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Can Rytary Cause Hallucinations?

Key Takeaways

  • Yes, Rytary can cause hallucinations in some people, especially older adults and those with advanced Parkinson’s disease.
  • Rytary is an extended-release capsule that contains carbidopa/levodopa, and levodopa can sometimes trigger psychosis-like symptoms such as hallucinations or confusion.
  • Hallucinations are more likely during dose changes, higher doses, or when combined with certain medications that cause drug interactions.
  • Low blood pressure (including orthostatic hypotension), sleepiness, and drowsiness can also occur and may increase fall risk for caregivers to watch for.
  • A healthcare provider can often reduce hallucinations by adjusting the dosage of Rytary or reviewing other Parkinson’s disease medications.

What Is Rytary?

Rytary is a brand-name medication that is FDA-approved to treat symptoms of Parkinson’s disease, such as muscle stiffness, tremor, and slowness. It contains carbidopa and levodopa in an extended-release formulation.

Carbidopa/levodopa is one of the most effective treatments for Parkinson’s motor symptoms. Levodopa converts into dopamine in the brain, helping improve movement. Carbidopa helps prevent levodopa from breaking down too early, which reduces nausea and increases the amount that reaches the brain.

Rytary capsules are designed to provide longer symptom control throughout the day. This differs from immediate-release carbidopa/levodopa products such as Sinemet.

Do Hallucinations Occur With Rytary?

Yes. Hallucinations are a known potential side effect of Rytary.

Hallucinations in Parkinson’s disease are often visual, such as seeing people, animals, or shadows that are not actually present. Some people may also experience delusions or symptoms of psychosis, especially if the condition progresses or medication doses increase.

Rytary-related hallucinations can occur even in people who have never had them before, particularly during a dosage adjustment or when starting the medication.

Why Carbidopa/Levodopa Can Cause Hallucinations

Hallucinations are linked to dopamine activity in the brain. Because levodopa increases dopamine levels, it can sometimes overstimulate certain pathways involved in perception and cognition.

People are more likely to experience hallucinations if they have:

  • Advanced Parkinson’s disease
  • Cognitive decline or dementia
  • Sleep disorders
  • A history of psychosis or mental health conditions
  • Multiple Parkinson’s medications

This is not unique to Rytary. Hallucinations can also occur with other formulations such as Sinemet and other dopamine-related medications.

Common Side Effects of Rytary

Common side effects of Rytary may include:

  • Dyskinesia (involuntary movements)
  • Nausea
  • Dizziness
  • Constipation
  • Drowsiness or sleepiness
  • Orthostatic hypotension (blood pressure drops when standing)

Because Parkinson’s disease itself can affect blood pressure regulation, both low blood pressure and lightheadedness may worsen with treatment.

Serious Side Effects to Know About

Rytary can cause serious side effects that require medical advice.

These may include:

  • Hallucinations or psychosis
  • Severe dyskinesia (movement disorder)
  • Impulsive behaviors
  • Allergic reaction (hives, swelling, trouble breathing)
  • Worsening narrow-angle glaucoma
  • Sleep attacks (falling asleep suddenly during daily activities)
  • Increased risk of a peptic ulcer or bleeding in your stomach

In rare cases, people with Parkinson’s disease may have heart problems such as arrhythmias, and levodopa can sometimes worsen cardiovascular symptoms in certain individuals.

Who Is Most at Risk for Hallucinations?

Hallucinations are more common in:

  • Older adults
  • People with early Parkinson’s disease who rapidly increase doses
  • Those with advanced Parkinson’s disease
  • Patients with existing mental health conditions
  • People taking other medications that affect dopamine or cognition

Caregivers should be aware of early warning signs such as confusion, new paranoia, seeing “things” at night, or major changes in behavior.

Do Rytary Hallucinations Mean I Have Parkinson’s Psychosis?

Not necessarily. Hallucinations can occur without full Parkinson’s psychosis, especially early on or during medication changes.

However, if hallucinations become frequent, bothersome, or are accompanied by delusions, it may indicate Parkinson’s disease psychosis. This is a treatable complication and should be addressed with a healthcare provider.

Drug Interactions That May Worsen Side Effects

Certain drug interactions can affect how well Rytary works or increase side effects.

Medications that may interact include:

  • Metoclopramide (can worsen Parkinson’s symptoms and interfere with levodopa effects)
  • Isoniazid
  • Nonselective monoamine oxidase inhibitors (MAOI)
  • Other inhibitors affecting dopamine pathways

High-protein meals can also interfere with levodopa absorption. Some healthcare professionals recommend separating Rytary doses from high protein intake if motor symptoms fluctuate.

Always review prescription drugs, supplements, and over-the-counter products with a healthcare provider.

What to Do If You Experience Hallucinations on Rytary

If hallucinations occur while taking Rytary:

  • Do not stop Rytary suddenly, as this may worsen motor symptoms
  • Contact your healthcare provider for medical advice
  • Keep a log of when hallucinations occur (time of day, dose timing, sleep changes)
  • Ask whether a dosage adjustment is needed

Sometimes, lowering the dose of Rytary or adjusting timing reduces hallucinations. In other cases, clinicians may adjust other Parkinson’s medications first or consider treatment for psychosis if needed.

Rytary Dosing

The dose of Rytary is individualized based on symptoms and whether someone is switching from immediate-release Sinemet. The dosage of Rytary may also change over time as Parkinson’s progresses.

Some people take Rytary capsules multiple times daily. If swallowing is difficult, the capsule may sometimes be opened and sprinkled on applesauce, but patients should follow the full prescribing information instructions.

When to Seek Urgent Medical Attention

Seek medical attention right away if hallucinations are severe or if you also have:

  • Trouble breathing or facial swelling (possible allergic reaction)
  • Chest pain or signs of a heart attack
  • Fainting due to low blood pressure
  • Dangerous confusion or behavior changes
  • Signs of severe psychosis

These may indicate serious side effects or another medical condition requiring evaluation.

Bottom Line

Yes, Rytary can cause hallucinations, and this is a known side effect of carbidopa/levodopa therapy, especially in older adults and those with advanced Parkinson’s disease. Hallucinations may improve with a dosage adjustment and careful medication review. If hallucinations appear, contact a healthcare provider promptly rather than stopping the medication on your own.

FAQs

Can Rytary cause hallucinations even if I never had them before?
Yes, hallucinations can happen in people who have never experienced them, especially when starting Rytary or during a dose adjustment. They are more likely with high doses or if other Parkinson’s disease medications are involved.

Are hallucinations from Rytary dangerous?
They can be concerning, but they are not always an emergency if the person remains calm and safe. However, hallucinations should be reported to a healthcare provider because they may worsen over time or increase the risk of falls, confusion, or unsafe behavior.

Will lowering the dose of Rytary stop hallucinations?
In some cases, reducing the dose of Rytary or adjusting the timing improves hallucinations. Your healthcare professional may also review drug interactions or switch other medications before changing Rytary.

When should I go to the hospital for hallucinations on Rytary?
Seek urgent care if hallucinations are severe, involve dangerous behavior, or occur with fainting, chest pain, or signs of an allergic reaction. A healthcare provider may recommend emergency evaluation if there are serious side effects or sudden mental status changes.

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