Levodopa/carbidopa/entacapone CINFA 150 mg/37.5 mg/200 mg film-coated tablets EFG

Package Leaflet: Information for the User

Introduction

Package Leaflet: Information for the User

Levodopa/Carbidopa/Entacapone cinfa 150 mg/37.5 mg/200 mg film-coated tablets EFG

Please read all of this leaflet carefully before you start taking this medicine, as it contains important information for you.

• Keep this leaflet as you may need to read it again.
• If you have any questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only and must not be given to other people, even if they have the same symptoms as you, because it could harm them.
• If you experience any adverse effects, consult your doctor or pharmacist, even if they are adverse effects not listed in this leaflet. See section 4.

Contents of the leaflet

1. What Levodopa/Carbidopa/Entacapone cinfa is and what it is used for
2. What you need to know before taking Levodopa/Carbidopa/Entacapone cinfa
3. How to take Levodopa/Carbidopa/Entacapone cinfa
4. Possible adverse effects
5. How to store Levodopa/Carbidopa/Entacapone cinfa
6. Contents of the pack and other information

1. What Levodopa/Carbidopa/Entacapone cinfa is and what it is used for

This medicine contains three active substances (levodopa, carbidopa and entacapone) in a film-coated tablet. Levodopa/Carbidopa/Entacapone is used to treat Parkinson's disease.

Parkinson's disease is caused by low levels in the brain of a substance called dopamine. Levodopa increases the amount of dopamine and thereby reduces the symptoms of Parkinson's disease. Carbidopa and entacapone enhance the anti-Parkinson effects of levodopa.

2. What you need to know before taking Levodopa/Carbidopa/Entacapone cinfa

Do not take Levodopa/Carbidopa/Entacapone cinfa if

• you are allergic to levodopa, carbidopa, or entacapone, or to any of the other ingredients of this medicine (listed in section 6).
• you have narrow-angle glaucoma (an eye disorder).
• you have a tumor of the adrenal glands.
• you are taking certain medicines for depression (combinations of selective MAO-A and MAO-B inhibitors, or non-selective MAO inhibitors).
• you have ever had neuroleptic malignant syndrome (NMS – a rare reaction to medicines used in the treatment of severe mental disorders).
• you have ever had non-traumatic rhabdomyolysis (a rare muscle disorder).
• you have severe liver disease.

Warnings and precautions

Talk to your doctor or pharmacist before starting Levodopa/Carbidopa/Entacapone cinfa.

If you have or have ever had:

• a heart attack or any other heart or blood vessel disease, including arrhythmias.
• asthma or any other lung disease.
• any liver problems, as your dose may need to be adjusted.
• any kidney disease or hormone-related disorder.
• stomach ulcer or seizures.
• prolonged diarrhea. Consult your doctor, as this may be a sign of inflammation of the colon.
• any form of severe mental disorder, such as psychosis.
• open-angle glaucoma, as your dose may need to be adjusted and your intraocular pressure monitored.

Talk to your doctor if you are taking:

• antipsychotics (medicines used to treat psychosis).
• any medicine that may cause a drop in blood pressure when standing up from a chair or bed. Be aware that Levodopa/Carbidopa/Entacapone may worsen these reactions.

Talk to your doctor if, during treatment with Levodopa/Carbidopa/Entacapone:

• you experience severe muscle stiffness or violent muscle contractions, or if you have tremors, agitation, confusion, fever, rapid pulse, or large fluctuations in blood pressure. If any of these occur, contact your doctor immediately.
• you feel depressed, have suicidal thoughts, or notice unusual changes in your behavior.
• you suddenly fall asleep or feel very sleepy. If this happens, you must not drive or operate tools or machinery (see also section "Driving and use of machines").
• you begin to experience uncontrolled movements or they worsen. If this occurs, your doctor may need to adjust your dose.
• you develop diarrhea; monitoring body weight is recommended to avoid excessive weight loss.
• you experience progressive loss of appetite, asthenia (weakness, exhaustion), and weight loss over a relatively short period. In such cases, a full medical evaluation, including liver function tests, should be considered.
• you are considering stopping this medicine; refer to the section "If you stop treatment with Levodopa/Carbidopa/Entacapone cinfa".

Inform your doctor if you or your family/caregiver notice that you are developing urges or a tendency to behave in a way that is unusual for you or that you cannot resist the impulse, determination, or temptation to carry out certain activities that could harm you or others. These behaviors are known as impulse control disorders and may include gambling addiction, compulsive eating, excessive spending, or abnormally increased sexual drive or preoccupation with sexual thoughts or sensations. Your doctor may need to review your treatment.

Inform your doctor if you or your family/caregiver notice that you are developing addiction-like symptoms, leading to a desire for high doses of levodopa/carbidopa/entacapone and other medicines used to treat Parkinson's disease.

During long-term treatment with Levodopa/Carbidopa/Entacapone, your doctor may perform regular blood tests.

If you are scheduled for surgery, you must inform your doctor that you are taking this medicine.

Levodopa/Carbidopa/Entacapone is not recommended for the treatment of extrapyramidal symptoms (e.g., involuntary movements, restlessness, muscle rigidity, and muscle contractions) caused by other medicines.

Children and adolescents

Experience with the use of Levodopa/Carbidopa/Entacapone in patients under 18 years of age is limited. Therefore, administration in children or adolescents is not recommended.

Other medicines and Levodopa/Carbidopa/Entacapone cinfa

Inform your doctor or pharmacist if you are taking, have recently taken, or might need to take any other medicines.

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

Levodopa/Carbidopa/Entacapone may increase the effect and also the adverse effects of certain medicines. These include:

• medicines used to treat depression, such as moclobemide, amitriptyline, desipramine, maprotiline, venlafaxine, and paroxetine
• rimiterol and isoprenaline, used to treat respiratory diseases
• adrenaline, used for severe allergic reactions
• noradrenaline, dopamine, and dobutamine, used to treat heart diseases and low blood pressure
• alpha-methyldopa, used to treat high blood pressure
• apomorphine, used to treat Parkinson's disease.

Certain medicines may reduce the effects of Levodopa/Carbidopa/Entacapone. These medicines are:

• dopamine antagonists used to treat mental disorders, nausea, and vomiting
• phenytoin, used to prevent seizures
• papaverine, used to relax muscles

Levodopa/Carbidopa/Entacapone may interfere with the gastrointestinal absorption of iron. Therefore, you should not take Levodopa/Carbidopa/Entacapone at the same time as iron supplements. If you take either, wait at least 2 to 3 hours between taking them.

Taking Levodopa/Carbidopa/Entacapone cinfa with food and drinks

This medicine can be taken with or without food.

In some patients, Levodopa/Carbidopa/Entacapone may not be well absorbed if taken with high-protein foods (meat, fish, dairy products, cereals, and nuts) or shortly after consuming them.

Consult your doctor if you think this applies to you.

Pregnancy, breastfeeding, and fertility

If you are pregnant, breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor or pharmacist before using this medicine.

You must not breastfeed while being treated with this medicine.

Driving and use of machines

Levodopa/Carbidopa/Entacapone may cause drowsiness and sudden episodes of sleep. If this occurs, you must not drive or engage in activities where reduced attention could result in death or serious injury to yourself or others (e.g., operating machinery) until these episodes and/or drowsiness have resolved.

Levodopa/Carbidopa/Entacapone cinfa 150 mg/37.5 mg/200 mg contains lactose

This medicine contains lactose. If your doctor has informed you of an intolerance to certain sugars, consult with them before taking this medicine.

Levodopa/Carbidopa/Entacapone cinfa 150 mg/37.5 mg/200 mg contains carmoisine (E-122)

This medicine may cause allergic reactions because it contains carmoisine (E-122). It may cause asthma, especially in patients allergic to acetylsalicylic acid.

3. How to take Levodopa/Carbidopa/Entacapona cinfa

Follow exactly the instructions for use of this medicine given by your doctor or pharmacist. If in doubt, consult your doctor or pharmacist again.

Adults and elderly patients:

• Your doctor will tell you the exact number of Levodopa/Carbidopa/Entacapona tablets you should take each day.
• The tablets must not be split or divided into smaller pieces.
• Take only one tablet at a time.
• Depending on how you respond to treatment, your doctor may instruct you to increase or reduce the dose.
• If you are taking Levodopa/Carbidopa/Entacapona tablets of 50 mg/12.5 mg/200 mg, 75 mg/18.75 mg/200 mg, 100 mg/25 mg/200 mg, 125 mg/31.25 mg/200 mg or 150 mg/37.5 mg/200 mg, do not take more than 10 tablets per day.

Talk to your doctor or pharmacist if you think the effect of this medicine is too strong or too weak, or if you experience possible adverse effects.

If you take more Levodopa/Carbidopa/Entacapona cinfa than you should

In case of overdose or accidental ingestion, contact your doctor or pharmacist immediately or call the Toxicology Information Service at telephone number 91 562 04 20, indicating the medicine and the amount ingested.

You may feel dizzy or agitated, your heart rate may be slower or faster than normal, or your skin, tongue, eyes, or urine may change color.

If you forget to take Levodopa/Carbidopa/Entacapona cinfa

Do not take a double dose to make up for missed doses.

If more than 1 hour remains until the next dose:

Take one tablet as soon as you remember, and take the next one at the usual time.

If less than 1 hour remains until the next dose:

Take one tablet as soon as you remember, wait 1 hour, and then take another tablet. After that, continue as usual.

There must always be a one-hour interval between doses of this medicine to avoid possible adverse effects.

If you stop taking Levodopa/Carbidopa/Entacapona cinfa

Do not stop taking this medicine unless your doctor tells you to. In that case, your doctor may need to adjust the dose of your other Parkinson's medications, especially levodopa, to ensure adequate symptom control.

If you suddenly stop taking Levodopa/Carbidopa/Entacapona and other Parkinson's medications, you may experience unwanted adverse effects.

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

4. Possible adverse effects

Like all medicines, this medicine can cause adverse effects, although not everyone experiences them. Many of these can be relieved by adjusting the dose.

If you experience any of the following symptoms during treatment with this medicine, contact your doctor immediately:

• Severe muscle stiffness or violent muscle contractions, tremors, agitation, confusion, fever, rapid pulse, or large fluctuations in blood pressure. These may be symptoms of neuroleptic malignant syndrome (NMS, a rare but serious reaction to medicines used to treat disorders of the central nervous system) or rhabdomyolysis (a rare and serious muscle disorder).
• Allergic reaction characterized by signs such as hives, itching, rash, or swelling of the face, lips, tongue, or throat. This reaction may cause difficulty breathing or swallowing.

Very common (may affect more than 1 in 10 people):

• Uncontrolled movements (dyskinesias)
• Feeling unwell (nausea)
• Harmless reddish-brown discoloration of the urine
• Muscle pain
• Diarrhea
• Urinary tract infections

Common (may affect up to 1 in 10 people):

• Fainting or collapse due to low blood pressure, high blood pressure
• Worsening of parkinsonism symptoms, dizziness, drowsiness
• Vomiting; abdominal pain and discomfort; heartburn; dry mouth; constipation
• Inability to sleep; hallucinations; confusion; abnormal dreams (with nightmares); fatigue
• Changes in mental state, including memory problems, anxiety, and depression (possibly with suicidal thoughts)
• Heart or artery problems (e.g., chest pain), irregular heartbeat
• More frequent falls
• Labored breathing
• Increased sweating, rashes
• Muscle cramps, swelling of the legs
• Blurred vision
• Anaemia
• Decreased appetite, weight loss
• Headache, joint pain
• Urinary infections

Uncommon (may affect up to 1 in 100 people):

• Heart attack
• Intestinal bleeding
• Changes in blood cell counts that may lead to bleeding and abnormalities in liver function tests
• Seizures
• Feeling restless
• Psychotic symptoms
• Colitis (inflammation of the colon)
• Changes in pigmentation other than in urine (e.g., skin, nails, hair, sweat)
• Difficulty swallowing
• Inability to urinate

Frequency not known (cannot be estimated from available data):

A strong desire for doses of Levodopa/Carbidopa/Entacapone higher than those required to control motor symptoms, known as dopamine dysregulation syndrome.

Some patients may experience severe abnormal involuntary movements (dyskinesias), mood changes, or other adverse effects after taking high doses of Levodopa/Carbidopa/Entacapona.

The following adverse effects have also been reported:

• Hepatitis (inflammation of the liver)
• Itching

You may experience the following adverse effects:

Inability to resist the impulse to carry out an action that could be harmful, which may include:

• A strong urge to gamble excessively despite serious personal or family consequences
• Increased or altered interest in sex and behavior that is concerning to you or others, such as increased sexual behavior
• Excessive or uncontrolled shopping or spending
• Binge eating (eating large amounts of food in short periods of time) or compulsive eating (eating more food than usual and more than necessary to satisfy hunger).

Inform your doctor if you experience any of these behaviors; they will discuss how to manage or reduce these symptoms.

Reporting of adverse effects

If you experience any adverse effect, consult your doctor or pharmacist, even if it is a possible adverse effect not listed in this leaflet. You can also report them directly via the Spanish Pharmacovigilance System for Human Medicines: https://www.notificaram.es. By reporting adverse effects, you can help provide more information on the safety of this medicine.

5. Storage of Levodopa/Carbidopa/Entacapone cinfa

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date stated on the packaging after EXP. The expiry date refers to the last day of the month indicated.

Store below 25°C.

Discard the product 175 days after opening the container.

Medicines should not be disposed of via wastewater or household waste. Dispose of unused medicines and their containers at the SIGRE point in your pharmacy. If you are in doubt, please ask your pharmacist how to dispose of unused medicines and containers. This will help protect the environment.

6. Contents of the pack and other information

Composition of Levodopa/Carbidopa/Entacapone cinfa

• The active substances are levodopa, carbidopa and entacapone. Each coated tablet contains 150 mg of levodopa, 37.5 mg of carbidopa and 200 mg of entacapone.
• The other components are: microcrystalline cellulose, anhydrous lactose, hydroxypropylcellulose, povidone (E-1201), colloidal anhydrous silica, magnesium stearate, titanium dioxide (E-171), hypromellose, glycerol (E-422), polysorbate 80, iron oxide red (E-172) and carmoisine (E-122).

Appearance of the product and pack contents

Biconvex, oval, dark red tablets, without score.

Levodopa/Carbidopa/Entacapone cinfa 150 mg/37.5 mg/200 mg is available in HDPE bottles with child-resistant PP caps, in packs of 100 tablets.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

Laboratorios Cinfa, S.A.

Carretera Olaz-Chipi, 10. Polígono Industrial Areta

31620 Huarte (Navarra) - Spain

Manufacturer

Teva Pharmaceutical Works Private

Pallagi út 13, 4042

Debrecen

Hungary

Or

Laboratorios Cinfa, S.A.

Carretera Olaz-Chipi, 10. Polígono Industrial Areta

31620 Huarte (Navarra) - Spain

Date of the most recent review of this leaflet: October 2023

Detailed information on this medicinal product is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/

You can access detailed and up-to-date information on this medicinal product by scanning with your mobile phone (smartphone) the QR code included in the leaflet and packaging. You may also access this information at the following internet address: https://cima.aemps.es/cima/dochtml/p/79648/P_79648.html

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