Levodopa with benserazide
Co-beneldopa
A levodopa medicine for Parkinson's disease, combined with benserazide to reduce nausea and side effects.
What is Co-beneldopa?
Co-beneldopa is a Parkinson's medicine that pairs levodopa, the main treatment for the movement symptoms of Parkinson's, with benserazide. The brain turns levodopa into dopamine, the chemical messenger that is in short supply in Parkinson's, easing slowness, stiffness and tremor. Benserazide stops levodopa being broken down before it reaches the brain, which means a smaller amount works better and causes much less nausea. It is the sister medicine of co-careldopa and is sold mainly as Madopar. Over years of use, its effect can start to 'wear off' between doses and cause extra movements, and it must never be stopped suddenly.
Education and reference only. This is a plain-language guide to Co-beneldopa — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Co-beneldopa is a combination tablet or capsule used to treat Parkinson's disease. It contains levodopa, which the brain converts into dopamine, plus benserazide, a 'helper' that protects the levodopa on its way to the brain. In Parkinson's the brain cells that make dopamine are gradually lost, so movements become slow, stiff and shaky; replacing the missing dopamine through levodopa is the most effective way to relieve these symptoms. It is one of two main UK levodopa combinations (the other is co-careldopa) and is best known by the brand Madopar, which also comes in a dispersible form and a slow-release form.
How it works
Levodopa is a building block that the brain turns into dopamine, the chemical messenger that is lacking in Parkinson's disease; topping it up improves slowness, stiffness and tremor. On its own, much of a levodopa dose is broken down in the body before it reaches the brain, which both wastes it and causes nausea. Benserazide blocks that early breakdown outside the brain, so more levodopa gets through, smaller amounts are needed and sickness is far less likely. Because the underlying loss of brain cells continues, the smooth effect of each dose can shorten over the years.
Company & origin
Originated / developed by: Generic (long-established).
A long-established Parkinson's medicine used in the UK that combines levodopa with benserazide; sold as Madopar.
What it treats
Conditions Co-beneldopa is used for
Practical use
How to take Co-beneldopa
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it regularly at the times you are given, as steady timing helps keep your symptoms under control.
- Capsules and tablets are usually taken with or just after food if they upset your stomach, but very high-protein meals can reduce how well a dose works, so ask about timing around food.
- The dispersible form can be mixed in water for people who find swallowing difficult or who need a faster effect.
- Never stop taking it suddenly or miss several doses, as this can cause a serious reaction; any change should be made gradually with your prescriber.
- Tell your prescriber if the effect seems to wear off before the next dose, or if you notice extra movements, so the schedule can be adjusted.
Weighing it up
Advantages & disadvantages of Co-beneldopa
Advantages
- The most effective treatment for the movement symptoms of Parkinson's, easing slowness, stiffness and tremor.
- The benserazide partner means less nausea and lets a smaller amount of levodopa work well.
- Comes in standard, dispersible and slow-release forms to suit different needs.
Disadvantages
- After some years the effect can 'wear off' between doses and cause extra involuntary movements (dyskinesia).
- Can cause nausea, low blood pressure on standing, sleepiness and sometimes impulsive behaviour.
- Must never be stopped abruptly, and protein-rich meals can reduce how well a dose works.
Practical use
Good to know
Co-beneldopa works in the same way as co-careldopa, its sister medicine; the difference is the helper substance (benserazide rather than carbidopa), and a prescriber may choose or switch between them. It usually gives good control of Parkinson's symptoms for several years, but as the disease progresses many people notice the benefit 'wearing off' before the next dose is due, along with extra involuntary movements (dyskinesia) around peak effect; these can often be smoothed by adjusting the timing or adding other medicines. A very important point is that levodopa should never be stopped suddenly, as this can cause a dangerous reaction, so any change is made gradually under medical guidance. Protein-rich meals can compete with levodopa and reduce how well a dose works, so timing it around food can help. It can also cause sleepiness, sudden urges (such as gambling or shopping) and a harmless darkening of urine or sweat.
Who should not take it / use with caution
- It should not be used by people with certain types of glaucoma (closed-angle) without specialist advice.
- It is avoided in people with some serious heart, hormone or psychiatric conditions unless a specialist decides it is suitable.
- It is not given alongside certain older antidepressants (irreversible MAOIs) without a suitable gap and medical supervision.
Monitoring
- Reviewing how well symptoms are controlled and adjusting the timing or amount as the disease changes.
- Watching for 'wearing-off', extra movements, daytime sleepiness and impulsive behaviour, asking family to report changes.
- Checking blood pressure, mood and standing dizziness, particularly when the medicine is started or changed.
Side effects
- Nausea, loss of appetite and dizziness on standing, especially when starting or increasing it.
- Over time, extra involuntary movements (dyskinesia) and the dose 'wearing off' before the next one is due.
- Sleepiness or sudden sleep, vivid dreams, confusion and sometimes impulsive urges such as gambling or shopping; urine or sweat may darken harmlessly.
Key interactions
- Older antidepressants known as irreversible MAOIs can cause a dangerous rise in blood pressure, so a suitable gap is needed.
- Vitamin B6 (pyridoxine) and high-protein meals can reduce how well levodopa works, and iron supplements lower its absorption, so separate the timing.
- Some medicines for nausea and certain antipsychotics block dopamine and can worsen Parkinson's or reduce the medicine's effect.
Available as: Standard capsules and tablets, dispersible tablets and slow-release (controlled-release) capsules taken by mouth.
Answers
Co-beneldopa: frequently asked questions
What is the difference between co-beneldopa and co-careldopa?
Both combine levodopa with a helper that protects it on the way to the brain; co-beneldopa uses benserazide and co-careldopa uses carbidopa. They work in much the same way, and a prescriber may choose or switch between them.
Why is benserazide added to the levodopa?
Benserazide stops levodopa being broken down before it reaches the brain, so more gets through, a smaller amount works well and there is much less nausea.
Can I stop taking it if I feel better?
No. Levodopa should never be stopped suddenly, as this can cause a serious reaction; any change must be made gradually under medical guidance.
Why does it seem to wear off before my next dose?
As Parkinson's progresses, the smooth effect of each dose can shorten, called 'wearing-off'; tell your prescriber, as the timing or other medicines can often be adjusted to help.
Does food affect how well it works?
Very high-protein meals can compete with levodopa and reduce how well a dose works, so it can help to space the medicine around protein-rich food; ask your prescriber about the best timing.
The wider class
About Levodopa (with benserazide)
Co-beneldopa belongs to the levodopa (with benserazide) class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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