Skip to content
ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Levodopa + benserazide Pregnancy: Contraindicated in pregnancy and in women of childbearing potential in the absence of adequate contraception; a pregnancy test prior to treatment is recommended to exclude pregnancy, and if pregnancy occurs in a woman taking Madopar the drug must be discontinued as advised by the prescribing physician. The safe use of Madopar during labour and delivery has not been established. The safe use during lactation has not been established and it is not known whether benserazide is excreted in human milk; mothers requiring Madopar treatment should not nurse their infants, as the occurrence of skeletal malformations in the infants cannot be excluded. No fertility studies have been performed.

Co-beneldopa

Brand names: Madopar

Co-beneldopa is a combination of levodopa and benserazide used to treat the motor symptoms of Parkinson's disease.

Adult dose

Dose: Parkinson's disease, adults not previously treated with levodopa: initially one capsule or dispersible tablet of Madopar 50 mg/12.5 mg (levodopa 50 mg with benserazide 12.5 mg) three or four times daily; if the disease is at an advanced stage, the starting dose should be one capsule or dispersible tablet of Madopar 100 mg/25 mg three times daily. The effective maintenance dose usually lies within the range of four to eight capsules or dispersible tablets of Madopar 100 mg/25 mg daily in divided doses (equivalent to two to four capsules of Madopar 200 mg/50 mg), most patients requiring no more than six capsules or dispersible tablets of Madopar 100 mg/25 mg daily
Route: Oral. Capsules and dispersible tablets should be taken 30 minutes before or one hour after meals. Dispersible tablets should be dispersed in at least 25 mL of water per tablet (or, if preferred, dilute orange squash - not orange juice), stirred before administration and used within 30 minutes of preparation
Frequency: Three or four times daily initially, thereafter in divided doses. Increase the daily dosage by one capsule or dispersible tablet of Madopar 100 mg/25 mg, or equivalent, once or twice weekly until a full therapeutic effect is obtained or side-effects supervene. In some elderly patients it may suffice to initiate treatment with one capsule or dispersible tablet of Madopar 50 mg/12.5 mg once or twice daily, increasing by one capsule or dispersible tablet every third or fourth day
Max: It is rarely necessary to give more than ten capsules or dispersible tablets of Madopar 100 mg/25 mg (five capsules of Madopar 200 mg/50 mg) per day
The SPC opens by stating that dosage and frequency of administration are variable and no more than a guide can be given. Source scope: this is the SPC for Madopar 100 mg/25 mg Dispersible Tablets; its section 4.2 covers the immediate-release capsules and dispersible tablets across the 50 mg/12.5 mg, 100 mg/25 mg and 200 mg/50 mg strengths. Modified-release (controlled-release) co-beneldopa dosing is NOT covered by this source. Optimal improvement is usually seen in one to three weeks, but the full therapeutic effect may not be apparent for some time, so allow several weeks to elapse before contemplating dosage increments above the average dose range; treatment should be continued for at least six months before failure is concluded from the absence of a clinical response. Madopar 200 mg/50 mg capsules are only for maintenance therapy once the optimal dosage has been determined using the 100 mg/25 mg strength. Patients who experience fluctuations in response may be helped by dividing the dosage into smaller, more frequent doses using Madopar 50 mg/12.5 mg without altering the total daily dose. SWITCHING - from levodopa alone: discontinue levodopa and start Madopar the following day, at a total of one less Madopar 100 mg/25 mg capsule or dispersible tablet daily than the total number of 500 mg levodopa tablets or capsules previously taken (for example, a patient previously taking 2 g levodopa daily starts on three capsules or dispersible tablets of Madopar 100 mg/25 mg daily); observe for one week, then increase if necessary as for new patients. From another levodopa/decarboxylase inhibitor combination: withdraw previous therapy for 12 hours (it may be beneficial to stop it at night and start Madopar the following morning) and begin with one capsule or dispersible tablet of Madopar 50 mg/12.5 mg three or four times daily. Other anti-Parkinsonian drugs (e.g. anticholinergics, amantadine) should be continued during initiation and may need reduction or gradual withdrawal as the effect of Madopar becomes apparent. Madopar must NOT be withdrawn abruptly - abrupt withdrawal may cause a neuroleptic malignant-like syndrome which may be life-threatening. PAEDIATRIC/YOUNG ADULT RESTRICTION: Madopar is not to be given to patients under 25 years of age (skeletal development must be complete), and the SPC therefore makes no dosage recommendations for children. Some sections of the product information we used were incomplete — check the full SPC.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Known hypersensitivity to levodopa or benserazide or any of the excipients
  • Patients receiving non-selective monoamine oxidase (MAO) inhibitors, because of the risk of hypertensive crisis. Selective MAO-B inhibitors such as selegiline and rasagiline, or selective MAO-A inhibitors such as moclobemide, are not contraindicated, but a combination of MAO-A and MAO-B inhibitors is equivalent to non-selective MAO inhibition and should not be given concomitantly
  • Decompensated endocrine disease (e.g. phaeochromocytoma, hyperthyroidism, Cushing syndrome), decompensated renal or hepatic function, cardiac disorders (e.g. severe cardiac arrhythmias and cardiac failure), psychiatric diseases with a psychotic component, or closed angle glaucoma (it may be used in wide-angle glaucoma provided intra-ocular pressure remains under control)
  • Patients less than 25 years old (skeletal development must be complete)
  • Pregnant women, and women of childbearing potential in the absence of adequate contraception - if pregnancy occurs the drug must be discontinued as advised by the prescribing physician
  • Persons who have a history of, or who may be suffering from, a malignant melanoma - suspicion has arisen that levodopa may activate a malignant melanoma

Side effects

  • Dyskinesia (choreiform and athetotic), fluctuations in therapeutic response, freezing phenomenon, end-of-dose deterioration, on and off phenomenon, restless legs syndrome
  • Somnolence and sudden onset of sleep
  • Psychiatric effects - confusional state, depression, agitation, anxiety, insomnia, hallucination, delusion, disorientation (these may occur particularly in elderly patients and in patients with a history of such disorders)
  • Impulse control disorders and dopamine dysregulation syndrome - pathological gambling, increased libido, hypersexuality, compulsive shopping or buying, binge eating and compulsive eating
  • Nausea, vomiting, diarrhoea, decreased appetite; discolouration of saliva, tongue, teeth and oral mucosa
  • Orthostatic hypotension; arrhythmia
  • Haemolytic anaemia, leukopenia, thrombocytopenia
  • Raised transaminases, alkaline phosphatase and gamma-glutamyltransferase; increased blood urea; chromaturia
  • Pruritus and rash
  • Ageusia and dysgeusia
  • This side-effect list may be incomplete — check the full SPC.

Interactions

  • Non-selective MAO inhibitors are contraindicated (risk of hypertensive crisis); combined MAO-A plus MAO-B inhibition is equivalent to non-selective MAO inhibition and must not be given concomitantly
  • Sympathomimetic drugs (e.g. where required for bronchial asthma) - possible potentiation of the cardiovascular effects of levodopa
  • Antihypertensive drugs - possible increased hypotensive action
  • When other drugs must be given in conjunction with Madopar, the patient should be carefully observed for unusual side-effects or potentiating effects

Monitoring

  • Periodical evaluation of blood cell count should be performed during treatment - decreases in blood cell count (haemolytic anaemia, thrombocytopenia, leukopenia) have been reported, and agranulocytosis and pancytopenia have been reported in a few instances
  • Cardiac function should be monitored with particular care in patients with pre-existing coronary artery disorders, cardiac arrhythmias or cardiac failure, during treatment initiation and regularly thereafter throughout treatment
  • Regular measurement of intraocular pressure is advisable in patients with open-angle glaucoma, as levodopa theoretically has the potential to raise intraocular pressure
  • All patients should be carefully monitored for psychological changes and depression with or without suicidal ideation, and for impulse control disorders and dopamine dysregulation syndrome
  • Close monitoring of patients with risk factors for, or a history of, orthostatic hypotension (e.g. elderly patients, concomitant antihypertensives or other medication with orthostatic potential), especially at the beginning of treatment or at dose increases
  • Care is needed in endocrine, renal, pulmonary or cardiovascular disease, particularly with a history of myocardial infarction or arrhythmia, and in psychiatric disturbance, hepatic disorder, peptic ulcer and osteomalacia

Clinical monograph

How it works

Levodopa is converted to dopamine in the brain to replenish deficient striatal dopamine, while benserazide is a peripheral dopa-decarboxylase inhibitor that reduces peripheral conversion, increasing central availability and limiting peripheral side effects.

Prescribing in practice

  • Do not stop treatment abruptly, as sudden withdrawal can precipitate a neuroleptic malignant syndrome-like reaction.
  • Long-term use is associated with motor fluctuations and dyskinesias, which may require regimen adjustment.
  • Impulse-control disorders and excessive daytime sleepiness can occur with dopaminergic therapy.

Monitoring

Monitor motor response, the emergence of dyskinesias or 'wearing-off', and behavioural changes such as impulse-control disorders and daytime somnolence.

Counselling the patient

  • Never stop this medicine suddenly; speak to the team if doses are missed or changes are needed.
  • Report new gambling, hypersexuality, compulsive shopping or eating, which can be caused by the medicine.
  • Be aware of possible sudden sleepiness, which may affect driving.

Evidence & guidelines

Levodopa-based therapy is the most effective treatment for the motor symptoms of Parkinson's disease and is endorsed by NICE.

Reference: NICE NG71; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways