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Stalevo 125 mg/31.25 mg/200 mg film-coated tablets Entacapon
2015-01-21 16:55:00 来源: 作者: 【 】 浏览:384次 评论:0

For doctors

 

What is it and how is it used?

Stalevo contains three active substances (levodopa, carbidopa and entacapone) in one film-coated tablet. Stalevo is used for the treatment of Parkinson’s disease.

Parkinson’s disease is caused by low levels of a substance called dopamine in the brain. Levodopa increases the amount of dopamine and hence reduces the symptoms of Parkinson’s disease. Carbidopa and entacapone improve the antiparkinson effects of levodopa.

What do you have to consider before using it?

Do not take Stalevo if you

Take special care with Stalevo

Consult your doctor if you have or have ever had:

Consult your doctor if you are currently taking:

Consult your doctor if during the treatment with Stalevo you:

Your doctor may take some regular laboratory tests during a long term treatment with Stalevo.

If you must undergo surgery, please tell your doctor that you are using Stalevo.

Stalevo is not recommended to be used for treatment of extrapyramidal symptoms (e.g. involuntary movements, shaking, muscle rigidity and muscle contractions) caused by other medicines.

Children
Experience with Stalevo in patients under 18 years is limited. Therefore, the use of Stalevo in children is not recommended.

Taking other medicines

Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription and herbal medicines.

Do not take Stalevo if you are taking certain medicines for treating depression (combinations of selective MAO-A and MAO-B inhibitors, or non-selective MAO inhibitors).

Stalevo may increase the effects and side effects of certain medicines. These include:

The effects of Stalevo may be weakened by certain medicines. These include:

Stalevo may make it harder for you to digest iron. Therefore, do not take Stalevo and iron supplements at the same time. After taking one of them, wait at least 2 to 3 hours before taking the other.

Taking Stalevo with food and drink

Stalevo may be taken with or without food. For some patients, Stalevo may not be well absorbed if it is taken with, or shortly after eating protein-rich food (such as meats, fish, dairy products, seeds and nuts). Consult your doctor if you think this applies to you.

Pregnancy and breast-feeding

If you are pregnant or think you may be pregnant, consult your doctor before taking Stalevo.

You should not breast-feed during treatment with Stalevo.

Driving and using machines

Stalevo may lower your blood pressure, which may make you feel light-headed or dizzy. Therefore, be particularly careful when you drive or when you use any tools or machines.

If you feel very drowsy, or if you sometimes find yourself suddenly falling asleep, wait until you feel fully awake again before driving or doing anything else that requires you to be alert. Otherwise, you may put yourself and others at risk of serious injury or death.

Important information about some of the ingredients of Stalevo

Stalevo contains sucrose (1.6 mg/tablet). If you have been told by your doctor that you have intolerance to some sugars, contact your doctor before taking this medicinal product.

How is it used?

Always take Stalevo exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not sure.

For adults and elderly:

Talk to your doctor or pharmacist if you think the effect of Stalevo is too strong or too weak, or if you experience possible side effects

If you take more Stalevo than you should

If you have accidentally taken more Stalevo tablets than you should, talk to your doctor or pharmacist immediately.

If you forget to take Stalevo

Do not take a double dose to make up for a forgotten tablet.

If it is more than 1 hour until your next dose:
Take one tablet as soon as you remember, and the next tablet at the normal time.

If it is less than 1 hour until your next dose:
Take a tablet as soon as you remember, wait 1 hour, then take another tablet. After that carry on as normal.

Always leave at least an hour between Stalevo tablets, to avoid possible side effects.

If you stop taking Stalevo

Do not stop taking Stalevo unless your doctor tells you to. In such a case your doctor may need to adjust your other antiparkinson medicines, especially levodopa, to give sufficient control of your symptoms. If you suddenly stop taking Stalevo and other antiparkinsonian medicines it may result in unwanted side effects.

If you have any further questions on the use of this product, ask your doctor or pharmacist.

What are possible side effects?

Like all medicines, Stalevo can cause side effects, although not everybody gets them. If you experience any of these side effects, talk to your doctor as soon as possible. Many of the side effects can be relieved by adjusting the dose.

The frequencies are defined as:
Very common ( affects more than 1 user in 10)
Common ( affects 1 to 10 users in 100)
Uncommon ( affects 1 to 10 users in 1,000)
Rare ( affects 1 to 10 users in 10,000)
Very rare ( affects less than 1 user in 10,000)
Not known (frequency cannot be estimated from the available data).

Very common

Common

Uncommon

The following side effects have also been reported:

If you during the treatment with Stalevo experience the following symptoms, contact your doctor immediately:

Behavioural changes such as urge to gamble (pathological gambling) or increased sexual desire and urges (increased libido and hypersexuality) have been reported in patients receiving dopamine replacement therapy including Stalevo.

If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

How should it be stored?

Keep out of the reach and sight of children.

Do not use after the expiry date which is stated on the bottle and the carton after EXP. The expiry date refers to the last day of that month.

This medicinal product does not require any special storage conditions.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

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For doctors

What is it?

Stalevo is a medicine that contains three active substances: levodopa, carbidopa and entacapone. It is available as a range of brown, oval tablets in six strengths, containing 50 to 200 mg levodopa and 12.5 to 50 mg carbidopa. All of the tablets contain 200 mg entacapone.

What is it used for?

Stalevo is used to treat adults with Parkinson’s disease. Parkinson’s disease is a progressive brain disorder that causes shaking, slow movement and muscle stiffness. Stalevo is used in patients who are being treated with a combination of levodopa and an inhibitor of dopa decarboxylase (two standard treatments for Parkinson’s disease) but are having ‘fluctuations’ towards the end of the period between two doses of their medication. Fluctuations happen when the effects of the medication wear off and symptoms re-emerge. They are linked with a reduction in the effect of levodopa, when the patient experiences sudden switches between being ‘on’ and able to move, and being ‘off’ and having difficulty moving about. Stalevo is used when these fluctuations cannot be treated with the standard combination alone.
The medicine can only be obtained with a prescription.

How is it used?

Each Stalevo tablet contains one complete dose of levodopa, in six strengths, with corresponding amounts of carbidopa and entacapone to improve its effectiveness. The strength of Stalevo that the patient should use is based on the amount of levodopa they need to control their symptoms. See the Summary of Product Characteristics (also part of the EPAR) for full instructions on how patients should be switched to Stalevo, and on how the dose is adjusted during treatment.
The maximum daily dose of Stalevo is 10 tablets, except for the tablets containing 200 mg levodopa and 50 mg carbidopa, for which the maximum daily dose is seven tablets. Stalevo tablets should be taken whole, with or without food. They should be used with caution in patients with mild to moderate problems with their liver or severe problems with their kidneys. They should not be used in patients with severe liver problems.

How does it work?

In patients with Parkinson’s disease, the cells in the brain that produce the neurotransmitter dopamine begin to die and the amount of dopamine in the brain decreases. The patients then lose their ability to control their movements reliably. All of the active substances in Stalevo work to restore the levels of dopamine in the parts of the brain that control movement and co-ordination.
Levodopa is converted into dopamine in the brain. Both carbidopa and entacapone block some of the enzymes that are involved in the breakdown of levodopa in the body: carbidopa blocks the enzyme dopa decarboxylase, and entacapone blocks the enzyme catechol-O-methyl transferase (COMT). As a result, levodopa remains active for longer. This helps to improve the symptoms of Parkinson’s disease, such as stiffness and slowness of movement.
Entacapone has been authorised in the European Union (EU) as Comtess/Comtan since 1998. The use of combinations of levodopa and carbidopa is well established, having being in use since the mid-1970s. Having all three substances in the same tablet can lower the number of tablets the patients have to take and help them stick to treatment.

How has it been studied?

The company used some of the data from Comtess/Comtan to support the use of Stalevo and presented data from the published literature for levodopa and carbidopa.
The company carried out ‘bioequivalence’ studies to show that taking Stalevo produces the same levels of levodopa, carbidopa and entecapone in the blood as taking separate tablets containing entacapone and the combination of levodopa and carbidopa.

What benefits has it shown during the studies?

The studies showed that Stalevo is bioequivalent to the separate tablets.

What is the risk associated?

The most common side effects with Stalevo (seen in more than 1 patient in 10) are dyskinesia (uncontrollable movements), aggravated Parkinsonism (worsening of Parkinson’s disease), nausea (feeling sick) and harmless urine discoloration. For the full list of all side effects reported with Stalevo, see the Package Leaflet.
Stalevo should not be used in people who may be hypersensitive (allergic) to levodopa, carbidopa, entacapone or any of the other ingredients. Stalevo must not be used in patients with:

Why has it been approved?

The Committee for Medicinal Products for Human Use (CHMP) decided that Stalevo’s benefits are greater than its risks for the treatment of patients with Parkinson’s disease and end-of-dose motor fluctuations not stabilised on levodopa/dopa decarboxylase inhibitor treatment. The Committee recommended that Stalevo be given marketing authorisation.

Further information

The European Commission granted a marketing authorisation valid throughout the EU for Stalevo on 17 October 2003. The marketing authorisation holder is Orion Corporation. The marketing authorisation was renewed on 17 October 2008.

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Name

 

Stalevo 125 mg/31.25 mg/200 mg film-coated tablets

 

Composition

 

Each tablet contains 125 mg of levodopa, 31.25 mg of carbidopa and 200 mg of entacapone.

Excipient: Each tablet contains 1.6 mg of sucrose.

For a full list of excipients, see section 6.1.

 

Pharmaceutical Form

 

Film-coated tablet

Light brownish red, oval film-coated tablets marked with ‘LCE 125’ on one side.

 

Are you an Healthcare Professional? Access professional drug leaflets on Diagnosia.com!

 

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