|Dosage and administration are variable and no more than a guide can be given.Adults|
Patients not previously treated with levodopaThe recommended initial dose is one capsule or dispersible tablet of Madopar 50 mg/12.5 mg three or four times daily. If the disease is at an advanced stage, the starting dose should be one capsule or dispersible tablet of Madopar 100 mg/25 mg three times daily.The daily dosage should then be increased by one capsule or dispersible tablet of Madopar 100 mg/25 mg, or their equivalent, once or twice weekly until a full therapeutic effect is obtained, or side-effects supervene.In some elderly patients, it may suffice to initiate treatment with one capsule or dispersible tablet of Madopar 50 mg/12.5 mg once or twice daily, increasing by one capsule or dispersible tablet every third or fourth day.The effective dose usually lies within the range of four to eight capsules or dispersible tablets of Madopar 100 mg/25 mg (two to four capsules of Madopar 200 mg/50 mg) daily in divided doses, most patients requiring no more than six capsules or dispersible tablets of Madopar 100 mg/25 mg daily.Optimal improvement is usually seen in one to three weeks but the full therapeutic effect of Madopar may not be apparent for some time. It is advisable, therefore, to allow several weeks to elapse before contemplating dosage increments above the average dose range. If satisfactory improvement is still not achieved, the dose of Madopar may be increased but with caution. It is rarely necessary to give more than ten capsules or dispersible tablets of Madopar 100 mg/25 mg (five capsules of Madopar 200 mg/50 mg) per day.Treatment should be continued for at least six months before failure is concluded from the absence of a clinical response.Madopar 50 mg/12.5 mg capsules or dispersible tablets may be used to facilitate adjustment of dosage to the needs of the individual patient. Patients who experience fluctuations in response may be helped by dividing the dosage into smaller, more frequent doses with the aid of Madopar 50 mg/12.5 mg capsules or dispersible tablets without, however, altering the total daily dose. Madopar 200 mg/50 mg capsules are only for maintenance therapy once the optimal dosage has been determined using Madopar 100 mg/25 mg capsules or dispersible tablets.
Patients previously treated with levodopaThe following procedure is recommended: Levodopa alone should be discontinued and Madopar started on the following day. The patient should be initiated on a total of one less Madopar 100 mg/25 mg capsule or dispersible tablet daily than the total number of 500 mg levodopa tablets or capsules previously taken (for example, if the patient had previously taken 2g levodopa daily, then he should start on three capsules or dispersible tablets Madopar 100 mg/25 mg daily on the following day). Observe the patient for one week and then, if necessary, increase the dosage in the manner described for new patients.
Patients previously treated with other levodopa/decarboxylase inhibitor combinationsPrevious therapy should be withdrawn for 12 hours. In order to minimise the potential for any effects of levodopa withdrawal, it may be beneficial to discontinue previous therapy at night and institute Madopar therapy the following morning. The initial Madopar dose should be one capsule or dispersible tablet of Madopar 50 mg/12.5 mg three or four times daily. This dose may then be increased in the manner described for patients not previously treated with levodopa.Other anti-Parkinsonian drugs may be given with Madopar. Existing treatment with other anti-Parkinsonian drugs, e.g. anticholinergics or amantadine, should be continued during initiation of Madopar therapy. However, as treatment with Madopar proceeds and the therapeutic effect becomes apparent, the dosage of the other drugs may need to be reduced or the drugs gradually withdrawn.
ElderlyAlthough there may be an age-related decrease in tolerance to levodopa in the elderly, Madopar appears to be well-tolerated and side effects are generally not troublesome.
ChildrenNot to be given to patients under 25 years of age, therefore, no dosage recommendations are made for the administration of Madopar to children.Madopar capsules and dispersible tablets are for oral administration. They should be taken with, or immediately after, meals.Madopar dispersible tablets may be swallowed whole or dispersed in at least 25ml water per tablet. They may be taken in dilute orange squash (at least 25ml per tablet) if preferred. However, orange juice should not be used. Madopar dispersible tablets are particularly suitable for patients who dislike taking capsules or have difficulty in swallowing solid dosage forms.