Twindopa 110 Tabletcontains a combination of two active ingredients:  

• Levodopa BP 100 mg
• Carbidopa BP 10 mg  

It is manufactured by Incepta Pharmaceuticals Ltd.  

Indications:

Twindopa is indicated for the treatment of the symptoms of:

• Idiopathic Parkinson's disease.
• Post-encephalitic parkinsonism.  
• Symptomatic parkinsonism which may follow injury to the nervous system by carbon monoxide intoxicationand/or manganese intoxication.  

It is useful in relieving many of the symptoms of parkinsonism, particularly rigidity and bradykinesia. It may also help with tremor, dysphagia, sialorrhea, and postural instability associated with Parkinson's disease and syndrome. Levodopa plus carbidopa before physiotherapymay increase motor recovery after stroke.  

Pharmacology:

Levodopa is the metabolic precursor of dopamine and crosses the blood-brain barrier, where it is converted to dopamine.Dopamine is deficient in the brains of patients with Parkinson's disease.Carbidopa inhibits the peripheral decarboxylation of levodopa, meaning more levodopa reaches the brain.  

Dosage and Administration:

Dosage should be individualized.

• For patients not currently receiving levodopa: The usual starting dose is one tablet of Twindopa 110 three or four times a day. The dosage may be increased by one tablet every day or every other day until a total of eight tablets (two tablets four times a day) is reached.  
• For patients transferring from levodopa: Levodopa must be discontinued at least 12 hours before starting Twindopa. The initial daily dose of Twindopa should provide approximately 25% of the previous levodopa dosage.

Side Effects:

The most common adverse reactions with Levodopa & Carbidopa are:

• Nausea  
• Choreiform dystonia and other involuntary movements

Other significant reactions can include:

• Convulsions
• Dementia and mental changes (including paranoid ideation, psychotic episodes, and depression with or without suicidal tendencies)  
• Dizziness  
• Sleepiness  
• Headache  
• Abnormal dreams  
• Anxiety  
• Insomnia  
• Abnormality of voluntary movements  
• Orthostatic hypotension(sudden lowering of blood pressure on standing)  

Precautions:

• Twindopa should be administered cautiously to patients with severe cardiovascular or pulmonary disease, bronchial asthma, renal, hepatic, or endocrine disease.  
• It should be used with caution in patients with a history of peptic ulcer disease or convulsions.  
• Levodopa alone, as well as combination products, is associated with dyskinesias, which may require dosage reduction.
• Monitor patients for depression with or without suicidal tendencies.  

Contraindications:

• Nonselective monoamine oxidase (MAO) inhibitors are contraindicated for use with Levodopa and carbidopa and must be discontinued at least two weeks prior to initiating therapy. 
• Hypersensitivity to any component of the drug.
• Narrow-angle glaucoma.  
• Suspicious undiagnosed skin lesion or a history of melanoma.

Drug Interactions:

• Pyridoxine (vitamin B6) reverses the effects of levodopa.
• Type B MAOIsmay have a synergistic effect.  
• The effect of levodopa may be reduced by phenothiazines, haloperidol, reserpine, pyridoxine, diazepam, oxazepam, chlordiazepoxide, and phenobarbitone.
• The effects of levodopa may be enhanced by carbidopa, amantadine, anticholinergics, and amphetamine.
• The effects of sympathomimetic agents may be enhanced.  
• Symptomatic postural hypotension may occur when Carbidopa-Levodopa is added to the treatment of patients receiving antihypertensive medications; dosage adjustment of the antihypertensive drug may be required.  
• There have been rare reports of adverse reactions, including hypertension and dyskinesias, resulting from the concomitant use of tricyclic antidepressants and Carbidopa-Levodopa. 
• Studies show a decrease in the bioavailability of Carbidopa and/or Levodopa when ingested with ferrous sulfate or ferrous gluconate.  
• Dopamine-2 receptor antagonists (e.g., phenothiazines, butyrophenones, and risperidone) and isoniazid maydecrease the therapeutic effects of Levodopa.  
• The beneficial effects of Levodopa in Parkinson's disease have been reported to be reversed by phenytoin and papaverine.  

Pregnancy and Lactation:

• Pregnancy Category C:Use of Carbidopa-Levodopa in women of childbearing potential requires that the anticipated benefits of the drug be weighed against possiblerisks should pregnancy occur.  
• Levodopa has been detected in human milk. Caution should be exercised when administered to a nursing woman. 

Storage:

Store as directed on the product packaging, usually in a cool, dry place away from light and moisture. Keep out of reach of children.

Important Note: This information is for general knowledge and informational purposes only and does not substitute professional medical advice. Always consult your doctor or pharmacist for specific instructions and guidance regarding your medication. They can assess your individual medical condition and provide the most appropriate advice.