Also called levodopa + benserazide

Key points about Madopar

  • Madopar is used to treat the symptoms of Parkinson's disease.
  • Madopar is a combination of levodopa + benserazide.
  • Find out how to take it safely and possible side effects.
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Madopar is a combination of levodopa and benserazide. Madopar is used to treat the symptoms of Parkinson's disease, or Parkinson-like symptoms such as tremor, shakiness, stiffness, and difficulty moving. Levodopa changes into dopamine, a chemical in the brain that helps control movement. Benserazide prevents levodopa changing to dopamine in the bloodstream. This means that more levodopa can enter the brain, and helps to lessen some of the side effects such as nausea and vomiting.

Levodopa becomes less effective over time. This is because it treats the symptoms of Parkinson's but cannot stop the dopamine-producing cells from being lost. This means that as they are lost you will continue to get symptoms and will need more frequent doses over time. 

Your brain can’t become resistant to levodopa. People with Parkinson’s will benefit from medications containing levodopa throughout their lifetime.

In Aotearoa New Zealand, Madopar is available in different forms and strengths with different amounts of carbidopa and benserazide in each capsule or tablet. This combination is available in 3 forms, capsules, modified-release capsules and dispersible tablets. Modified release means that the capsules release the medicine slowly over several hours, so the effect of the medicine lasts longer than that of standard capsules. Dispersible means that the tablets can be dissolved in water for people who find it hard to swallow tablets or capsules. 

  • Madopar capsules: 62.5mg, 125 mg, 250 mg
  • Madopar HBS (also called modified-release capsules): 125 mg
  • Madopar Rapid (also called dispersible tablets): 62.5 mg.

The dose of Madopar is different for different people.

  • You will be started on a low dose and, depending on your response, your doctor will increase your dose to control your symptoms.
  • Always take your Madopar exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much Madopar to take, how often to take it, and any special instructions.

  • Capsules (also called immediate release capsule): swallow the capsule whole. If you are struggling to swallow the capsules, you can open it and mix the contents of the capsule with a liquid or soft food such as a spoonful of yoghurt.
  • Modified release capsules (usually has HBS after the name): swallow the capsule whole, with a glass of water. Do not crush or chew the capsules because this will release all the medicine at once, increasing the chance of side effects and causing a loss in symptom control.
  • Dispersible tablets: swallow the tablets whole, or you can disperse (dissolve) the tablet into a small glass of water or orange cordial (but not fruit juice).
  • Timing: Take Madopar at the same times of day each day. Madopar is best taken on an empty stomach, but if it upsets your stomach, take it with or just after food. Avoid taking Madopar with a high-protein meal because the protein may decrease the effects of this medication.
  • Missed dose: If you do miss a dose and it is nearly time for your next dose, skip the missed dose and take your next dose at the usual time. Otherwise, take the missed dose as soon as you remember. Do not take two doses at the same time or very close together.
  • Keep taking Madopar regularly. Do not stop taking Madopar or lower the dose, without checking with your doctor. Your doctor may want you to gradually reduce your dose before stopping completely. This may help reduce the possibility of withdrawal symptoms such as muscle stiffness, fever and mental changes.

For some people with Parkinson’s, protein (which is found mainly in meat, fish, eggs, cheese, beans and pulses) seems to interfere with how well levodopa medications are absorbed by the body. Because of this, you may benefit from taking your medicine 30–60 minutes before you eat a meal.

You may also benefit from a protein redistribution diet, where you take most of your daily protein in the evening. This can help the levodopa treatment to be more effective in the daytime, when you are likely to need it more.

Protein is essential for a healthy diet so you should not reduce your overall intake. Talk to your doctor before you make any changes to what you eat.

Like all medicines, Madopar can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Side effects What should I do?
  • Changes in the colour of your urine, sweat or saliva — it may turn red, brown or black
  • This is harmless and is nothing to worry about.
  • Falling asleep suddenly during daily activities (such as talking on the phone, or driving)
  • This sleep effect can occur without any feelings of drowsiness beforehand, and can happen anytime during treatment with this medication, including up to 1 year after starting the medication
  • Tell your doctor.
  • Do not drive or use tools until you know how this medicine affects you and until these have stopped happening.
  • Avoid drinking alcohol.
  • Feeling sick (nausea)
  • Vomiting
  • Loss of appetite(not wanting to eat)
  • Changes in taste
  • These are quite common when you first start taking Madopar.
  • Try taking your doses after a light meal or with a low protein snack such as crackers.
  • Tell your doctor if these bother you.
  • Feeling dizzy when you stand up
  • Be careful when getting up from either lying down or sitting to avoid falls.
  • Tell your doctor.
  • Changes in your mood such as feeling anxious, nervous or agitated, or feeling excited or depressed
  • Tell your doctor.
  • Uncontrollable jerky movements, where you switch suddenly from being able to move to being immobile
  • Tell your doctor immediately or ring Healthline 0800 611 116
Did you know that you can report a side effect to a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product(external link)

Madopar can interact with some medications, herbal supplements and rongoā Māori, so check with your doctor or pharmacist before starting Madopar and before starting any new products.

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Credits: Sandra Ponen, Pharmacist, Healthify He Puna Waiora. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Maya Patel, MPharm PGDipClinPharm, Auckland

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