Generic Stalevo (Carbidopa/Entacapone/Entacapone)

Introduction

Stalevo is an oral fixed-dose combination used to treat the motor symptoms of Parkinson’s disease in adults. Each tablet contains the three active ingredients carbidopa, levodopa and entacapone, delivered in the strengths 25 mg/100 mg/200 mg respectively. The medication belongs to the class of dopaminergic agents that increase central dopamine levels while limiting peripheral metabolism. Stalevo is manufactured by Novartis (as the branded product) and is also available as a generic formulation. In addition to its approved use for Parkinson’s disease, clinicians sometimes consider it for off-label situations such as motor fluctuations in advanced therapy, though such use is not formally approved by regulatory agencies.

What is Stalevo?

Stalevo is a fixed-ratio tablet that combines three pharmacologically active compounds:

• Levodopa - a dopamine precursor that crosses the blood-brain barrier and is converted to dopamine in the central nervous system.
• Carbidopa - an inhibitor of aromatic L-amino-acid decarboxylase (AADC) that prevents peripheral conversion of levodopa to dopamine, thereby increasing the amount of levodopa that reaches the brain and reducing peripheral side effects such as nausea.
• Entacapone - a reversible inhibitor of catechol-O-methyltransferase (COMT) that slows the breakdown of levodopa in the periphery, prolonging its plasma half-life.

The combination is marketed under the brand name Stalevo and also sold as a generic tablet containing the same three active substances. Our online pharmacy provides this generic alternative as a cost-effective treatment option for patients who need reliable dopamine replacement therapy.

How Stalevo Works

Levodopa is absorbed from the small intestine and, after transport across the blood-brain barrier, is decarboxylated to dopamine, restoring deficient dopaminergic transmission in the basal ganglia. Carbidopa, which does not cross the blood-brain barrier, blocks peripheral AADC, reducing the conversion of levodopa to dopamine outside the central nervous system. This results in higher, more predictable levodopa concentrations reaching the brain and a lower incidence of gastrointestinal adverse effects.

Entacapone inhibits COMT, an enzyme responsible for metabolizing levodopa to 3-O-methyldopa in the periphery. By preventing this pathway, entacapone extends levodopa’s plasma half-life from approximately 1-2 hours to 4-5 hours, smoothing plasma peaks and troughs and reducing “off” periods (times when motor symptoms reappear).

The combined effect is a more stable and efficient delivery of dopamine to the brain, which translates into improved motor control for patients with Parkinson’s disease.

Conditions Treated with Stalevo

Parkinson’s disease (PD) - motor fluctuations Approved indication: Adjunctive therapy to levodopa in adult patients experiencing “wearing-off” phenomena, where the effect of a levodopa dose diminishes before the next dose is due. Stalevo’s COMT inhibition provides longer levodopa exposure, decreasing the frequency and severity of these fluctuations.

The medication is not indicated for non-motor symptoms of PD, for pediatric use, or for other neurological disorders.

Off-Label and Investigational Uses of Stalevo

• Management of dyskinesias in advanced PD - Small open-label studies have reported that adding entacapone to levodopa/carbidopa may reduce levodopa-induced dyskinesias by allowing lower levodopa dosing frequencies. These findings are not yet supported by large randomized trials, and the use remains off-label.

• Treatment of restless-leg syndrome (RLS) refractory to dopaminergic agents - Case series suggest that the levodopa component may alleviate RLS symptoms, but safety and efficacy have not been established for this indication.

• Adjunctive therapy in atypical parkinsonian syndromes - Clinicians occasionally trial Stalevo in progressive supranuclear palsy or multiple system atrophy to address motor deficits, though regulatory approval is lacking and evidence is limited.

All off-label applications must be undertaken only under the direct supervision of a qualified healthcare professional. The efficacy and safety of Stalevo for these conditions have not been officially approved by the FDA, EMA, or comparable agencies.

Is Stalevo the Right Medication for You?

Stalevo is most appropriate for adult patients with idiopathic Parkinson’s disease who are already receiving regular levodopa therapy but experience wearing-off phases between doses. It is particularly useful when:

• The patient requires fewer daily levodopa administrations.
• Persistent motor fluctuations are impacting daily activities.
• The individual tolerates carbidopa/levodopa but needs a longer plasma half-life for steadier symptom control.

Contraindications include:

• Known hypersensitivity to levodopa, carbidopa, entacapone, or any tablet excipients.
• History of severe non-cardiac arrhythmias or pheochromocytoma (due to potential catecholamine effects).
• Concurrent use of non-selective MAO-A inhibitors (e.g., phenelzine) because of the risk of hypertensive crisis.

Patients with hepatic impairment, severe renal dysfunction, or a history of narrow-angle glaucoma should be evaluated carefully before initiating therapy.

Risks, Side Effects, and Interactions

Common

• Nausea, vomiting, and loss of appetite
• Dry mouth
• Dizziness or light-headedness, especially on standing (orthostatic hypotension)
• Hallucinations or vivid dreams

Rare

• Urinary retention
• Hyperpyrexia (rare fever)
• Psychotic episodes requiring dose adjustment or antipsychotic therapy

Serious

• Neuroleptic malignant syndrome (extremely rare but life-threatening)
• Severe hypertensive episodes when combined with non-selective MAO inhibitors
• Severe liver injury (reported with entacapone, monitor transaminases)

Drug-Drug Interactions

• MAO-B inhibitors (e.g., selegiline, rasagiline) - May potentiate dopaminergic effects, increasing the risk of hallucinations and hypotension.
• Non-selective MAO-A inhibitors (e.g., phenelzine, tranylcypromine) - Concomitant use can precipitate hypertensive crises; avoid combination.
• Dopamine agonists (pramipexole, ropinirole) - Additive dopaminergic activity may increase the incidence of dyskinesias and psychiatric side effects.
• Iron supplements and certain antacids - May reduce levodopa absorption; separate dosing by at least 30 minutes.

Drug-Food Interactions

• High-protein meals compete with levodopa for intestinal transport, potentially reducing its absorption and blunting therapeutic response. Patients are advised to take Stalevo 30 minutes before meals or after a low-protein snack and maintain consistent dietary protein timing.

Use: Dosing, Missed Dose, Overdose

Standard dosing - The usual starting dose for adults is one tablet (25 mg carbidopa / 100 mg levodopa / 200 mg entacapone) taken three times daily, with adjustments based on clinical response. Some patients may require 2 tablets per dose or a different frequency, always under physician guidance.

Missed dose - If a dose is missed and the scheduled time for the next dose is less than 4 hours away, skip the missed tablet and continue with the regular schedule. Do not double the dose.

Overdose - Symptoms of levodopa overdose may include severe nausea, vomiting, diarrhea, confusion, and uncontrolled movements (dyskinesia). Entacapone overdose can cause elevated liver enzymes and hypertension. In suspected overdose, seek emergency medical care promptly; supportive measures and monitoring are the mainstay of treatment.

Practical precautions -

• Take Stalevo with a light snack; avoid high-protein breakfasts when possible.
• Alcohol can increase dizziness; limit intake, especially when initiating therapy.
• Operating heavy machinery or driving should be avoided until the individual knows how the medication affects them, as dizziness and visual hallucinations can occur.

FAQ

• What should I do if my Stalevo tablets change appearance during a refill?   Different manufacturers may use slightly different tablet colors or imprints while keeping the same strengths. Verify the strength printed on the tablet and confirm with the pharmacy labeling. If the appearance seems inconsistent with the prescribed dose, contact the dispensing pharmacy for clarification.

• Can I travel internationally with Stalevo, and are there any customs restrictions?   Stalevo is a prescription medication in most countries. When travelling, keep the medication in its original labeled container, carry a copy of the prescription or a doctor’s letter, and declare it if required by the destination’s customs regulations.

• How should Stalevo be stored in hot climates?   Store tablets at a controlled room temperature, generally 20-25 °C (68-77 °F), and protect them from excessive heat and humidity. In very hot environments, keep the medication in a cool, dry place, possibly inside a insulated pouch or a refrigerator (avoid freezing).

• Are there any sugar-free formulations of Stalevo for patients with diabetes?   The tablet formulation does not contain added sugars, but inactive ingredients such as lactose or sorbitol may be present. Patients with specific intolerances should review the excipient list on the package insert or ask the pharmacist.

• Does Stalevo interact with over-the-counter antihistamines?   First-generation antihistamines (e.g., diphenhydramine) can increase sedation and may exacerbate orthostatic hypotension. Second-generation agents (e.g., cetirizine) have a lower risk of interaction but should still be used cautiously.

• What laboratory tests are recommended while taking Stalevo?   Baseline liver function tests (ALT, AST, bilirubin) are advisable because entacapone may cause hepatic enzyme elevation. Periodic monitoring every 3-6 months is recommended, especially if the patient has pre-existing liver disease.

• Can Stalevo be crushed or split for dose adjustment?   The tablets are not formulated for crushing; doing so may affect the release characteristics of entacapone and alter dosing accuracy. If a smaller dose is needed, a prescriber should adjust the regimen to a lower-strength tablet rather than modifying the tablet manually.

• Is Stalevo detectable in standard drug-screening tests?   Levodopa and its metabolites are generally not included in routine workplace drug screens. However, specialized tests could detect levodopa, but this is uncommon.

• How does Stalevo compare to using levodopa/carbidopa alone?   Adding entacapone prolongs levodopa’s plasma half-life, reducing the frequency of dosing and smoothing motor fluctuations. This can lead to fewer “off” periods compared with levodopa/carbidopa alone, though individual response varies.

• What should I know about Stalevo’s shelf-life after opening the bottle?   Tablets retain potency until the expiration date printed on the package, provided they are stored correctly. Opening the bottle does not affect stability, but exposure to moisture should be minimized; always replace the cap tightly after each use.

Glossary

Levodopa

A precursor of dopamine that crosses the blood-brain barrier and is converted to dopamine in the central nervous system, restoring deficient dopaminergic activity in Parkinson’s disease.

COMT (catechol-O-methyltransferase)

An enzyme that metabolizes levodopa to 3-O-methyldopa in peripheral tissues; inhibition by entacapone increases levodopa’s bioavailability.

Wearing-off phenomenon

The re-emergence of Parkinsonian motor symptoms before the next scheduled dose of levodopa, due to declining drug levels.

AADC (aromatic L-amino-acid decarboxylase)

The enzyme that converts levodopa to dopamine outside the brain; inhibition by carbidopa limits peripheral dopamine formation.

Buying Stalevo from Our Online Pharmacy

Patients who encounter high out-of-pocket costs or limited local availability can obtain Stalevo through our online pharmacy. We source the generic tablets from licensed, audited manufacturers, ensuring that each batch meets stringent quality standards identical to the branded product.

Affordability - Prices are set close to the international reference cost, providing a substantial saving compared with retail pharmacies.

Verified quality - All shipments are accompanied by a certificate of analysis and batch-level authentication, guaranteeing product integrity.

Reliable delivery - Discreet packaging and secure shipping options are available, with express delivery in 7 days for most destinations and regular airmail arriving within approximately three weeks.

Our service operates as a pharmacy-broker platform, partnering with overseas licensed pharmacies that specialize in chronic-care medications. This model allows us to maintain patient privacy, offering a confidential and professional experience for those who need consistent access to Stalevo.

Disclaimer

The content presented about Stalevo is intended for general informational purposes only and does not substitute professional medical advice. Treatment choices, including any off-label applications, should be made under the guidance of a qualified healthcare practitioner. Readers are presumed to be competent adults capable of informed health decisions. Our online pharmacy provides access to Stalevo for individuals who may encounter limited availability via conventional pharmacies or who seek cost-effective generic alternatives. Always discuss any medication changes, initiation, or discontinuation with your clinician before proceeding.