Gastrointestinal:- Anorexia, nausea, vomiting, diarrhoea (less commonly than with levodopa) mainly occurring in the early stages of treatment may be controlled by taking Madopar with some food or liquid or increasing the dose slowly.- Gastro-intestinal bleeding has been reported with levodopa therapy.- Isolated cases of loss or alterations of taste.
Skin:- rarely allergic reactions such as pruritus and rash.
Cardiovascular:- Occasional reports of cardiac arrhythmias and orthostatic hypotension (less frequently than with levodopa alone). Orthostatic disorders usually improve following dosage reduction.
Haematological:- Rare cases of haemolytic anaemia, transient leucopenia and thrombocytopenia.
Neuropsychiatric:- Psychiatric disturbances are common in Parkinsonian patients, including those treated with levodopa, including mild elation, anxiety, agitation, insomnia, drowsiness, depression, aggression, delusions, hallucinations, temporal disorientation and unmasking of psychoses.- Levodopa is associated with somnolence and has been associated very rarely with excessive daytime somnolence and sudden sleep onset episodes.- Involuntary movements (e.g. choreiform or athetotic, oral dyskinesias, paddling foot) are common, particularly on long-term administration. These are usually dose-dependent and may disappear or become tolerable after dose adjustment.
Impulse control disorders:Pathological gambling, increased libido, hypersexuality, compulsive spending or buying, binge eating and compulsive eating can occur in patients treated with dopamine agonists and/or other dopaminergic treatments containing levodopa, including Madopar (see section 4.4 'Special warnings and precautions for use).
Laboratory abnormalities:- Transient rises in SGOT, SGPT and alkaline phosphatase values have been noted.- Increase of gamma-Glutamyltransferase has been reported.- Serum uric acid and blood urea nitrogen levels are occasionally increased.
Others:- Flushing and sweating have been reported with levodopa.- Urine passed during treatment may be altered in colour; usually red-tinged, this will turn dark on standing. These changes are due to metabolites and is no cause for concern.Tolerance to Madopar varies widely between patients and is often related to the rate of dosage increases. With long-term administration, fluctuations in the therapeutic response may be encountered. They include freezing episodes, end-of-dose deterioration and the so-called on-off effect. Patients may be helped by dosage reduction or by giving smaller and more frequent doses.