Indications  

Rytary is a prescribed medication for alleviating symptoms of Parkinson’s disease, including tremors, rigidity, and difficulty in movement.  

Rytary may also be prescribed for managing Parkinson’s-like symptoms resulting from encephalitis (swelling of the brain) or nervous system damage caused by carbon monoxide or manganese poisoning. 

This medication is a combination of carbidopa and levodopa. Levodopa is a central nervous system agent that converts to dopamine in the brain. Conversely, carbidopa is a decarboxylase inhibitor that prevents the breakdown of levodopa in the bloodstream, enabling increased levodopa passage to the brain. Moreover, carbidopa helps alleviate certain side effects of levodopa, including nausea and vomiting. 

Uses and Dosage 

Before starting treatment with Rytary and with each prescription refill, carefully review its medication guide and patient information leaflet. Do not hesitate to consult your healthcare provider or pharmacist for any inquiries. 

The dosage of this medication is determined based on the patient’s medical condition and response to the treatment. 

Typically, Rytary is taken three times a day, as prescribed by the doctor, irrespective of food intake. However, high-protein diets must be avoided if taken with food as they may hinder the absorption of the medication. 

Furthermore, refrain from taking this medication with a high-fat, high-calorie meal, as it can delay its onset by approximately 2 hours. The recommended approach is to take the initial dose of the day around 1 to 2 hours before eating. 

Rytary capsules must be swallowed whole, not crushed or chewed, as doing so can immediately release all medications, thereby raising the potential for adverse reactions. 

In case of difficulty swallowing the capsule, its contents may be sprinkled onto a small amount (1 to 2 tablespoons or 15 to 30 grams) of applesauce. Consume the mixture promptly without chewing, and do not prepare it in advance for future use. 

To achieve optimal results, adhere to the prescribed instructions for taking Rytary. Take it at the same time(s) daily and maintain regular intervals to ensure a consistent drug level in your body throughout the day. 

Certain individuals may encounter a “wearing-off” effect of this medication shortly before the next scheduled dose or experience an “on-off” effect at other times. If these effects arise and cause concern, inform your doctor. Do not adjust the dosage of this or any other medication without consulting your doctor beforehand. 

Consult your doctor before discontinuing Rytary, as abruptly stopping may worsen certain conditions.  

Moreover, sudden cessation of this medication may result in withdrawal symptoms such as anxiety, depression, confusion, fever, and muscle stiffness. To mitigate withdrawal, your doctor may gradually decrease your dosage.  

Side Effects 

Listed below are the potential adverse effects of Rytary. Inform your doctor right away if any of them last or worsen. 

Common Side Effects 

• Jerky or twisting muscle movements 
• Headache or dizziness 
• Low blood pressure (feeling light-headed) 
• Sleep problems or strange dreams 
• Dry mouth 
• Muscle contractions 
• Nausea, vomiting, or constipation 

Serious Side Effects 

• Involuntary facial muscle movements (chewing, lip smacking, frowning, tongue, blinking, or eye movements) 
• Exacerbation of tremors (uncontrolled shaking) 
• Severe or persistent vomiting or diarrhea 
• Confusion, hallucinations, unusual mood or behavioral changes 
• Depression or suicidal thoughts 
• Serious nervous system reaction: 
  • Extreme muscle stiffness 
  • High fever 
  • Sweating 
  • Confusion 
  • Rapid or irregular heartbeats 
  • Tremors 
  • Feeling faint 

Tell your doctor right away if you encounter any serious side effects. 

Certain individuals using Rytary have experienced unintended daytime sleep episodes while engaging in regular activities such as working, talking, eating, or driving. If you encounter any daytime or drowsiness issues, inform your doctor promptly. 

While using this medication, you may experience heightened sexual urges, unusual urges to gamble, or other intense urges. Should such reactions occur, discuss them with your doctor promptly. 

A change in the color of your sweat, urine, or saliva may be observed, appearing dark, such as red, brown, or black. While not harmful, it could lead to clothes or bed sheets staining. 

Allergic Reactions 

Although rare, a severe allergic reaction to Rytary may occur. Seek prompt medical help if you encounter any signs of an allergic response, such as: 

• Hives 
• Breathing difficulties 
• Swelling of face, lips, tongue, or throat 

Not all side effects of Rytary are included in this list. Inform your doctor promptly if any unlisted effects occur. 

Cautions 

Before starting treatment with Rytary, inform your doctor if you have any known allergies, particularly to carbidopa, levodopa, or other medications. 

Consult your pharmacist for further information about Rytary, as it may contain inactive components that may prompt allergic reactions or other complications. 

To ensure Rytary is safe for you, disclose to your physician your medical background, especially if you have a history of: 

• Blood disorders 
• Breathing problems (e.g., asthma, emphysema) 
• Glaucoma 
• Heart or blood vessel problems (e.g., irregular heartbeat, heart attack, angina) 
• Kidney disease 
• Liver disease 
• Mental/mood disorders (e.g., depression, schizophrenia) 
• Ulcers of the stomach/intestines 
• Seizures 
• Sleep disorders 

Notify all healthcare providers of any current or recently started or stopped medications, including prescription and over-the-counter drugs, vitamins, and herbal supplements, to minimize the possibility of drug interaction with Rytary. 

Some products that may interact with Rytary include: 

• Antipsychotic drugs (e.g., chlorpromazine, haloperidol, thioridazine) 
• Certain drugs to treat high blood pressure (e.g., methyldopa) 

Avoid taking MAO inhibitors listed below during treatment with Rytary due to the risk of serious drug interaction: 

• Isocarboxazid 
• Linezolid  
• Metaxalone  
• Methylene blue  
• Moclobemide  
• Phenelzine  
• Procarbazine  
• Tranylcypromine  

Most MAO inhibitors should not be taken for two weeks before starting Rytary. However, certain MAO inhibitors such as rasagiline, safinamide, and selegiline may be used with careful monitoring by your doctor. Consult your doctor for guidance on when to start or stop taking this medication in relation to MAO inhibitors. 

Ensure a considerable time gap between the intake of Rytary and any iron supplements or iron-containing products (e.g., multivitamins with minerals) you might consume. Iron has the potential to decrease the absorption of Rytary in your body. 

Rytary can affect specific lab tests (e.g., urine catecholamine/glucose/ketone tests), leading to false test results. Inform lab personnel and all healthcare providers about your use of this medication. 

The use of Rytary can lead to dizziness, lightheadedness, and fainting when rising too quickly from a lying position. This effect is more prevalent when beginning the medication. To prevent such issues, gradually transition from lying to standing by resting your feet on the floor for a few minutes before fully standing up. 

During pregnancy, the use of Rytary should be limited to situations where it is deemed necessary. Discuss with your doctor the potential risks and benefits of this medication. 

Levodopa is excreted into breast milk in minimal quantities and may impact lactation, while the presence of carbidopa in breast milk is uncertain. Consult your doctor before breastfeeding.