Rytary Capsule: Uses, Dosage, Side Effects, Precautions and Alternates

Quick overview

Rytary Capsule is an extended-release prescription medicine containing carbidopa and levodopa, used to treat Parkinson's disease and certain types of parkinsonism. It helps manage symptoms such as muscle stiffness, tremors, spasms, and poor muscle control by delivering medicine that converts into dopamine in the brain. Rytary is taken by mouth, usually several times a day, and comes with important warnings about sudden sleepiness, abrupt discontinuation, and mental health changes.

What is Rytary Capsule

Rytary is an extended-release prescription capsule that contains carbidopa and levodopa. It is used to treat Parkinson's disease and certain types of parkinsonism. It belongs to a class of medicines called dopaminergic antiparkinsonism agents.

Rytary Capsule uses

• Treats symptoms of Parkinson's disease, such as muscle stiffness, tremors, spasms, and poor muscle control
• Treats parkinsonism that follows carbon monoxide poisoning or manganese poisoning
• Treats post-encephalitic parkinsonism

Benefits of Rytary Capsule

• Reduces daily "off" time when symptoms return
• Increases smooth "on" time compared with immediate-release versions
• Helps control muscle stiffness, tremors, spasms, and poor muscle control
• Provides extended-release delivery of carbidopa and levodopa
• Helps improve mobility and muscle coordination
• May reduce periods of reduced medication effectiveness

How Rytary Capsule works

Levodopa changes into dopamine in the brain to help control movement. Carbidopa stops levodopa from breaking down in the bloodstream before it reaches the brain, so more of it gets there.

Rytary Capsule dosage

Take this medicine exactly as your doctor prescribes and follow the directions on your prescription label. Take doses at regular, evenly spaced times to keep a steady amount of medicine in your body. It is usually taken three times a day, and up to five times a day if needed.

Swallow the capsule whole; do not chew, divide, or crush it. If you have trouble swallowing, you can twist the capsule apart and sprinkle the contents onto one to two tablespoons of applesauce, then take it right away; do not save the mixture for later. It can be taken with or without food, though a high-fat, high-calorie meal can delay the medicine from working by two to three hours, so you may want to take your first dose of the day one to two hours before eating.

Do not take other carbidopa and levodopa products with Rytary unless your doctor tells you to. It may take several weeks before your symptoms improve; keep taking it as directed and tell your doctor if it doesn't seem to be working or wears off quickly between doses. Do not stop taking this medicine suddenly; ask your doctor how to stop safely. This medicine is not approved for use in children.

Available forms and strengths

Rytary is available as extended-release oral capsules.

Side effects of Rytary Capsule

Common

• Nausea and vomiting
• Constipation
• Dizziness and lightheadedness
• Headache
• Sleep problems and strange or vivid dreams
• Dry mouth
• Dyskinesia (jerky or twisting uncontrolled movements)
• Anxiety
• Low blood pressure on standing, which can cause lightheadedness, nausea, sweating, or fainting

Serious

• Signs of an allergic reaction: hives, difficulty breathing, swelling of face, lips, tongue, or throat
• Uncontrolled muscle movements in the face such as chewing, lip smacking, frowning, tongue movement, blinking, or eye movement
• New or worsening uncontrolled movements (dyskinesia) or worsening tremors
• Severe or ongoing vomiting or diarrhea
• Confusion, hallucinations, paranoia, agitation, or unusual changes in mood or behavior
• Depression or suicidal thoughts
• Severe nervous system reaction: very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out
• Chest pain or other signs of a heart problem
• Cracking, crusting, or scaling in the corners of the mouth
• Inflammation of the tongue
• Skin rash, or a new or changing mole
• Anemia
• Nerve pain (neuropathy)
• Falling asleep suddenly during daily activities such as driving
• Stomach bleeding: bloody or black, tar-like stools, vomiting blood or material that looks like coffee grounds
• Sudden eye pain or changes in vision, such as blurry vision, seeing halos around lights, or vision loss
• Urges to gamble, binge eat, spend money, or engage in unusual sexual activity

Warnings and precautions

• Some people have fallen asleep suddenly during normal daytime activities, including while driving, sometimes without warning. This can happen even more than a year after starting treatment.
• Do not stop taking this medicine suddenly. Stopping abruptly or lowering the dose too quickly can cause a serious reaction with fever, severe muscle stiffness, confusion, and unstable blood pressure or heart rate.
• This medicine can cause hallucinations and psychosis, usually soon after starting treatment, and should not be used by people with a major psychotic disorder.
• Do not take this medicine if you are taking, or have taken in the past two weeks, a nonselective MAO inhibitor such as phenelzine or tranylcypromine, since this combination can cause dangerously high blood pressure.
• This medicine may lower vitamin B6 levels in the body, which can lead to seizures that don't respond well to usual seizure medicines but improve with vitamin B6.
• Heart problems from reduced blood flow have occurred in people taking this medicine, mostly those who already had heart disease or risk factors for it.
• People taking this medicine may develop intense, uncontrollable urges such as compulsive gambling, spending, eating, or increased sexual urges. They may not notice these changes themselves.
• Tell your doctor if you are pregnant or planning to become pregnant. There isn't enough information on the risk to a pregnancy from Rytary, but in animal studies, the ingredients caused birth defects at doses similar to those used in people.
• Tell your doctor if you are breastfeeding. Levodopa passes into breast milk and can also reduce milk production. Effects on a breastfed baby are not known.
• Tell your doctor if you have kidney disease before taking this medicine.
• Tell your doctor if you have liver disease before taking this medicine.
• Avoid drinking alcohol while taking this medicine, as it can increase drowsiness and is not recommended with certain forms of this medicine.
• Avoid driving or hazardous activities until you know how this medicine affects you, since it can impair your reactions and cause sudden sleep onset.

Storage

• Store at room temperature between 20 and 25 degrees C (68 and 77 degrees F)
• Protect from light and moisture
• Keep the container tightly closed
• Get rid of any unused medication after the expiration date
• Take the medication to a medication take-back program when no longer needed; check with your pharmacy or law enforcement to find a location
• If you cannot return the medication, check the label or package insert to see if it should be thrown in the garbage or flushed; if unsure, ask your care team; if safe to trash, mix the medication with something like cat litter, dirt, or coffee grounds, seal it in a bag, and put it in the trash

When to see a doctor

• Get emergency medical help right away for signs of an allergic reaction: hives, difficulty breathing, or swelling of the face, lips, tongue, or throat.
• Call your doctor right away if you have a severe nervous system reaction with very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, or feeling like you might pass out.
• Call your doctor right away if you have confusion, hallucinations, paranoia, agitation, unusual mood or behavior changes, depression, or suicidal thoughts.
• Call your doctor right away if you have chest pain or other signs of a heart problem.
• Call your doctor right away if you have new or worsening uncontrolled movements, worsening tremors, or uncontrolled movements of the face such as chewing, lip smacking, or blinking.
• Call your doctor right away if you have severe or ongoing vomiting or diarrhea.
• If you think you have taken too much of this medicine, seek emergency medical attention or contact a poison control center right away.
• Contact your care team right away if you fall asleep suddenly without warning during activities like driving, talking, or eating.

Alternatives

• Safinamide
• Rotigotine
• Ropinirole
• Pramipexole