Encarlev 200

Introduction
Encarlev 200 is a prescription medicine used in the treatment of Parkinson’s disease. This medicine helps to reduce excessive shaking by slowing down the body movements. It works by increasing the amount of chemical messenger that is needed to control abnormal movements. Encarlev 200 is taken with or without food, but better to avoid high protein meal and dairy products. However, it is advised to take it at the same time each day as this helps to maintain a consistent level of medicine in the body. Take this medicine in the dose and duration advised by your doctor and if you have missed a dose, take it as soon as you remember. You should never skip any doses and try to finish the full course of treatment even if you feel better. It is important that this medication is not stopped suddenly without talking to the doctor as it can result in harmful effects. This medicine may cause side effects like nausea, vomiting, constipation, discoloration of urine, and dryness in the mouth. It causes a sudden onset of dizziness and sleepiness, so do not drive or do anything that requires mental focus until you know how this medicine affects you. It is common to have diarrhea with this medicine, so drink plenty of fluids and watch for weight loss. Take caution while taking medicine if you are suffering from liver or kidney disease. Your doctor should also know about all other medicines you are taking as many of these may make this medicine less effective or change the way it works. Inform your doctor if you are pregnant, planning pregnancy or breastfeeding.

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Uses of Encarlev 200
Parkinson's disease
Side effects of Encarlev 200
Common
Nausea
Vomiting
Constipation
Urine discoloration
Headache
Dryness in mouth
Insomnia (difficulty in sleeping)
Orthostatic hypotension (sudden lowering of blood pressure on standing)
Anxiety
Dizziness
Abnormality of voluntary movements
Abnormal dreams
How to use Encarlev 200
Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Encarlev 200 may be taken with or without food, but it is better to take it at a fixed time. Avoid Encarlev 200 with high protein meals such as cottage cheese, Swiss cheese, protein powder, eggs and milk.
How Encarlev 200 works
Encarlev 200 is a combination of three medicines: Levodopa, Carbidopa and Entacapone which treat Parkinsonism. Levodopa is a Carbidopa precursor which gets converted to dopamine, a chemical messenger that controls movement in the brain. Carbidopa is a peripheral decarboxylase inhibitor which prevents the breakdown of Levodopa allowing it to enter the brain and increase dopamine levels. Entacapone is COMT inhibitor which causes higher and more sustained levels of levodopa in blood, leading to greater relief from the symptoms of Parkinson’s disease.
Quick Tips
You have been prescribed Encarlev 200 to treat your symptoms of parkinson’s disease.
Avoid a high-protein diet (eg.meat, poultry, and dairy products) while you are taking this medicine as that can reduce the amount of medication absorbed by your body.
It may cause dizziness or sleepiness. Don’t drive or do anything requiring concentration until you know how it affects you.
To lower the chance of feeling dizzy or passing out, rise slowly if you have been sitting or lying down.
Do not stop taking the medication suddenly without talking to your doctor. It may result in a serious syndrome that causes fever, stiff muscles, unusual body movements, sweating and confusion.
Talk to your doctor in case you develop hallucinations or notice other changes in your behavior.
Brief Description
Indication
Parkinson’s disease and ‘end of dose’ motor fluctuations
Administration
May be taken with or without food. Keep a consistent diet. A change in diet to foods high in protein may delay levodopa absorption & reduce amount taken up in circulation. Excessive acidity also delays stomach emptying & thus delays levodopa absorption. Fe salts (eg in multivit prep) may also reduce amount of levodopa available to the body. Swallow whole.

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Adult Dose
Parkinson’s disease Adult: PO: Each tab contains levodopa and carbidopa in a ratio of 4:1 and entacapone 200 mg: Initial: 1 tab/day. Titrate dose according to patient’s response. Recommended to take only 1 tab per dose administration. Max: 8 tabs/day. Hepatic impairment: Severe: Contraindicated.

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Child Dose
Safety & efficacy not established

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Contraindication
Hypersensitivity. Narrow angle glaucoma. Should not be used in patients with suspicious, undiagnosed skin lesions or a history ot melanoma.
Mode of Action
Levodopa is the metabolic precurosor of dopamine, it crosses the blood-brain barrier and is converted to dopamine in the brain. Carbidopa increases the amount of levodopa that is transported into the CNS by inhibiting the decarboxylation of peripheral levodopa. Entacapone is a selective inhibitor of catechol-o-methyltransferase. Given concurrently, entacapone results in greater and more substained plasma levels of levodopa, leading to greater control of parkinsonism symptoms.
Precaution
Periodic monitoring of hepatic, renal, haematopoietic and CV functions in patients on prolonged therapy. Monitor for changes in IOP in patients with chronic wide-angle glaucoma. Caution when used in patients with biliary obstruction. Caution when interpreting plasma and urine levels of catecholamines and their metabolites. Withdrawal should be gradual. Lactation: not known if excreted in breast milk; use caution

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Side Effect
>10% Entacapone Dyskinesia (25%),Nausea (14%),Diarrhea (10%),Hyperkinesia (10%),Urine discoloration (10%) 1-10% Entacapone Hypokinesia (9%), dizziness (8%), Fatigue (6%), hallucinations (1-4%), anxiety (2%), somnolence (2%), asthenia (2%), agitation (1%),Increased sweating (2%),Purpura (2%),Abdominal pain (8%), constipation (6%), vomiting (4%), dry mouth (3%), dyspepsia (2%), flatulence (2%), taste perversion (1%), gastritis (1%),Back pain (4%),Dyspnea (3%),Bacterial infection (1%) Frequency Not Defined Levodopa/Carbodopa Edema,Agitation, anxiety, ataxia, bruxism, confusion, daytime somnolence decreased attention span, dyskinesia, dystonia, euphoria, insomnia, fainting, fatigue, increased trembling of hands, insouciance, malaise, memory loss, nightmares, nervousness, restlessness, trismus, vivid dreams,Alopecia, hot flushes, increased &/or dark perspiration, skin eruptions,Abdominal pain & discomfort, burning feeling in tongue, constipation, diarrhea, dysgeusia, dry mouth, dysphagia, hiccups, meteorism, sialorrhea, nausea, weight loss,Muscular spasms, muscular cramp,Hematuria, dark urine, incontinence, priapism, urine retention,Blurred vision, diplopia, dilated pupil, oculogyric problems. Entacapone Postural hypotension,Insomnia,Confusion Potentially Fatal: Rhabdomyolysis.

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Pregnancy Category Note
Pregnancy Category: C Lactation: not known if excreted in breast milk; use caution

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Interaction
Increased risk of postural hypotension when used concurrently with hypotensive drugs. Severe orthostatic hypotension may result from concurrent usage with MAOIs. Dopamine D2 receptor antagonists, phenytoin or papaverine may reduce the efficacy of levodopa. Iron salts may reduce the bioavailability. Concurrent usage with drugs that interfere with biliary excretion may lead to increased plasma levels of entacapone. May depress prolactin secretion and increase growth hormone levels.