Stalevo for Parkinson’s

Stalevo is a prescription Parkinson’s disease medication that combines carbidopa, levodopa, and entacapone in one tablet. It may be used for people who need the same combination as separate medicines or for some patients whose carbidopa/levodopa wears off before the next dose. Stalevo can help manage motor symptoms, but it can also cause side effects such as dyskinesia, nausea, diarrhea, dizziness, sleepiness, hallucinations, and low blood pressure.

Stalevo is not a cure for Parkinson’s disease. It is a symptom-management medication that should be taken exactly as prescribed. The right dose depends on a person’s current levodopa schedule, wearing-off symptoms, side effect history, and other medical conditions.

Medical Disclaimer: This article is for educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Do not start, stop, or change the dose or timing of Stalevo or any Parkinson’s medication unless your healthcare provider tells you to. Parkinson’s medications can affect movement, blood pressure, sleep, thinking, mood, and safety, so medication changes should be guided by a clinician.

What is Stalevo?

Stalevo is a brand-name prescription medication for Parkinson’s disease. It combines three medicines in one tablet:

Levodopa is the main symptom-treating ingredient. Carbidopa supports levodopa by helping limit its breakdown before it reaches the brain. Entacapone is added to extend levodopa’s effect in some people, especially when symptoms return before the next dose.

How does Stalevo work for Parkinson’s disease?

Stalevo works by increasing and extending levodopa’s effect. Parkinson’s disease affects brain pathways involved in movement, and many symptoms are linked to reduced dopamine activity. Levodopa helps because the body can convert it into dopamine. This helps improve movement symptoms such as:

• • slowness
  • stiffness
  • tremor
  • difficulty moving

It does not reverse Parkinson’s disease, but it can improve daily function for many patients.

Carbidopa, the second ingredient, helps prevent levodopa from being broken down too early outside the brain. This helps more levodopa get to the brain, where it can be converted into dopamine. Carbidopa can also help reduce levodopa-related nausea for some patients.

Entacapone, Stalevo’s third ingredient, is a COMT inhibitor. COMT stands for catechol-O-methyltransferase, an enzyme involved in breaking down levodopa outside the brain. By blocking COMT, entacapone may help levodopa last longer between doses.

How effective is Stalevo for Parkinson’s symptoms?

Stalevo may help some people with Parkinson’s disease whose levodopa benefit wears off before the next dose. It can reduce end-of-dose wearing-off symptoms in selected patients, but it does not work the same way for everyone and may increase side effects in some people.

“Wearing off” means Parkinson’s symptoms return before the next scheduled medication dose. Symptoms may include stiffness, tremor, slowness, trouble walking, or a general feeling that the medication has stopped working.

The Parkinson’s Foundation notes that clinicians may manage OFF time by adjusting Parkinson’s medications, using longer-acting options, adding medicines that help levodopa last longer, or using quick-acting treatments for sudden OFF periods. It also cautions that increasing levodopa exposure may reduce OFF time but can increase side effects such as dyskinesia (involuntary movements), dizziness, or nausea.

Does Stalevo help with wearing-off symptoms?

Across randomized trials and pooled evidence, Stalevo or its equivalent triple regimen generally improves wearing-off symptoms by extending ON time, reducing OFF time, and improving daily functioning or motor scores compared with levodopa/DDCI alone.

In one study, over 70% of patients in both groups reported clinical improvement, and over 80% had reduced fluctuations. Stalevo had similar motor improvement to levodopa/DDCI plus separate entacapone, with 81% preferring Stalevo over taking two separate tablets.

Another study showed that the OFF-time category improved in 36% with entacapone versus 22% with placebo, and 28% of entacapone patients reduced their daily levodopa dose.

A 2025 study published in Frontiers in Neurology found that Stalevo-type therapy helped Parkinson’s patients spend about 1.5-1.8 fewer hours per day in OFF time and increased good symptom control time by about 1.4-1.6 hours per day, with generally mild side effects.

Who might be prescribed Stalevo?

Stalevo may be prescribed for people with Parkinson’s disease who already take carbidopa/levodopa plus entacapone as separate tablets, or for some people taking carbidopa/levodopa who have end-of-dose wearing-off symptoms.

Who may not be a good candidate?

Stalevo may not be right for people with certain risks or medical histories. Contraindications for carbidopa, levodopa, and entacapone tablets include the use with nonselective MAO inhibitors and having narrow-angle glaucoma.

It may also not be recommended for people currently taking any of the following medications because of potential drug-drug interactions.

• • MAO Inhibitors
  • Drugs metabolized by catechol-o-methyltransferase (COMT)
  • Antihypertensive agents
  • Tricyclic antidepressants
  • Dopamine D2 receptor antagonists (e.g., metoclopramide, phenothiazines, butyrophenones, risperidone)
  • Isoniazid
  • Phenytoin
  • Papaverine
  • Iron salts or multi-vitamins containing iron salts
  • Drugs known to interfere with biliary excretion, glucuronidation, and intestinal beta-glucuronidase, including probenecid, cholestyramine, and some antibiotics (e.g., erythromycin, rifampicin, ampicillin, and chloramphenicol).
  • Drugs metabolized via CYP2C9 (e.g., coumadin)

What Stalevo doses and strengths are available?

Stalevo is a fixed-dose combination of levodopa/carbidopa/entacapone, and it comes in several tablet strengths. Each tablet contains 200 mg of entacapone, while the levodopa and carbidopa amounts vary by strength.

The dose is individualized. This means the doctor adjusts the strength and timing based on how well symptoms are controlled and whether side effects occur.

Maximum tablets per day

How is Stalevo taken?

Stalevo is taken by mouth as a tablet:

• • Take only 1 tablet at each dosing time
  • Do not split, crush, or chew the tablet
  • It can be taken with or without food
  • A high-fat, high-calorie meal may delay levodopa absorption by about 2 hours

Switching from separate tablets

If you’re currently taking separate carbidopa/levodopa + entacapone, you may be switched to the matching Stalevo strength.

Example:

• • Carbidopa/levodopa 25 mg/100 mg
  • Plus entacapone 200 mg

Can be switched to:

• • One Stalevo 100 tablet, which contains carbidopa 25 mg, levodopa 100 mg, and entacapone 200 mg

Dose adjustments

Some patients may need a lower levodopa dose when entacapone is added, especially if they:

• • Have moderate or severe dyskinesia
  • Take more than 600 mg of levodopa per day

The dose can be lowered by:

• • Using a lower Stalevo strength, or
  • Taking doses less often by spacing them farther apart

Note: Stalevo should not be stopped suddenly unless directed by a doctor, because suddenly reducing or stopping levodopa medicines can cause serious reactions such as high fever and severe stiffness.

What are the most common side effects of Stalevo?

Common Stalevo side effects may include:

• • nausea
  • abdominal pain
  • diarrhea
  • dizziness
  • sleepiness
  • dry mouth
  • constipation
  • urine discoloration
  • dyskinesia (extra involuntary movements)
  • hyperkinesia (excessive or abnormal body movement)

Some side effects are related to levodopa exposure. Others may relate to entacapone or the combination of medicines. Side effects should be reported if they are severe, persistent, new, or interfere with safety.

Notice: On March 20, 2026, the Food and Drug Administration (FDA) released a MedWatch safety alert stating that levodopa and carbidopa may cause vitamin B6 deficiency, which can potentially result in seizures. Your healthcare provider may monitor your vitamin B6 levels before starting treatment and throughout therapy. Seek immediate medical attention or inform your doctor right away if you experience symptoms such as seizures, depression, confusion, swelling or inflammation of the lips, tongue, or skin, as well as numbness, tingling, sharp pain, or muscle weakness in your arms or legs.

Serious side effects of Stalevo

Seek urgent medical help for the following adverse events:

• • chest pain
  • trouble breathing
  • Fainting
  • severe allergic reaction
  • severe confusion
  • sudden sleep episodes
  • dangerous hallucinations
  • severe involuntary movements
  • high fever with muscle stiffness after medication changes

Serious side effects are less common, but should be addressed immediately since they can affect alertness, blood pressure, thinking, mood, movement, and behavior.

How much does Stalevo cost?

In the US, brand-name Stalevo 100 is listed on Drugs.com at about $807.80 for 100 tablets. That equals about $8.08 per tablet. A separate drug-pricing source lists Stalevo at $7.43 per tablet or about $743.49 for a 100-tablet bottle.

To lower your costs, generic carbidopa/levodopa/entacapone is available in the US. GoodRx lists prices for generic Stalevo starting around $116.15, which is much lower than the brand price. Availability can vary by pharmacy and dosage strength.

Summary

Stalevo combines carbidopa, levodopa, and entacapone in one tablet. It can simplify treatment for certain patients and may extend levodopa’s effect. However, it requires careful dosing and monitoring for dyskinesia, dizziness, diarrhea, hallucinations, sleepiness, impulse-control changes, and interactions.

Stalevo may be worth discussing if Parkinson’s symptoms return before the next carbidopa/levodopa dose or if a patient already takes carbidopa/levodopa and entacapone separately. It may help some people manage wearing off, but it can also increase side effects and is not suitable for everyone.

Talk with a neurologist, movement disorder specialist, pharmacist, or prescribing clinician before making any changes to Parkinson’s medication.

Frequently Asked Questions

Sources

Brooks, D., Agid, Y., Eggert, K., Widner, H., Østergaard, K., & Holopainen, A. (2005). Treatment of End-of-Dose Wearing-Off in Parkinson’s Disease: Stalevo^® (Levodopa/Carbidopa/Entacapone) and Levodopa/DDCI Given in Combination with Comtess^®/Comtan^® (Entacapone) Provide Equivalent Improvements in Symptom Control Superior to That of Traditional Levodopa/DDCI Treatment. European Neurology, 53(4), 197–202. https://doi.org/10.1159/000086479

Fénelon, G., Giménez-Roldán, S., Montastruc, J. et al. Efficacy and tolerability of entacapone in patients with Parkinson’s disease treated with levodopa plus a dopamine agonist and experiencing wearing-off motor fluctuations. A randomized, double-blind, multicentre study. J Neural Transm 110, 239–251 (2003). https://doi.org/10.1007/s00702-002-0799-z

Yu, C., Liu, W., Gong, A., Ye, M., Huang, H., Zhao, Y., Liu, C., Guo, Y., Chen, J., Zhang, X., Chen, X., Shen, L., & Li, D. (2025). Levodopa/carbidopa/entacapone versus levodopa/benserazide plus pramipexole in Chinese patients with Parkinson’s disease experiencing wearing off. Frontiers in Neurology, 16, 1682614. https://doi.org/10.3389/fneur.2025.1682614

Managing “Off” time in Parkinson’s. (n.d.). Parkinson’s Foundation. https://www.parkinson.org/library/fact-sheets/managing-off-time

DailyMed – CARBIDOPA, LEVODOPA AND ENTACAPONE tablet, film coated. (n.d.). https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2f8e82d7-6baf-456a-b8c3-4fda6e317902

Carbidopa, entacapone, and levodopa (oral route). (2026, May 1). Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/carbidopa-entacapone-and-levodopa-oral-route/description/drg-20061604