Effectiveness of Stalevo Drug Usage in Parkinson's Patients: A Narrative Review
DOI:
10.29303/jppipa.v12i3.14651Published:
2026-03-25Downloads
Abstract
Parkinson's Disease (PD) is a neurodegenerative disorder that affects patients' quality of life, with primary motor symptoms such as tremor, muscle rigidity, and bradykinesia. Levodopa is the mainstay of PD therapy, but approximately 80% of patients experience motor complications, such as motor fluctuations and "wearing-off" after several years of therapy. This study evaluates the efficacy, safety, and rational use of Stalevo (levodopa, carbidopa, and entacapone) in managing motor complications and "wearing-off" phenomena in patients with Parkinson's Disease (PD). This research was conducted as a narrative review to provide a recent evidence-based synthesis of the efficacy and safety of Stalevo. Methods included a search of articles in PubMed, ScienceDirect, and Google Scholar published between 2015 and 2025 using the keywords "Stalevo" and "Parkinson's disease." The study revealed that Stalevo was effective in prolonging the duration of levodopa's effect, reducing the required levodopa dose, and improving patients' quality of life, particularly in patients with motor fluctuations. Although side effects such as dyskinesia and diarrhea may occur, Stalevo's overall safety profile is well-received. Stalevo is a cost-effective, evidence-based intervention for intermediate-to-advanced PD. Rational use requires precise patient selection and monitoring for dopaminergic side effects, such as dyskinesia and diarrhea, to optimize quality of life and ensure patient safety.
Keywords:
Antiparkinson agents Catechol O-Methyltransferase inhibitors Drug combinations Levodopa Parkinson's disease Treatment outcomeReferences
Armstrong, M. J., & Okun, M. S. (2020). Diagnosis and Treatment of Parkinson Disease. JAMA, 323(6), 548. https://doi.org/10.1001/jama.2019.22360 DOI: https://doi.org/10.1001/jama.2019.22360
Barić, V. (2021). The role of COMT inhibitors in the management of Parkinson’s disease. Current Pharmaceutical Design, 27(10), 1275–1282. https://doi.org/10.2174/1381612826666201109110415
Boiko, A. N., Batysheva, T. T., Minaeva, N. G., Babina, L. A., Vdovichenko, T. V, Zhuravleva, E. Y., Shikhkerimov, R. K., Malykhina, E. A., Khozova, A. A., Zaitsev, K. A., & Kostenko, E. V. (2008). Use of the new levodopa agent Stalevo (levodopa/carbidopa/entacapone) in the treatment of Parkinson’s disease in out-patient clinical practice (the START-M open trial). Neuroscience and Behavioral Physiology, 38(9), 933–936. https://doi.org/10.1007/s11055-008-9085-3 DOI: https://doi.org/10.1007/s11055-008-9085-3
Brooks, D. J., 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 Con. European Neurology, 53(4), 197–202. https://doi.org/10.1159/000086479 DOI: https://doi.org/10.1159/000086479
Corporation, O. (2010). Stalevo (carbidopa, levodopa and entacapone) tablets prescribing information. In Food and Drug Administration. Silver Spring. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020796s015lbl.pdf
Dams, J., Zapp, J.-J., & König, H.-H. (2023). Modelling the Cost Effectiveness of Treatments for Parkinson’s Disease: An Updated Methodological Review. PharmacoEconomics, 41(10), 1205–1228. https://doi.org/10.1007/s40273-023-01289-0 DOI: https://doi.org/10.1007/s40273-023-01289-0
Ferreira, J. J., Katzenschlager, R., Bloem, B. R., Bonuccelli, U., Burn, D., Deuschl, G., Dietrichs, E., Fabbrini, G., Friedman, A., Kanovsky, P., Kostic, V., Nieuwboer, A., Odin, P., Poewe, W., Rascol, O., Sampaio, C., Schüpbach, M., Tolosa, E., Trenkwalder, C., … Oertel, W. H. (2013). Summary of the recommendations of the EFNS/MDS-ES review on therapeutic management of Parkinson’s disease. European Journal of Neurology, 20(1), 5–15. https://doi.org/10.1111/j.1468-1331.2012.03866.x DOI: https://doi.org/10.1111/j.1468-1331.2012.03866.x
Findley, L. J., Lees, A., Apajasalo, M., Pitkänen, A., & Turunen, H. (2005). Cost-effectiveness of levodopa/carbidopa/entacapone (Stalevo) compared to standard care in UK Parkinson’s disease patients with wearing-off. Current Medical Research and Opinion, 21(7), 1005–1014. https://doi.org/10.1185/030079905X49653 DOI: https://doi.org/10.1185/030079905X49653
Fox, S. H., Katzenschlager, R., Lim, S., Barton, B., de Bie, R. M. A., Seppi, K., Coelho, M., & Sampaio, C. (2018). International Parkinson and movement disorder society evidence‐based medicine review: Update on treatments for the motor symptoms of Parkinson’s disease. Movement Disorders, 33(8), 1248–1266. https://doi.org/10.1002/mds.27372 DOI: https://doi.org/10.1002/mds.27372
Habet, S. (2022). Clinical Pharmacology of Entacapone (Comtan) From the FDA Reviewer. International Journal of Neuropsychopharmacology, 25(7), 567–575. https://doi.org/10.1093/ijnp/pyac021 DOI: https://doi.org/10.1093/ijnp/pyac021
Hauser, R. A., Poewe, LeWitt, Olanow, Brooks, Reinikainen, Stocchi, & Obeso. (2004). Levodopa/carbidopa/entacapone (Stalevo). Neurology, 62(1), 64– 71. https://doi.org/10.1212/wnl.62.1_suppl_1.s64 DOI: https://doi.org/10.1212/WNL.62.1_suppl_1.S64
Horstink, M. W. I. M., Dekker, M. C., Montagna, P., Bonifati, V., & van De Warrenburg, B. P. (2010). Pallidopyramidal disease: A misnomer? Movement Disorders, 25(9), 1109–1115. https://doi.org/10.1002/mds.23118 DOI: https://doi.org/10.1002/mds.23118
Hsu, A., Yao, H., Gupta, S., & Modi, N. B. (2015). Comparison of the pharmacokinetics of an oral extended‐release capsule formulation of carbidopa‐levodopa (IPX066) with immediate‐release carbidopa‐levodopa (Sinemet ® ), sustained‐release carbidopa‐levodopa (Sinemet ® CR), and carbidopa‐levodopa‐entacapon. The Journal of Clinical Pharmacology, 55(9), 995–1003. https://doi.org/10.1002/jcph.514 DOI: https://doi.org/10.1002/jcph.514
Ingman, K., Naukkarinen, T., Vahteristo, M., Korpela, I., Kuoppamäki, M., & Ellmén, J. (2012). The effect of different dosing regimens of levodopa/carbidopa/entacapone on plasma levodopa concentrations. European Journal of Clinical Pharmacology, 68(3), 281–289. https://doi.org/10.1007/s00228-011-1121-5 DOI: https://doi.org/10.1007/s00228-011-1121-5
Jenner, P. (2023). Stalevo ® : A pioneering treatment for OFF periods in Parkinsons disease. European Journal of Neurology, 30(S2), 3–8. https://doi.org/10.1111/ene.15994 DOI: https://doi.org/10.1111/ene.15994
Jenner, P., Poewe, W., & Reichmann, H. (2023). The 20th anniversary of the first clinical use of Stalevo ®. European Journal of Neurology, 30(S2), 1–2. https://doi.org/10.1111/ene.15996 DOI: https://doi.org/10.1111/ene.15996
Koller, W., Guarnieri, M., Hubble, J., Rabinowicz, A. L., & Silver, D. (2005). An open-label evaluation of the tolerability and safety of Stalevo� (carbidopa, levodopa and entacapone) in Parkinson?s disease patients experiencing wearing-off. Journal of Neural Transmission, 112(2), 221–230. https://doi.org/10.1007/s00702-004-0184-1 DOI: https://doi.org/10.1007/s00702-004-0184-1
Koprich, J., Johnston, T., Howson, P., Reyes, G., Omana, V., & Brotchie, J. (2018). Characterization and reproducibility of a macaque model of Parkinson’s disease alpha-synucleinopathy. Parkinsonism & Related Disorders, 46, e3–e4. https://doi.org/10.1016/j.parkreldis.2017.11.012 DOI: https://doi.org/10.1016/j.parkreldis.2017.11.012
Larasanti, P., Purwa Samatra, D. P. G., Trisnawati, S. Y., & Sumada, I. K. (2020). Karakteristik Klinis Dan Derajat Berat Gejala Motorik Penyakit Parkinson Di RSUP Sanglah Dan RSUD Wangaya Denpasar. Callosum Neurology, 3(1), 6–11. https://doi.org/10.29342/cnj.v3i1.106 DOI: https://doi.org/10.29342/cnj.v3i1.106
Lees, A., Tolosa, E., Stocchi, F., Ferreira, J. J., Rascol, O., Antonini, A., & Poewe, W. (2023). Optimizing levodopa therapy, when and how? Perspectives on the importance of delivery and the potential for an early combination approach. Expert Review of Neurotherapeutics, 23(1), 15–24. https://doi.org/10.1080/14737175.2023.2176220 DOI: https://doi.org/10.1080/14737175.2023.2176220
Männistö, P. T., Keränen, T., Reinikainen, K. J., Hanttu, A., & Pollesello, P. (2024). The Catechol O-Methyltransferase Inhibitor Entacapone in the Treatment of Parkinson’s Disease: Personal Reflections on a First-in-Class Drug Development Programme 40 Years On. Neurology and Therapy, 13(4), 1039–1054. https://doi.org/10.1007/s40120-024-00629-2 DOI: https://doi.org/10.1007/s40120-024-00629-2
Medsafe. (2021). Stalevo data sheet. Wellington, NZ: New Zealand Medicines and Medical Devices Safety Authority. Retrieved from https://www.medsafe.govt.nz/profs/datasheet/s/stalevotab.pdf
Moga, S., Teodorescu, A., Ifteni, P., Petric, P.-S., & Miron, A.-A. (2022). Clozapine and Neutropenia in Patients with Schizophrenia and SARS-CoV-2 Infection. Neuropsychiatric Disease and Treatment, Volume 18, 977–983. https://doi.org/10.2147/NDT.S361405 DOI: https://doi.org/10.2147/NDT.S361405
Oktariza, Y., Amalia, L., Sobaryati, S., & Kurniawati, M. Y. (2019). Evaluasi Kualitas Hidup Pasien Parkinson Berdasarkan Terapi Berbasis Levodopa. Indonesian Journal of Clinical Pharmacy, 8(4), 246. https://doi.org/10.15416/ijcp.2019.8.4.246 DOI: https://doi.org/10.15416/ijcp.2019.8.4.246
Olanow, C. W., Kieburtz, K., Rascol, O., Poewe, W., Schapira, A. H., Emre, M., Nissinen, H., Leinonen, M., & Stocchi, F. (2013). Factors predictive of the development of Levodopa‐induced dyskinesia and wearing‐off in Parkinson’s disease. Movement Disorders, 28(8), 1064–1071. https://doi.org/10.1002/mds.25364 DOI: https://doi.org/10.1002/mds.25364
Poewe, W., Seppi, K., Tanner, C. M., Halliday, G. M., Brundin, P., Volkmann, J., Schrag, A.-E., & Lang, A. E. (2017). Parkinson disease. Nature Reviews Disease Primers, 3(1), 17013. https://doi.org/10.1038/nrdp.2017.13 DOI: https://doi.org/10.1038/nrdp.2017.13
Poulopoulos, M., & Waters, C. (2010). Carbidopa/levodopa/entacapone: The evidence for its place in the treatment of Parkinson’s disease. Core Evidence, 5, 1–10. https://doi.org/10.2147/ce.s7031 DOI: https://doi.org/10.2147/CE.S7031
Putri, R. N., & Zein, I. S. (2023). Parkinson disease. An-Najat: Jurnal Ilmu Farmasi Dan Kesehatan, 1(4), 183–193. Retrieved from https://jurnal.stikes-ibnusina.ac.id/index.php/an-Najat/article/view/556 DOI: https://doi.org/10.59841/an-najat.v1i4.556
Reichmann, H. (2023). Real-world considerations regarding the use of the combination of levodopa, carbidopa, and entacapone (Stalevo®) in Parkinson’s disease. European Journal of Neurology, 30(S2), 15–20. https://doi.org/10.1111/ene.15992 DOI: https://doi.org/10.1111/ene.15992
Ruggiero, T., Carossa, M., Camisassa, D., Bezzi, M., Rivetti, G., Nobile, V., & Pol, R. (2024). Hyaluronic Acid Treatment of Post-Extraction Tooth Socket Healing in Subjects with Diabetes Mellitus Type 2: A Randomized Split-Mouth Controlled Study. Journal of Clinical Medicine, 13(2), 452. https://doi.org/10.3390/jcm13020452 DOI: https://doi.org/10.3390/jcm13020452
Schapira, A. H. V., Chaudhuri, K. R., & Jenner, P. (2017). Non-motor features of Parkinson disease. Nature Reviews Neuroscience, 18(7), 435–450. https://doi.org/10.1038/nrn.2017.62 DOI: https://doi.org/10.1038/nrn.2017.62
Sethi, K. D., Hauser, R. A., Isaacson, S. H., & McClain, T. (2009). Levodopa/carbidopa/entacapone 200/50/200 mg (Stalevo® 200) in the treatment of Parkinson’s disease: a case series. Cases Journal, 2(1), 7134. https://doi.org/10.4076/1757-1626-2-7134 DOI: https://doi.org/10.4076/1757-1626-2-7134
Sivanandy, P., Leey, T. C., Xiang, T. C., Ling, T. C., Wey Han, S. A., Semilan, S. L. A., & Hong, P. K. (2021). Systematic Review on Parkinson’s Disease Medications, Emphasizing on Three Recently Approved Drugs to Control Parkinson’s Symptoms. International Journal of Environmental Research and Public Health, 19(1), 364. https://doi.org/10.3390/ijerph19010364 DOI: https://doi.org/10.3390/ijerph19010364
Solla, P. (2010). Therapeutic interventions and adjustments in the management of Parkinson disease: role of combined carbidopa/levodopa/entacapone (Stalevo®). Neuropsychiatric Disease and Treatment, 6, 483. https://doi.org/10.2147/NDT.S5190 DOI: https://doi.org/10.2147/NDT.S5190
Trosch, J. S. (2012). Entacapone: A review of its use in the treatment of Parkinson’s disease. Expert Opinion on Pharmacotherapy, 13(7), 1041–1052. https://doi.org/10.1517/14656566.2012.673587
License
Copyright (c) 2026 M Andri Prasetyo, Fauna Herawati

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with Jurnal Penelitian Pendidikan IPA, agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution 4.0 International License (CC-BY License). This license allows authors to use all articles, data sets, graphics, and appendices in data mining applications, search engines, web sites, blogs, and other platforms by providing an appropriate reference. The journal allows the author(s) to hold the copyright without restrictions and will retain publishing rights without restrictions.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Jurnal Penelitian Pendidikan IPA.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).






