Carbidopa is a drug used in the treatment of Parkinson's disease in order to inhibit peripheral
metabolism of levodopa. This property is significant because allows a greater proportion of
peripheral levodopa to cross the blood–brain barrier for central nervous system effect, thus
paving way for the best possible absorption. Parkinson’s disease damages the neurons that
produce dopamine, the motor symptoms of PD appear, including tremor, rigidity, impaired
balance, and includes loss of spontaneous movement. These are motor symptoms of PD
related to depletion of the neurotransmitter (chemical messenger) dopamine in the brain.
Carbidopa prevents the conversion of L-DOPA to dopamine peripherally, thus reducing the
side effects caused by dopamine on the periphery, and finally increasing the concentration of
L-DOPA and dopamine in the brain.
Many combinations of Carbidopa/levodopa carry the brand names of Kinson, Sinemet,
Pharmacopa and Atamet.
Amerigens Pharmaceuticals Ltd, first approved product by the FDA containing only
carbidopa in 2014. Initially, The combination treatment of carbidopa/levodopa was originally
developed by Watson Labs, However, the historical information by the FDA brings back to
the approval of this combination therapy by Mayne Pharma in 1992.
Forms and dosage
The combination of levodopa/carbidopa is sold as a regular tablet, an orally disintegrating
tablet, an extended-release, long-acting tablet, and an extended-release, long-acting capsule to
take by mouth. It is also sold as a suspension to be given into your stomach through a PEG-J
tube or sometimes through a naso-jejunal tube using a special infusion pump.
The regular and orally disintegrating tablets are given three or four times a day and extended-
release capsule is usually taken three to five times a day. The suspension is usually given as a
morning dose by infusion over 10 to 30 minutes and then as a continuous dose given by
infusion over 16 hours.
The cost of Carbidopa
In the USA, the consumers have to pay an average retail price of $44.23 and in the UK a
supply of 100 tablets of 25mg strength cost 35 pounds. In India, the same supply costs less
than dollar for a generic brand.
How does it work?
Carbidopa works by inhibiting aromatic-L-amino-acid decarboxylase, an enzyme important
in the biosynthesis of L-tryptophan to serotonin and in the biosynthesis of L-DOPA to
dopamine (DA). Increased dopamine availability increases the effectiveness of the remaining
neurons thus providing alleviation from symptoms for a time. However, exogenously
provided, L-DOPA gets metabolized peripherally before reaching the blood–brain barrier.
But, Carbidopa decreases peripheral DDC conversion of L-DOPA before it crosses the
blood–brain barrier. Carbidopa acts as a peripheral DDC inhibitor, it has no effect on brain
DDC conversion of L-DOPA to dopamine. As result of these actions, a greater proportion of
the exogenously provided levodopa/L-DOPA reaches the brain
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