## Breadcrumb - [Home](/) - [Living with Parkinson's](/living-with-parkinsons) - [Treatment](/living-with-parkinsons/treatment) - [Prescription Medications](/living-with-parkinsons/treatment/prescription-medications) ## Breadcrumb - [Home](/) - [Living with Parkinson's](/living-with-parkinsons) - [Treatment](/living-with-parkinsons/treatment) - [Prescription Medications](/living-with-parkinsons/treatment/prescription-medications) # Levodopa ## 💡 Quick Summary - Levodopa, most often combined with carbidopa as Sinemet, is the most effective treatment for Parkinson’s disease [movement symptoms.](/understanding-parkinsons/movement-symptoms "Movement Symptoms") - It works by converting to dopamine in the brain and is available in several forms, including tablets, capsules, pump medications and inhalers. - Side effects like nausea or dizziness can usually be managed through gradual dosing, [timing with meals](/living-with-parkinsons/management/activities-daily-living/eating "Mealtime & Dining Out "), or adding [medications](/living-with-parkinsons/treatment/prescription-medications "Prescription Medications"). - Carbidopa-levodopa can cause some people to experience extra, involuntary movements (known as [dyskinesias](/understanding-parkinsons/movement-symptoms/dyskinesia "Dyskinesia")) or more irregular ["on-off" periods](/library/fact-sheets/managing-off-time "Managing "Off" Time in Parkinson's") (known as motor fluctuations). ![Woman looking at pill bottle](/sites/default/files/styles/no_sizing/public/images/levodopa.jpg?itok=PbN9dMaL) The most potent medication for Parkinson’s disease (PD) is levodopa. Its development in the late 1960s represents one of the most important breakthroughs in the history of medicine. Levodopa alone can produce nausea and vomiting, but when combined with carbidopa this side effect is significantly lessened if not eliminated. The well-known combined carbidopa-levodopa name brand formulation is called Sinemet. Many patients and providers will use carbidopa-levodopa and Sinemet synonymously. ## Quick Facts - Levodopa is often viewed as the first-line drug for the management of Parkinson's movement symptoms. - Levodopa (in pill form) is absorbed in the blood from the small intestine and travels through the blood to the brain, where it is converted into dopamine. - Levodopa is almost always given in combination with the drug carbidopa, which reduces or prevents the nausea that levodopa alone can cause. - Carbidopa-levodopa is delivered in many forms, including immediate release, controlled release, or extended release. In addition to pills and capsules, levodopa is also available through pumps that deliver medication either under the skin or directly into the small intestine and as an inhaled powder. ### Be Prepared The [Hospital Safety Guide](/resources-support/hospital-safety-guide "Hospital Safety Guide") is a resource for people with Parkinson's and their care partners filled with useful tools and information to prepare for and navigate a hospital stay. [Order Now](/resources-support/pd-library/order-publications) ## Forms of Levodopa Taking the right medication on time every time is critical to Parkinson’s symptom management. Due to various strengths and sizes, it is important that people with PD are aware which carbidopa-levodopa preparation they are taking. Be careful when renewing prescriptions at the pharmacy or when receiving medications in the hospital because the accidental substitution of a different formulation may lead to an under or over dose. - ### Carbidopa-levodopa Immediate-release Tablets (Sinemet) **Available Doses:** 10-100 mg, 25-100 mg, 25-250 mg **Typical Treatment Regimen**: 150 to 2,000 mg of levodopa total per day (divided 3 to 4 times) **Common Side Effects**: nausea, lower blood pressure, confusion, hallucinations, [dyskinesia](/understanding-parkinsons/movement-symptoms/dyskinesia "Dyskinesia") (extra movements) **Indications for Usage**: Monotherapy (alone) or combination therapy for slowness, stiffness, and tremor - ### Carbidopa-levodopa Controlled-release Tablets (Sinemet CR\*) *\*Sinemet CR is no longer being produced, but the generic forms continue to be available.* **Available Doses:** 25-100 mg, 50-200 mg **Typical Treatment Regimen**: 400 to 2,400 mg of levodopa in divided doses, depending on daily need **Common Side Effects**: nausea, lower blood pressure, confusion, hallucinations, dyskinesia (extra movements) **Indications for Usage**: Monotherapy or combination therapy for slowness, stiffness and tremor - ### Carbidopa-levodopa Enteral Suspension (Duopa) *This form of carbidopa-levodopa is delivered through a surgically implanted tube in the small intestine, rather than a pill. Following surgery, this delivery method increases “on” time (when you have* [*good symptom control*](/library/fact-sheets/managing-off-time "Managing "Off" Time in Parkinson's") *and can move and function well) without troublesome, involuntary* dyskinesia *movements.* **Available Doses:** 4.63/20 per mL **Typical Treatment Regimen**: Up to 2,000 mg of levodopa over 16 hours **Common Side Effects**: nausea, lower blood pressure, confusion, hallucinations, dyskinesia (extra movements) **Indications for Usage:** For the treatment of motor fluctuations in people with [advanced Parkinson’s disease](/understanding-parkinsons/what-is-parkinsons/stages "Stages of Parkinson's") - ### Carbidopa-levodopa Extended-release (ER) Capsules (Crexont) *This form of carbidopa/levodopa contains both immediate-release granules and extended-release pellets designed to gradually release in the small intestine. This can improve “on” time while requiring fewer medication doses. Carbidopa/levodopa ER capsules are not interchangeable with other carbidopa/levodopa medications in the same amounts.* **Available Doses:** 35 mg/140 mg, 52.5 mg/210 mg, 70 mg/280 mg, 87.5 mg/350 mg **Typical Treatment:** 560 to 2,100 mg of levodopa divided, depending on daily need. Maximum of 4 doses per day. Do not chew or crush. **Common Side Effects:** nausea, anxiety, dizziness, dyskinesia (extra, involuntary movements) **Indications for Usage:** Can be used alone (monotherapy) or with another medication (adjunct therapy) for slowness, stiffness and tremor. - ### Carbidopa-levodopa Extended-release (ER) Capsules (Rytary) *This form of carbidopa-levodopa contains beads of both medications that dissolve and are absorbed at different rates. This can improve* “on” time *while requiring fewer medication doses. Dosages of carbidopa-levodopa ER capsules are not interchangeable with dosages of other carbidopa-levodopa products.* **Available Doses:** 23.75-95 mg, 36.25-145 mg, 48.75-195 mg, 61.25-245 mg **Typical Treatment Regimen**: 855 to 2,340 mg of levodopa in divided doses, depending on daily need **Common Side Effects**: nausea, lower blood pressure, confusion, hallucinations, dyskinesia (extra movements) **Indications for Usage**: Monotherapy or adjunct therapy for slowness, stiffness and tremor - ### Carbidopa-levodopa-entacapone Tablets (Stalevo) *This is a combination drug which includes entacapone and carbidopa-levodopa in one pill. It is more convenient compared with carbidopa-levodopa and entacapone taken separately.* **Available Doses:** 12.5-50-200 mg, 18.75-75-200 mg, 25-100-200 mg, 31.25-125-200 mg, 37.5-150-200 mg, 50-200-200 mg **Typical Treatment Regimen**: 150 to 1,200 mg of levodopa total daily dose, depending on daily need (maximum 8 tablets daily) **Common Side Effects**: nausea, lower blood pressure, confusion, hallucinations, dyskinesia (extra, involuntary movements), diarrhea, and discolored urine **Indications for Usage**: Replacement for carbidopa-levodopa for motor fluctuations, with the benefit of entacapone, which extends the life of levodopa - ### Levodopa Inhalation Powder (Inbrija) *This is an inhaled form of levodopa most commonly used for early morning OFFs or sudden OFFs, giving a low but quicker acting boost of dopamine. This is often in addition to a more stable regimen.* **Available Doses:** 42mg **Typical Treatment Regimen**: 42 to 84mg (1 to 2 capsules) up to 5 times per day **Common Side Effects**: cough, dyskinesia (extra, involuntary movements) **Indications for Usage**: Used for early morning OFFs or Sudden OFFs - ### Foscarbidopa and foslevodopa (Vyalev) for subcutaneous infusion *This form of levodopa is delivered continuously under the skin (subcutaneous) through a small pump, typically in the belly area.* **Available Doses:** 120 mg foscarbidopa and 2,400 mg of foslevodopa per 10 mL **Typical Treatment:** The dose is individualized for each person, typically providing up to 3,525 mg of foslevodopa (equivalent to approximately 2,500 mg levodopa) over a 16-hour period (waking hours) or 24-hour period. **Most Common Side Effects:** hallucinations, dyskinesia (extra, involuntary movements), site irritation or infection, nausea, vomiting, orthostatic hypotension (drop in blood pressure upon standing), confusion. **Indications for Usage:** Indicated for the treatment of movement (motor) fluctuations in people with advanced Parkinson’s disease, particularly during "off" periods when symptoms worsen. **Special note:** VYALEV was approved by the FDA on October 17, 2024. Medicare coverage is expected in the second half of 2025. **Common levodopa side effects include:** - Nausea - Vomiting - Loss of appetite - Lightheadedness - Lowered blood pressure - Confusion - Dyskinesia (extra movements) - Hallucinations - Sleepiness or sudden-onset sleep (uncommon) - Impulsivity (uncommon) Side effects can be minimized with a low starting dose when initiating treatment with any antiparkinsonian drug and increasing the dose slowly to a satisfactory level. This is particularly helpful in elderly people with Parkinson's whose tolerance for medications is often less than in younger persons. Taking drugs with meals can also reduce the frequency and intensity of gastrointestinal side effects, although some may find less benefit if taken with a high protein meal. For people who have persistent nausea or vomiting, adding extra carbidopa (Lodosyn) to each dose of carbidopa-levodopa can also help. **Rare but serious:** Seizures linked to low vitamin B6 (pyridoxine) levels have been reported, especially at higher doses of carbidopa-levodopa. Other rare side effects can occur. Ask your doctor to help you understand your risk. ## Nutrition and Levodopa/Sinemet Most people have no problem taking medications with meals, but some experience less benefit if they take carbidopa-levodopa with a high protein meal (including meats, cheeses and other dairy products). When this occurs, it is recommended to only take carbidopa-levodopa along with non-protein foods or similarly 30 minutes before, or 60 minutes after eating a meal. This allows for quick absorption before food can interfere. The absorption of levodopa may also be reduced when taken with iron supplements. ### Nutrition Explore our [**Diet & Nutrition**](/living-with-parkinsons/management/diet-nutrition "Diet & Nutrition") page to learn how the right foods can optimize your medications. [Learn More](/living-with-parkinsons/management/diet-nutrition) ## Managing Nausea Caused by Levodopa/Sinemet Ginger tea is a good choice for many people, because it often “settles the stomach”. A graham or soda cracker along with ginger tea may help and are low in protein so should not interfere with the absorption of carbidopa-levodopa If you cannot tolerate carbidopa-levodopa because of nausea or upset stomach, you may need to take it with food. Visit our [**Constipation & Nausea**](/understanding-parkinsons/non-movement-symptoms/constipation "Constipation & Nausea") page for more tips to tackle common Parkinson's digestion changes. ## Delaying Use of Carbidopa-Levodopa Levodopa may be extremely beneficial to those with Parkinson’s and can dramatically improve quality of life. Some people with PD have been reluctant to rely on carbidopa-levodopa, believing it to be a last resort. However, most neurologists agree that delaying treatment too long is unwise, and the Parkinson’s Foundation [**Parkinson’s Outcomes Project**](/advancing-research/our-research/parkinsons-outcomes-project "Parkinson’s Outcomes Project") reports utilizing levodopa more than any other drug for Parkinson’s therapy. There is no reliable data that levodopa contributes to faster disease progression or produces damage to brain cells. The decision about when to start carbidopa-levodopa is different for every person with Parkinson’s and requires consideration of potential benefits, risks, and the availability of alternatives. Some people living with PD may experience extra, involuntary movements – known as [dyskinesias](/understanding-parkinsons/movement-symptoms/dyskinesia "Dyskinesia") – or more irregular ["on-off" periods](/library/fact-sheets/managing-off-time "Managing "Off" Time in Parkinson's") – known as motor fluctuations - when exposed to carbidopa-levodopa. These can be limiting and require adjustment in therapy. - ### Disclaimers Please note that the side effects listed in the tables that accompany each class of medication are the most *commonly experienced*. Not all individuals will experience such side effects. Careful adjustments to dosage or the timing of individual doses can often effectively limit or eliminate side effects for many people. Speak to your doctor immediately if you experience any side effects. For a complete description of each drug and its possible side effects, please request a “package insert” from your pharmacist for each drug used. **It is recommended that all prescriptions be filled at the same pharmacy to avoid interactions between medications.** Interactions can be dangerous and even life-threatening, so make sure the pharmacist knows of all medications and supplements being taken, including over-the-counter medications and supplements. **Caution:** Parkinson’s medications may have interactions with certain foods, other medications, vitamins, herbal supplements, over-the-counter cold pills and other remedies. Anyone taking a PD medication should talk to their doctor and pharmacist about potential drug interactions. *Page reviewed by Dr. Chauncey Spears, Clinical Assistant Professor and Dr. Amelia Heston, Movement Disorders Fellow at the University of Michigan.* ## Related Materials Podcasts ### [ Episode 6: New Levodopa Delivery Methods for Parkinson’s ](/library/podcast/6) [Listen Now](/library/podcast/6) Fact Sheets ### [ Medications for Movement Symptoms ](/library/fact-sheets/medications-movement-symptoms) [Read Now](/library/fact-sheets/medications-movement-symptoms) Books ### [ Medications: A Treatment Guide to Parkinson’s Disease ](/library/books/medications) [Read Now](/library/books/medications) ## Related Blog Posts ![Woman holding a pill](/sites/default/files/styles/500x360/public/images/shortageplan-bloghero.png?h=ed9ce7df&itok=R7_m9rO0) Raise Awareness ### [ What’s Hot: What should I do if there is a Sinemet (Carbidopa/Levodopa) shortage? ](/blog/research/sinemet-shortage) READ NOW ![lots of pill boxes](/sites/default/files/styles/500x360/public/images/newdruglevo-blogprev.png?h=ed9ce7df&itok=Kjr_vxcZ) Science News ### [ New Drug Shows Promise for Levodopa-Induced Dyskinesia ](/blog/science-news/new-drug-dyskinesia) READ NOW ![giving medications to older man](/sites/default/files/styles/500x360/public/images/medicationadvancingtreatment-blog.jpg?h=f2fcf546&itok=_oFS4UXr) Advancing Research ### [ PD and Medication: Advancing Treatment ](/blog/research/medication-treatment) READ NOW ### Order a Parkinson’s Hospital Safety Guide The Hospital Safety Guide is a resource for people with Parkinson's and their care partners filled with useful tools and information to prepare for and navigate a hospital stay. 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