Drug interactions
Asenapine + Levodopa inhaled
Severity: Major
Asenapine and Levodopa inhaled: major interaction.
Last updated Sources: UK SmPC
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Asenapine blocks dopamine D2 receptors and can directly oppose the dopaminergic effect of levodopa. This may cause loss of motor control in Parkinson's disease, with worsening of symptoms during OFF periods.
What this interaction means in plain words
Asenapine and Levodopa inhaled can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Pharmacodynamic antagonism: D2 receptor blockade by asenapine opposes dopamine replacement by levodopa.
What to do
Avoid the combination where possible; if an antipsychotic is needed in Parkinson's disease, choose quetiapine or clozapine instead. Monitor motor function closely if asenapine cannot be avoided.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
- Sycrest 10mg sublingual tablets - SmPC sections 4.3/4.5 (names the partner; "Asenapine may antagonise the effect of levodopa and dopamine agonists.") — electronic medicines compendium (UK SmPC)
Other interactions of Asenapine
- Asenapine + Pimozide Contraindicated
- Asenapine + Thioridazine Contraindicated
- Asenapine + Vandetanib Contraindicated
- Adagrasib + Asenapine Major
- Alfentanil + Asenapine Major
- Alfuzosin + Asenapine Major
Frequently asked questions
Can I take Asenapine with Levodopa inhaled?
MediHelp rates the interaction as major. Asenapine and Levodopa inhaled can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Asenapine blocks dopamine D2 receptors and can directly oppose the dopaminergic effect of levodopa. This may cause loss of motor control in Parkinson's disease, with worsening of symptoms during OFF periods.
How serious is the interaction between Asenapine and Levodopa inhaled?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where possible; if an antipsychotic is needed in Parkinson's disease, choose quetiapine or clozapine instead. Monitor motor function closely if asenapine cannot be avoided.
What other medicines interact with Asenapine?
MediHelp also lists interactions of Asenapine with, for example, Pimozide, Thioridazine, Vandetanib. The full list is on the Asenapine page.
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