inhibits peripheral catechol-O-methyltransferase (COMT) – prolongs levodopa T½ and reduces wearing-off. The triple combination smooths dopamine fluctuations in advanced disease.
Second line
Parkinson's disease in patients with wearing-off on levodopa-carbidopa therapy. Per MDS 2018 and SEN 2024, the triple combination is second-line for motor fluctuations. Dose: individualized, based on prior levodopa dose; standard tablets 50/12.5/200, 75/18.75/200, 100/25/200, 125/31.25/200, 150/37.5/200, 200/50/200 mg 4-10 times daily depending on regimen. Not first-line in levodopa-naïve patients.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Use when clearly needed. Parkinson's in young women is rare; decisions on continuation are made with neurology and obstetrics.
Suppresses lactation by lowering prolactin. Hale L4. If therapy continues, switch to formula feeding.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Levodopa + Carbidopa + Entacapone is evaluated for the following indications with varying evidence strength: Parkinson's disease (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of Levodopa + Carbidopa + Entacapone (≥ 1 in 100): Dyskinesias (with long-term use), Nausea, vomiting, Orthostatic hypotension, Daytime sleepiness and sleep attacks, Orange urine and sweat, Dry mouth. See the Safety section for uncommon and serious reactions.
FDA category C. Use when clearly needed. Parkinson's in young women is rare; decisions on continuation are made with neurology and obstetrics.
Suppresses lactation by lowering prolactin. Hale L4. If therapy continues, switch to formula feeding.
Levodopa + Carbidopa + Entacapone is contraindicated in: Hypersensitivity; Angle-closure glaucoma; Pheochromocytoma; Severe hepatic impairment; History of neuroleptic malignant syndrome or nontraumatic rhabdomyolysis. Full list in the Safety section.