Rytary (carbidopa/levodopa) is a brand-name prescription medication. The Food and Drug Administration (FDA) has approved it to treat the following conditions in adults:
- Parkinson’s disease
- Parkinsonism that occurs as a result of:
- a high manganese level
Rytary contains two active drugs, carbidopa and levodopa. Carbidopa is a type of medication called a decarboxylase blocker. Levodopa belongs to a drug class called dopamine precursors.
Rytary is an oral extended-release (ER) capsule. ER means that the drug is released into your body slowly over time. This helps the drug work for a longer period.
At this time, Rytary capsules are only available as a brand-name drug. No generic form of Rytary is currently available. There are generic forms of carbidopa and levodopa ER tablets. However, these come in different strengths and dosages than Rytary. They’re not the same as Rytary and can’t be used interchangeably.
Your doctor can provide more information on how they’ll select the medication prescribed to treat your condition.
For information about the dosing of Rytary, including the Rytary ER dosage, a dosing chart, and how to take the drug, keep reading. For a comprehensive look at Rytary, see this article.
This article describes typical dosages for Rytary provided by the drug’s manufacturer. When taking Rytary, always follow the dosage prescribed by your doctor.
Before you start taking Rytary, your doctor will discuss your treatment plan with you.
Rytary form
Rytary comes as an oral extended-release capsule.
Rytary strengths
Rytary comes in the following strengths:
- 23.75 milligrams (mg) of carbidopa/95 mg of levodopa
- 36.25 mg of carbidopa/145 mg of levodopa
- 48.75 mg of carbidopa/195 mg levodopa
- 61.25 mg of carbidopa/245 mg of levodopa
Typical dosages
Typically, your doctor will start you taking a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.
The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.
Dosage for Parkinson’s and Parkinsonism
The dosage of Rytary is the same, whether you’re taking the drug to treat Parkinson’s disease or Parkinsonism. However, your dosage may be different if you’ve never taken levodopa before, compared with someone who has taken the drug before. Before you start your treatment with Rytary, your doctor will discuss a dosing schedule with you.
Dosage if you haven’t taken levodopa before
If you’ve never taken levodopa before, your doctor will typically recommend starting at a lower dose of Rytary. Then, they will slowly increase your dose over time. This allows your body to adjust to the drug.
Your doctor will likely recommend a starting dose of 23.75 mg of carbidopa/95 mg of levodopa three times per day for the first 3 days. Then, on your fourth day of taking Rytary, your doctor may recommend increasing your dose to 36.25 mg of carbidopa/145 mg of levodopa three times per day.
After that, your doctor will see how well Rytary is working for you. If you still have symptoms of Parkinson’s disease or Parkinsonism, your doctor may recommend increasing your dose even more. In some cases, such as if the drug’s effects are wearing off too quickly, your doctor may recommend taking Rytary more than three times per day. For example, they may recommend taking a dose up to five times per day.
The maximum dosage of Rytary that’s typically recommended is 97.5 mg of carbidopa/390 mg of levodopa three times per day. However, in some cases, the maximum dose may go as high as 612.5 mg of carbidopa/2,450 mg of levodopa per day.
To decrease your risk of side effects including nausea or involuntary muscle movements, your doctor may recommend taking the lowest dose of Rytary possible that works for you. Talk with your doctor about the best dose for your condition.
Dosage if you’re switching from immediate-release levodopa/carbidopa to Rytary
Rytary is an oral extended-release (ER) capsule. It contains the active drugs carbidopa and levodopa. An ER capsule releases the drug into your body slowly over time. This helps the drug to work for a longer period. In comparison, an immediate-release (IR) drug works right after you take your dose.
IR drugs work for a shorter period than ER drugs do. Because of this, you’ll typically have to take IR drugs more often than ER drugs. So, switching from an IR form of this medication to an ER form means that your doctor will likely change your dosage.
If you’re currently taking an IR form of levodopa/carbidopa and want to switch to Rytary, your doctor or pharmacist will calculate the best dose for you. They will do this based on how much levodopa you’re currently taking.
Below is an example of a dosing chart your doctor may use to calculate your dose of Rytary based on how much IR levodopa you’ve been taking:
| Total daily dose of levodopa in current treatment | Typical recommended starting dose of Rytary |
| 400 mg to 549 mg | three capsules of 23.75 mg/95 mg three times per day |
| 550 mg to 749 mg | four capsules of 23.75 mg/95 mg three times per day |
| 750 mg to 949 mg | three capsules of 36.25 mg/145 mg three times per day |
| 950 mg to 1249 mg | three capsules of 48.75 mg/195 mg three times per day |
| 1,250 mg or more | four capsules of 48.75 mg/195 mg three times per day, or three capsules of 61.25 mg/245 mg three times per day |
So, for example, if you’re currently taking an IR formulation of 50 mg of carbidopa/200 mg of levodopa three times per day, your total daily levodopa dose will be 600 mg. In this case, you will start taking Rytary at a dose of four capsules of 23.75 mg of carbidopa/95 mg of levodopa three times per day. Then, your doctor may adjust your dose of Rytary based on how well the drug is working for you.
The maximum recommended dose of Rytary is 612.5 mg of carbidopa/2,450 mg of levodopa per day. If you have questions or concerns about the best dose of Rytary for you, talk with your doctor.
Long-term treatment
Rytary is meant to be a long-term treatment. If you and your doctor determine that Rytary is safe and effective for you, you’ll likely take it long term.
Below are the answers to some frequently asked questions about the dosage of Rytary.
If my doctor switches me to Rytary, is there a dosing conversion tool or calculator?
Yes, there is a dosing conversion tool available for your doctor to calculate the best dosage of Rytary for you. This conversion tool is available on the drug manufacturer’s website for your doctor to use. They can then determine what the best dose of Rytary will be for you if you’re switching from an immediate-release (IR) form of carbidopa/levodopa.
Your dosage of Rytary will be calculated based on how much levodopa you are currently taking in your IR treatment. For a conversion chart and more information, refer to “Dosage if you’re switching from immediate-release levodopa/carbidopa to Rytary” in the “Rytary dosage” section above.
If you have additional questions about your dose of Rytary, talk with your doctor.
How long should I wait between each dose of Rytary?
In most cases, Rytary is taken three times per day. So, the manufacturer recommends waiting 4 to 6 hours between each dose of Rytary before taking another dose of medication. For example, if you take your first dose at 9:00 a.m., you can then take your second dose at any time between 1:00 p.m. and 3:00 p.m. You can take your third dose 4 to 6 hours after that.
If you have specific questions about when to take each dose of Rytary, discuss your treatment plan with your doctor.
In addition, if you feel as if your medication is wearing off before reaching 4 to 6 hours, tell your doctor. In some cases, they may recommend increasing how often you take your dose of Rytary. Though it’s typically taken three times per day, Rytary can be taken up to five times per day if your doctor recommends it.
If you miss your dose of Rytary, contact your doctor or pharmacist. They can help determine when you should take your next dose of medication. In some cases, they may recommend taking your missed dose as soon as you remember. Other times, such as if it’s almost time for your next dose, they may recommend skipping your missed dose. In this case, you would continue on with your typical medication schedule.
You should not take two doses of Rytary at the same time to make up for a missed dose. Doing so may increase your risk of side effects.
To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm or using a timer. You could also download a reminder app on your phone.
The Rytary dosage your doctor prescribes will depend on several factors. These include:
- the severity of the condition you’re taking Rytary to treat
- whether you took a medication in the past that contains levodopa before switching to Rytary
- other medications that you take with Rytary
Other medical conditions you may have can also affect your Rytary dosage.
Rytary comes as an oral capsule. Be sure to swallow your Rytary capsule whole. The capsules should not be chewed, crushed, or divided. This is because the drug is an extended-release form, and crushing or breaking apart the capsule can cause you to get too much medication at once.
If you have trouble swallowing capsules, see this article for tips on how to take this form of medication. You can also talk with your doctor or pharmacist. In some cases, your doctor may recommend opening the capsule and sprinkling it into applesauce. Be sure to take the combination of Rytary and applesauce right away. This can make it easier for you to swallow your dose.
Taking your dose of Rytary with a high fat, high calorie meal may cause the medication to work slower than it should. This is because this type of meal can slow down your body’s absorption of Rytary.
It may be helpful to take Rytary around the same time every day. This helps maintain a steady level of the drug in your body so Rytary can work effectively.
ACCESSIBLE DRUG LABELS AND CONTAINERSIf you’re having trouble reading your prescription label, talk with your doctor or pharmacist. Some pharmacies offer labels with large print, braille, or a code you scan with a smartphone to convert text to speech. If your local pharmacy doesn’t have these options, your doctor or pharmacist might be able to recommend a pharmacy that does.
If you’re having trouble opening medication bottles, ask your pharmacist about putting Rytary in an easy-open container. They also may recommend tools that can make it easier to open bottles.
If you take more Rytary than your doctor prescribes, you may develop serious side effects.
It’s important that you don’t take more Rytary than your doctor advises.
Symptoms of an overdose
Overdose symptoms of Rytary can include:
- low blood pressure
- kidney problems
- involuntary muscle movements
- psychosis
- an irregular heart rate
If you take more than the recommended amount of Rytary
Call your doctor right away if you believe you’ve taken too much Rytary. Another option is to call the American Association of Poison Control Centers at 800-222-1222 or use its online tool. If you have severe symptoms, immediately call 911 or your local emergency number, or go to the nearest emergency room.
You should not stop treatment with Rytary suddenly. Suddenly stopping Rytary or decreasing your dose of the medication too quickly can cause you to experience withdrawal symptoms. Withdrawal symptoms can occur when your body is used to a medication that you suddenly stop taking.
Withdrawal symptoms of this drug may include symptoms similar to those of a condition called neuroleptic malignant syndrome. These may include:
- a high fever
- changes in your level of consciousness
- rigid muscles
- confusion
- a fast or slow heart rate
Because of the risks of suddenly stopping Rytary, it’s important to talk with your doctor before stopping treatment with this medication. They can recommend a plan to slowly reduce your dose of Rytary over time. This will help your body adjust to not having the drug, which decreases the risk of withdrawal symptoms occurring.
The dosages in this article are typical dosages provided by the drug manufacturer. If your doctor recommends Rytary for you, they will prescribe the dosage that’s right for you. Always follow the dosage that your doctor prescribes.
As with any drug, never change your dosage of Rytary without your doctor’s recommendation. If you have questions about the dosage of Rytary that’s best for you, talk with your doctor.
Besides learning about dosage, you may want other information about Rytary. These additional articles might be helpful:
- More about Rytary. For information about other aspects of Rytary, refer to this article.
- Drug comparison. To find out how Rytary compares with Sinemet, read this article.
- Details about your condition. For details about Parkinson’s, see our Parkinson’s disease hub.
Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
