A fixed combination of 2 drugs in one pill.
Sold as Crexont, Dhivy, Duopa, Rytary, Sinemet and 1 more.
A combination is graded by its riskiest ingredient: each part of the score is the lowest of the ingredients' scores. This grade answers one narrow question: how strong is the public evidence and safety record behind this drug, and how clean is its money trail and court record? It is not a verdict on whether the drug is right for you.
Each ingredient has its own full page with the FDA label, side-effect reports, recalls, evidence, and payments. Open them for the detail behind this grade.
Score breakdown (73/100)
Safety ×35%
A
Evidence ×25%
D
Regulatory ×15%
A
Money & lawsuits ×15%
C
Options ×10%
F
Safety: 89
Graded by its riskiest ingredient, carbidopa (89)
FDA issued 1 Drug Safety Communication(s) naming this drug since 2010, most recently 2026 (-8)
Death appears in 1.7x the share of reports seen across all of FAERS (-3)
Evidence: 52
Graded by its riskiest ingredient, carbidopa (52)
136 randomized trials and 14 systematic reviews/meta-analyses indexed in PubMed
On the WHO Model List of Essential Medicines (shown for context; no score effect)
No Cochrane review found (-5)
Only 45% of completed registered trials posted results (-8)
Regulatory history: 96
Graded by its riskiest ingredient, levodopa (96)
No recalls on record since 2016
2 label changes approved since 2021 (-4)
Money & lawsuits: 70
Graded by its riskiest ingredient, levodopa (85)
Pharma paid doctors $243,264 tied to this drug last year (-15)
Not named in any pending federal MDL
For the combination product itself:
Pharma paid doctors $1,581,918 tied to this drug last year (-30)
Not named in any pending federal MDL
Options: 40
Graded by its riskiest ingredient, levodopa (40)
No generic version approved: brand-only pricing (-30)
No same-class alternatives found: little leverage to switch (-30)
Money and lawsuits
In 2024, drug companies reported $1,581,918 in payments to US physicians and hospitals tied to this combination's brands across 17,797 transactions (Crexont $537,294, Rytary $495,870, Duopa $308,253, Vyalev $240,266, Dhivy $237).
No pending federal MDL names this combination or its brands.
The ingredients' own payments and lawsuits are on their pages and already count toward this grade.
Who takes it and what it costs
738,372Medicare Part D patients (2024)
3,799,983prescriptions filled
$105average cost per fill
$400Mtotal Medicare spend
Product
Fills
$/fill
Carbidopa-Levodopa
2,964,396
$31
Carbidopa-Levodopa ER
604,966
$50
Rytary
224,759
$1,209
Crexont
2,918
$854
Dhivy
1,703
$575
Sinemet
844
$364
Duopa
397
$7,017
Questions to ask your prescriber
This is a fixed combination of carbidopa and levodopa. Why both together, instead of only the one I need?
In 2026 the FDA issued a safety communication about this drug (FDA Is Requiring Warning about Vitamin B6 Deficiency and Associated Seizures for Drug Products Containing Carb). Does that risk apply to me?
The most-reported problems in FDA's adverse event data are hallucination, death, fall. How would we recognize and handle those?
What result are we expecting, by when, and what is the plan if it does not happen?
If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)
The most-reported problems in FDA's adverse event data are cough, parkinson^s disease, dyskinesia. How would we recognize and handle those?
There is no generic. Is there an older generic in the same class that works as well for my situation?