Carbidopa levodopa (Sinemet) is a combination medication used most commonly in the treatment of Parkinson's disease. Sinemet is also prescribed for Parkinson-like complications resulting from carbon monoxide or manganese intoxication. The majority of side effects from this medication affect the central nervous system and result in abnormal physical movements. Serious side effects also affect blood chemistry and the liver. Patients should also be monitored for possible psychological side effects.
Kinetic Side Effects
Although carbidopa levodopa is designed to reduce the movements and tremors most associated with Parkinson's disease, several movement, or kinetic, side effects have been noted in patients taking this drug. The PDR Nurse's Drug Handbook reports that involuntary "dancing" or writhing movement (choreic), prolonged muscular contractions that cause torsion of body parts (dystonia), twitching or spasming (myoclonic), defective muscular coordination (ataxia) and tongue protruding, grimacing, lip smacking and puckering (collectively, dyskinetic) are the most common kinetic side effects with carbidopa levodopa therapy. These side effects should be reported to a physician as a medication adjustment may be warranted.
Muscles twitching and eye pain or spasms may indicate early signs of drug overload or overdose and should be reported immediately to a health care provider.
Blood Chemistry Concerns
Low platelet levels (thrombocytopenia) resulting in the inability to form blood clots when cuts or abrasions occur, a reduction in the number of white blood cells (leukopenia) which lowers resistance to infection, and a decrease in the number of white blood cells specific to the bone marrow (agranulocytosis) are the most serious side effects possible with carbidopa levodopa therapy. Patients should be cautioned that an increase in clotting time is to be expected should they experience a break in the skin, and that they must guard against infection by using universal precautions such as proper hand washing and avoiding those who are ill while taking this medication.
Liver Toxicity Possibilities
Hepatoxicity may result from taking carbidopa levodopa. Patients may notice a yellowing of the eyes or skin (jaundice), an overall feeling of malaise or lethargy, fever, nausea, vomiting and loss of appetite. These symptoms should be reported to a physician as liver damage may occur.
Psychological Events
An increase in suicidal ideation is the most serious psychological side effect. Families should closely monitor the patient for severe depression, anxiety and withdrawal. These symptoms should be reported immediately to the patient's physician. Patients may also experience disturbing dreams, euphoria, dementia, hallucinations, confusion, insomnia and agitation. These latter symptoms may dissipate as therapeutic levels of the drug are reached.
References
- "PDR Nurse's Drug Handbook 2010;" Thomson Reuters and Alexander Ivy; 2009
- "Mosby's 2010 Nursing Drug Reference;" Linda Skidmore-Roth; 2009
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