Nacom® (Levodopa 250 mg, Carbidopa 25 mg) 100 tablets

Common/Other brand names: Sinemet, Duodopa, Parcopa, Stalevo, Syndopa, Levocarb, Carbidopa-Levodopa, Sinemet CR, Atamet

What is Nacom® (Levodopa / Carbidopa)?

Nacom® is a medication primarily used to treat Parkinson's disease and parkinsonism syndromes. It combines two active ingredients: levodopa, which is converted into dopamine in the brain to help restore normal motor function, and carbidopa, which prevents levodopa from breaking down before it reaches the brain.

This combination increases the efficiency of levodopa and reduces its side effects, such as nausea and vomiting, often caused when levodopa is used alone.

Nacom® helps manage symptoms like tremors, stiffness, and slowness of movement, providing relief to individuals with Parkinson's disease.

How does Nacom® work?

Levodopa is the most effective treatment for managing Parkinson's symptoms because it is converted into dopamine once it enters the brain.

However, when taken on its own, much of levodopa is converted into dopamine outside the brain, leading to fewer benefits and more side effects.

Carbidopa plays a crucial role by inhibiting the enzyme that converts levodopa into dopamine before it reaches the brain.

This allows more levodopa to be transported across the blood-brain barrier, where it can effectively increase dopamine levels.

The combination of these two drugs maximizes symptom control while minimizing the side effects associated with levodopa.

What are the indications for Nacom®?

Nacom® is prescribed for conditions associated with dopamine deficiency, such as:

• Parkinson's disease: A progressive neurodegenerative disorder characterized by tremors, muscle stiffness, and difficulty with movement.
• Parkinsonism syndromes: These are conditions similar to Parkinson’s disease but may arise due to other causes, such as side effects of certain medications or brain injuries.

Nacom® helps improve motor function and manage symptoms like bradykinesia (slowness of movement), rigidity, and tremors. It can significantly improve the daily functioning and quality of life for people suffering from these conditions.

What precautions should be taken before using Nacom®?

Before starting Nacom®, several important considerations must be taken into account. Nacom® is contraindicated in individuals who:

• Have a known allergy to levodopa, carbidopa, or any of the inactive ingredients in the medication.
• Are currently taking non-selective monoamine oxidase (MAO) inhibitors, which can cause dangerous interactions, leading to a sudden spike in blood pressure.
• Suffer from closed-angle glaucoma, a condition that increases eye pressure and can lead to vision loss if untreated.
• Have a history of melanoma, or currently have this type of skin cancer, as levodopa has been associated with an increased risk of melanoma.
• Have severe liver or kidney disease, as the medication may worsen their condition.
• Are pregnant or breastfeeding, because Nacom® can harm the fetus or newborn.
• Are under 18 years old, since the safety and efficacy of Nacom® in children and adolescents have not been established.

Additionally, people with a history of mental health disorders, such as psychosis or severe depression, should use Nacom® with caution, as it may worsen these conditions.

What is the risk of melanoma with Nacom®?

There is a noted increased risk of melanoma in patients with Parkinson’s disease, and while the exact cause is unclear, the risk could be related to the disease itself or the medications used for its treatment, including Nacom®.

Studies suggest that Parkinson's patients may be 2-6 times more likely to develop melanoma compared to the general population.

Given this potential risk, it is strongly recommended that patients and their caregivers conduct regular skin checks for any new or unusual skin changes.

Periodic evaluations by a healthcare professional, such as a dermatologist, are also advised during treatment with Nacom® to detect and address melanoma at an early stage.

How should Nacom® be taken?

The correct dosage of Nacom® should be carefully adjusted for each individual to provide the best therapeutic effect while minimizing side effects.

If you are starting Nacom® for the first time or switching from another medication like levodopa alone, it is important to stop levodopa at least 12 hours before beginning Nacom®.

The initial dose usually starts at ½ tablet once or twice daily, and this can be gradually increased based on the patient’s response to the treatment.

For those transitioning from levodopa, the recommended starting dose of Nacom® should provide approximately 20% of the previous daily dose of levodopa.

Over time, the dose may need to be adjusted as the body responds to the treatment.

Regular monitoring by a healthcare professional is essential, as Nacom® may cause involuntary movements (dyskinesia) or other side effects if the dose is too high.

In some cases, the full therapeutic effect of Nacom® can be observed within a week, whereas treatment with levodopa alone can take weeks or even months to achieve similar benefits.

The maximum recommended dose is 8 tablets per day, which provides 200 mg of carbidopa and 2 g of levodopa.

What side effects may occur with Nacom®?

Like all medications, Nacom® can cause side effects, some of which may be serious. Common side effects include:

• Dyskinesia: Involuntary movements, such as twitching or jerking, which are caused by the increased dopamine in the brain.
• Nausea and vomiting: Although carbidopa reduces these effects, they can still occur, especially in the early stages of treatment.
• Sleep disturbances: Including trouble falling asleep, staying asleep, or excessive sleepiness during the day.
• Hallucinations and confusion: Some patients, especially older adults, may experience visual or auditory hallucinations, confusion, or disorientation.
• Orthostatic hypotension: A sudden drop in blood pressure when standing up, leading to dizziness or fainting.

In rare cases, Nacom® can cause more severe side effects, such as compulsive behaviors (e.g., gambling, hypersexuality, or binge eating) or psychiatric symptoms, like depression with suicidal tendencies.

These behaviors are related to the drug's effect on the brain’s dopamine system and should be reported to a healthcare provider immediately.

Adjusting the dose can often help manage these side effects.

In addition, long-term use of Nacom® may result in the development of motor fluctuations (the "on-off" phenomenon) where the effects of the medication wear off unpredictably, causing alternating periods of good and poor motor function.

How should Nacom® be stored?

Nacom® should be stored in a dry, cool place at temperatures below 25°C (77°F).

It must be kept out of reach of children.

The medication should not be used after the expiration date indicated on the packaging.