Nakom is an anti-Parkinsonian drug, which is a combination of a peripheral dopa decarboxylase inhibitor and a dopamine precursor.
Release form and composition
Dosage form - tablets: oval, biconvex, blue with white and separate dark blue splashes, with a notch on one side (10 pieces in a blister, in a cardboard box 10 blisters).
Active ingredients in 1 tablet:
- Levodopa - 250 mg;
- Carbidopa - 25 mg.
Additional substances: corn starch, pregelatinized starch, microcrystalline cellulose, magnesium stearate, blue dye (indigotin E132).
Indications for use
Nacom is used to treat Parkinson’s disease and Parkinson’s syndrome.
- Skin diseases of unknown etiology;
- Melanoma established or suspected;
- Angle-closure glaucoma;
- Co-administration with non-selective monoamine oxidase inhibitors and 2 weeks after their withdrawal;
- Age up to 18 years;
- Pregnancy (except in cases of vital necessity);
- Lactation (or breastfeeding should be stopped);
- Increased individual sensitivity to the components of the drug.
- Severe diseases of the cardiovascular system, incl. history of myocardial infarction, accompanied by cardiac arrhythmias, and heart failure;
- Severe diseases of the respiratory system, including bronchial asthma;
- Convulsive seizures in history, incl. epileptic;
- Decompensated diseases of the endocrine system, including diabetes;
- Erosive and ulcerative lesions of the gastrointestinal tract;
- Severe renal / hepatic failure;
- Open-angle glaucoma.
Dosing and Administration
Nakom take inside. Tablets, if necessary, can be divided in half.
The optimal dose, carefully selecting, determines the doctor individually.
In the process of treatment may require dose adjustment and / or frequency of administration. The average daily dose is 70-100 mg carbidopa.
When prescribing Nacoma patients who receive standard drugs from parkinsonism (except for those containing one levodopa), their reception can be continued, but dose adjustment is required.
The initial dose, as a rule, is ½ tablets 1-2 times a day. If necessary, further it is increased to 1 whole tablet every day or every other day.
When switching to Nacom with levodopa preparations, the latter are canceled at least 12 hours later, and in the case of long-acting agents, within 24 hours. The dose of Nakoma is selected in such a way that it provides approximately 20% of the dose of levodopa, which was taken by the patient.
For patients who received more than 1500 mg of levodopa, the initial dose of Nakoma is 1 tablet 3-4 times a day.
When maintaining therapy, the dose of Nakoma, if the need arises, is increased by ½-1 tablet every day or every other day until the maximum permissible dose is reached - 8 tablets, which for a patient weighing 70 kg is approximately 30 mg of levodopa and 3 mg carbidopa per kilogram of body weight. The experience of using a daily dose of carbidopa over 200 mg is limited.
The most common side effects of nakoma are nausea and dyskinesia, incl. involuntary movements (including dystonic and choreiform). Such early signs as blepharospasm and muscle twitching may be grounds for discontinuation of the drug.
Other possible side effects of the drug:
- Central and peripheral nervous system: episodes of bradykinesia ("on-off" syndrome), neuroleptic malignant syndrome, paresthesia, drowsiness, sleep disorders, dizziness, depression (including the development of suicidal intentions), confusion, agitation, dementia, episodes psychotic states (including paranoid thinking, illusions and hallucinations), increased libido; rarely, convulsions (a causal relationship with the drug has not been established);
- Digestive system: bleeding from the gastrointestinal tract, diarrhea, vomiting, anorexia, saliva darkening, exacerbation of duodenal ulcer;
- Respiratory system: dyspnea;
- Hematopoietic system: thrombocytopenia, anemia (including hemolytic), leukopenia, agranulocytosis;
- Urogenital system: dark urine;
- Cardiovascular system: arrhythmias and / or heart palpitations, phlebitis, orthostatic effects (including episodes of a decrease or increase in blood pressure);
- Dermatological and allergic reactions: rash, alopecia, darkening of the secretion of sweat glands, pruritus, urticaria, angioedema, Schönlein-Genoch disease;
- Other: chest pain, fainting.
Other adverse reactions that may occur due to levodopa use:
- Digestive system: feeling of bitterness in the mouth, bruxism, attacks of hiccups, dysphagia, dry mouth, dyspepsia, sialorea, flatulence, constipation, burning sensation of the tongue, discomfort and pain in the abdomen;
- Metabolism: swelling, increase or decrease in body weight;
- Central nervous system: headache, fatigue, asthenia, fainting, decreased mental activity, weakness, disorientation, muscle cramps, increased hand tremors, tremors, torpor, activation of latent Bernard-Horner syndrome, euphoria, anxiety, psychomotor agitation, insomnia, instability gait, ataxia;
- Sense organs: pupillary dilation, blurred vision, diplopia, ocular crises;
- Urogenital system: incontinence or urinary retention, priapism;
- Others: flushing of the skin of the neck, face and chest, malaise, dyspnea, hoarseness, malignant melanoma;
- Laboratory parameters: increase of serum creatinine increase of urea nitrogen and plasma bilirubin, elevated alkaline phosphatase, lactate dehydrogenase, alanine aminotransferase and aspartate aminotransferase, decreased hematocrit and hemoglobin bacteriuria, leukocytosis, red blood cell, a positive Coombs, hyperglycemia, hyperuricemia.
Drugs containing levodopa and carbidopa can cause a false-positive reaction to ketone bodies in the urine if a test strip is used to determine ketonuria. False-negative results are possible when using the glucose oxidase method for the determination of glucosuria.
Before prescribing Nakoma to patients with arrhythmia (ventricular, nodular or atrial), or who have suffered a myocardial infarction, a thorough medical examination is necessary. Such patients during treatment should monitor cardiac activity, especially after taking the first dose and during the period of dose selection.
Patients with open-angle glaucoma should constantly monitor intraocular pressure during treatment.
Nacom is also indicated for patients with parkinsonism who take vitamin preparations with pyridoxine hydrochloride (vitamin B 6 ).
All patients during treatment should be carefully monitored, because there is a risk of developing a depressive state, including suicidal intent. Particular caution should be exercised in the selection of the dose in patients with a history of psychosis.
Extremely cautious Nakom should be prescribed simultaneously with psychotropic drugs.
During prolonged treatment, it is necessary to monitor the function of the kidneys, liver, hematopoietic and cardiovascular systems.
In the case of abrupt withdrawal of the anti-parkinsonian agent, the development of a symptom complex resembling a malignant neuroleptic syndrome, including muscle rigidity, mental disorders, fever, increase in serum creatine phosphonokinase concentration, is possible. For this reason, it is necessary to carefully monitor patients during the period of a sharp reduction in the dose of Nakoma and complete withdrawal of the drug, especially if the patient receives antipsychotics.
If necessary, general anesthesia can be taken as long as the patient is allowed oral medication and fluids.
If for some reason the treatment is temporarily interrupted, it should be resumed at the usual dose.
Possible interaction reactions in the case of simultaneous use of Nakoma with other drugs:
- Antihypertensive drugs: the development of symptomatic orthostatic hypotension;
- Monoamine oxidase inhibitors (with the exception of type B): circulatory disorders;
- Tricyclic antidepressants: the risk of high blood pressure and the development of dyskinesia;
- Iron gluconate, ferrous sulfate: reduced bioavailability of carbidopa and / or levodopa;
- Beta-adrenostimulyatory, means of inhalation anesthesia, ditilin: the risk of cardiac arrhythmias;
- Dopamine D 2 receptor antagonists (including butyrophenones, phenothiazines, risperidone), isoniazid: a decrease in the therapeutic effect of levodopa;
- Papaverine, phenytoin: blocking the positive therapeutic effect of levodopa in Parkinson's disease is possible;
- Lithium drugs: the risk of hallucinations and dyskinesias;
- Methyldopa: increased side effects nakoma;
- Tubocurarin: risk of arterial hypotension.
Carbidopa inhibits the action of vitamin B6 (pyridoxine hydrochloride), which accelerates the biotransformation of levodopa into dopamine in peripheral tissues.
In some cases, patients adhering to a high-protein diet may have impaired absorption of levodopa.
Terms and conditions of storage
Store at temperatures up to 25 C out of the reach of children, protected from light and moisture.
Shelf life - 3 years.