Tidomet/Tidomet CR Special Precautions

Levodopa is contraindicated in patients with angle closure glaucoma and should be used with caution in open-angle glaucoma. Caution is also required in patients with cardiovascular disease, pulmonary disease, endocrine disorders, psychiatric disturbances, osteomalacia, hepatic or renal disease, or a history of peptic ulceration. Periodic evaluations of hepatic, psychiatric, haematological, renal, and cardiovascular functions have been advised.
Since an association between levodopa and activation of malignant melanoma has been suspected (although not confirmed), it is generally recommended that levodopa should not be given to patients with (or with a history of) the disease or with skin disorders suggestive of it.
Parkinsonian patients who benefit from levodopa therapy should be warned to resume normal activities gradually to avoid the risk of injury. Treatment with levodopa should not be stopped abruptly. Excessive daytime sleepiness and sudden onset of sleep may occur with levodopa and caution is advised when driving or operating machinery; patients who suffer such effects should not drive or operate machinery until the effects have stopped recurring.
Levodopa inhibits prolactin secretion and may therefore interfere with lactation. Food interferes with the absorption of levodopa, though levodopa is usually given with or immediately after meals to reduce nausea and vomiting. However, patients experiencing the 'on-off' phenomenon may benefit from dosage on an empty stomach.