Levomed Special Precautions

LEVOMED may be given to patients already receiving Levodopa alone; however, the Levodopa alone must be discontinued at least 12 hours before LEVOMED is started.
LEVOMED should be substituted at a dosage that will provide approximately 20 percent of the previous Levodopa dosage.
LEVOMED is not recommended for the treatment of drug-induced extrapyramidal reactions.
LEVOMED should be administered cautiously to patients with severe cardiovascular or pulmonary disease, bronchial asthma, renal, hepatic or endocrine disease.
All patients should be monitored carefully for the development of mental changes, depression with suicidal tendencies, or other serious antisocial behaviour.
Patients with current psychoses should be treated with caution.
Patients with a history of severe involuntary movements or psychotic episodes when treated with Levodopa alone should be observed carefully when LEVOMED is substituted.
These reactions are thought to be due to increased brain dopamine following administration of Levodopa, and use of LEVOMED may cause a recurrence.
If concomitant administration of psychoactive drugs such as phenothiazines and butyrophenones is necessary, such drugs should be administered with caution and patients carefully observed for loss of antiparkinsonian effect.
Patients with a history of convulsions should be treated with caution.
The beneficial effects of Levodopa in Parkinson's disease have also been reported to be reversed by phenytoin and by papaverine.
Patients with chronic wide angle glaucoma may be treated cautiously with LEVOMED, provided the intraocular pressure is well controlled and the patient monitored carefully for changes in intraocular pressure during therapy.
Care should be exercised in administering LEVOMED to patients with a history of myocardial infarction who have atrial, nodal, or ventricular arrhythmia. In such patients, cardiac function should be monitored with particular care during the period of initial dosage adjustment.
Symptomatic postural hypotension has been reported occasionally. For this reason, LEVOMED should be given cautiously to patients on antihypertensive drugs. When LEVOMED is started, dosage adjustment of the antihypertensive drug may be required. (For patients receiving pargyline, see the contraindication on monoamine oxidase inhibitors).
As with Levodopa there is a possibility of upper gastrointestinal hemorrhage in patients with a history of peptic ulcer.
If general anesthesia is required, therapy with LEVOMED may be continued as long as the patient is permitted to take fluids and medication by mouth. If therapy is interrupted temporarily, the usual daily dosage may be administered as soon as the patient is able to take oral medication.
Transient abnormalities in laboratory tests which, however, have not been associated with clinical evidence of disease include elevations of blood urea nitrogen, SGOT, SGPT, LDH, bilirubin, alkaline phosphatase or protein bound iodine.
Positive Coombs tests have been reported both with LEVOMED and with Levodopa alone, but haemolytic anemia is extremely rare.
Use in Children: The safety of LEVOMED in patients under 18 years of age has not been established.