What is the LIMIT when prescribing carbidopa levodopa?

Daily limit:

Dr. Fahn - 2,000mg

Mayo Clinic - no designated limit

My current neurologist - 700 mg

What high dose is working for you? 1,400mg daily? 2,000mg daily? What?

[Astra7]

My neurologist says there is no limit.I’m on 600mg a day after 5 years. He has people on 2000mg.

He never mentions anything other than prescription meds.

[Hidden in reply to Astra7]

After nine years I feel I should be on 800, 1,000, 1,400

[laglag]

You may have read a previous reply I made approximately a month ago, but I was on 1400 to 1600 a couple of years ago and it about did me in. Long story short, it about did me in. I was under a lot of stress with my dad being ill & I was his only caregiver for several years. I was on 400-500 mg for several years. My neurologist was on pregnancy leave so another neuro told the nurse to tell me I could double my meds. I did that & ended up taking them at my night, then doubling those because of the stress I was going thru. I started having really bad dyskinsea. Went to a different neur & had to cut back to 800 - 900 mg, now I'm back to 600 - 700. That was the worst time of my life. It was similar to a drug addict would go thru. I had shakes and horrible movements, I didn't want to go anywhere, see anyone, and very rarely got out of bed except shower. Lost 18 pds. My husband had to drag me to the doctor. I couldn't take my meds early. 5 minutes seemed like an hour. It took 6 months to get back, so I would say there is a limit.

[condor39]

I have been on 1,900 mg of levodopa a day for a year, with no side effects ,I weigh 205 lbs.

But I am on Prolopa (Canadian version of Madopar) You asked about carbidopa levodopa.

No supplements at all.

[park_bear]

There is also a maximum recommended dose of carbidopa of 200 mg/day. More than that can cause orthostatic hypotension. See here for details:

cambridge.org/core/journals...

There is a carbidopa levodopa formulation of 10/100 available if one has to take a lot of levodopa.

[yondunzX6317]

my neuro says i should NOT take more than 4 tabs of 250mg per day........

[Hidden in reply to yondunzX6317]

Dose with what brings comfort

[Hidden]

Carbidopa levodopa, tremor and blood pressure.7.. THERE IS NO REASON TO RESTRICT LEVODOPA DOSAGE: USE WHAT WORKS BEST

When initiating carbidopa/levodopa in PD, it is conventionally administered 3 times daily and specifically 1 or more hours before meals. Using the 25/100 immediate-release formulation of carbidopa/levodopa, it is typically begun with a dose of one-half to 1 tablet 3 times daily.

The treatment goal is to capture the best levodopa response, and specifically the dose that allows the patient to be active and fully life-engaged, including exercise. With that in mind, carbidopa/levodopa can be increased weekly by half-tablet increments of all doses. The goal, as the doses are increased, is reversal of parkinsonism, sufficient to allow patients to function as normally as possible in all aspects of their life. The point of diminishing returns with dose increments is 2.5 tablets each dose for most PD patients; however, occasional patients require 3 tablets each dose for the best effect (provided that the 25/100 formulation is taken on an empty stomach). In other words, higher individual doses, such as 4 to 5 tablets at a time, provide no incremental improvement. Restated, the optimum individual dose is between 1 and 3 tablets and in early PD is taken 3 times daily.

It is reasonable to allow the newly treated PD patient to increase the dose to 3 tablets 3 times daily and then decide which dose works best. If several doses are equally beneficial, the lowest of those equipotent doses can be maintained. A standard dose escalation scheme is:

25/100 immediate-release tablets

Start with the low dose and increase weekly, guided by your response. If a dose markedly improves your parkinsonian symptoms (walking difficulties, tremor, slowness, stiffness, etc.), you can continue taking that dose. Otherwise continue to escalate, up to 2½ to 3 tablets each dose. Ultimately, if several doses are equally beneficial, choose to continue taking the lowest of those equally effective doses.

Week 1. Start with one tablet three times per day.

Week 2. Increase to 1½ tablets three times per day.

Week 3. If not markedly improved, increase to 2 tablets three times per day.

Week 4. If necessary, increase again to 2½ tablets three times per day. For most, this dose is at the point of diminishing returns.

Option, Week 5. If there is not substantial improvement on the above dosage, you can try 1 more increment to 3 tablets three times per day.

Again, if several doses produce the same degree of benefit, settle on the lowest of these.

For patients with no improvement with any of the doses: You can reverse this process, decreasing your dosage every few days down to zero, or whatever dose seems to be providing benefit.

Follow-up is appropriate, typically about 6 to 8 weeks after initiating carbidopa/levodopa, to identify the maintenance dose and address any adverse effects.

Notably, some PD symptoms respond to carbidopa/levodopa in an “all-or-none” fashion. For example, rest tremor may not resolve with the lower doses on this schedule but may be controlled as higher doses are taken. Hence, patients should not become discouraged and abandon the scheme if the initial doses are not effective.

Parkinson disease is associated with variable degrees of dysautonomia, and hence there is potential for orthostatic hypotension. This may be primed by drugs already on patients' medication lists, such as antihypertensives, α1 blockers for prostatism (eg, tamsulosin), or diuretics. Obtain the standing blood pressure before starting carbidopa/levodopa, and if it is less than 100 mm Hg systolic, defer starting the drug until this is addressed. Patients with initially low-normal blood pressure should be advised to monitor their pressure as carbidopa/levodopa doses are increased; systolic values should be maintained above 90 mm Hg.

[Hidden in reply to Hidden]

-Dose and dosing interval may be increased or decreased at intervals of at least 3 days based on therapeutic response

-Dose range: Most patients will require levodopa 400 to 1600 mg/day in divided doses every 4 to 8 hours during waking hours; doses of 2400 mg/day at intervals of less than 4 hours have been used, but are generally not recommended.

[Hidden in reply to Hidden]

There is also a maximum recommended dose of carbidopa of 200 mg/day. More than that can cause orthostatic hypotension. See here for details:

cambridge.org/core/journals...

There is a carbidopa levodopa formulation of 10/100 available if one has to take a lot of levodopa.