{
 "query": "carbidopa / levodopa",
 "ingredient": "carbidopa / levodopa",
 "slug": "carbidopa-levodopa",
 "rxcui": "103990",
 "brands": [
  "Crexont",
  "Dhivy",
  "Duopa",
  "Rytary",
  "Sinemet",
  "Vyalev"
 ],
 "names": [
  "carbidopa / levodopa"
 ],
 "components": [
  {
   "ingredient": "carbidopa",
   "slug": "carbidopa",
   "grade": "B",
   "total": 81,
   "scores": {
    "safety": "A",
    "evidence": "D",
    "regulatory": "A",
    "conflict": "A",
    "options": "C"
   },
   "boxed": false,
   "controlled": false,
   "first_approval_fmt": "04/25/1977",
   "first_approval": "19770425"
  },
  {
   "ingredient": "levodopa",
   "slug": "levodopa",
   "grade": "B",
   "total": 83,
   "scores": {
    "safety": "A",
    "evidence": "B",
    "regulatory": "A",
    "conflict": "B",
    "options": "F"
   },
   "boxed": false,
   "controlled": false,
   "first_approval_fmt": "06/04/1970",
   "first_approval": "19700604"
  }
 ],
 "classes": [],
 "alternatives": [],
 "label": {},
 "faers": null,
 "faers_base": {
  "total": 20692304,
  "serious_share": 0.5742697381596559,
  "death_share": 0.09102355155810585
 },
 "recalls": [],
 "recall_total": 0,
 "drugsfda": {
  "first_approval": "19700604",
  "first_approval_fmt": "",
  "anda": 0,
  "nda": 0,
  "rems": false,
  "labeling_recent": 0
 },
 "trials": null,
 "pubmed": null,
 "payments": {
  "year": "2024",
  "usd": 1581918.46,
  "records": 17797,
  "by_name": [
   [
    "Crexont",
    537293.86
   ],
   [
    "Rytary",
    495869.51
   ],
   [
    "Duopa",
    308252.63
   ],
   [
    "Vyalev",
    240265.73
   ],
   [
    "Dhivy",
    236.73
   ]
  ],
  "names_checked": [
   "carbidopa / levodopa",
   "Rytary",
   "Crexont",
   "Dhivy",
   "Sinemet",
   "Duopa",
   "Vyalev"
  ],
  "source": "bulk-index"
 },
 "partd": {
  "year": "2024",
  "claims": 3799983,
  "beneficiaries": 738372,
  "spend": 399523751.74,
  "by_brand": [
   {
    "brand": "Carbidopa-Levodopa",
    "claims": 2964396,
    "per_claim": 30.755617998,
    "is_generic": false
   },
   {
    "brand": "Carbidopa-Levodopa ER",
    "claims": 604966,
    "per_claim": 49.597665571,
    "is_generic": false
   },
   {
    "brand": "Rytary",
    "claims": 224759,
    "per_claim": 1209.2254962,
    "is_generic": false
   },
   {
    "brand": "Crexont",
    "claims": 2918,
    "per_claim": 853.67392735,
    "is_generic": false
   },
   {
    "brand": "Dhivy",
    "claims": 1703,
    "per_claim": 574.84298884,
    "is_generic": false
   },
   {
    "brand": "Sinemet",
    "claims": 844,
    "per_claim": 363.5988981,
    "is_generic": false
   },
   {
    "brand": "Duopa",
    "claims": 397,
    "per_claim": 7017.2557431,
    "is_generic": false
   }
  ],
  "per_claim": 105.13829976081472
 },
 "mdl": [],
 "dsc": [],
 "settlements": [],
 "prescrire": null,
 "eml": null,
 "exposure": null,
 "scores": {
  "safety": {
   "score": 89,
   "letter": "A",
   "why": [
    "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)"
   ],
   "weight": 0.35
  },
  "evidence": {
   "score": 52,
   "letter": "D",
   "why": [
    "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)"
   ],
   "weight": 0.25
  },
  "regulatory": {
   "score": 96,
   "letter": "A",
   "why": [
    "Graded by its riskiest ingredient, levodopa (96)",
    "No recalls on record since 2016",
    "2 label changes approved since 2021 (-4)"
   ],
   "weight": 0.15
  },
  "conflict": {
   "score": 70,
   "letter": "C",
   "why": [
    "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"
   ],
   "weight": 0.15
  },
  "options": {
   "score": 40,
   "letter": "F",
   "why": [
    "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)"
   ],
   "weight": 0.1
  }
 },
 "total": 73,
 "grade": "C",
 "questions": [
  "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?"
 ]
}