[Ling2]

Recently, I am rather puzzled as to what constitutes the safe level of sinemet intake? Sometimes, when I found that my medication tends to have pre-mature wear off, I have to take extra dosage of sinemet but is wary about running the risk of overdosage. Currently, the maximum dosage I took is 450mg sinemet cr.

Thanks

LING

[K.Ibsen]

Sinemet is a combination of carbidopa and levodopa. You have to consider safe levels of both ingredients.

I read recently that it is best to keep carbidopa levels between 70 and 100 mg. For this reason, sinemet comes in 1:4 and 1:10 ratios. My ratio, for example is 1:4. I take three 25/100 tablets per day which provides me with 75mg of carbidopa. Three per day is the manufacturer's recommendation and also allows me to take a fourth tablet and remain within the safety range for carbidopa. For the 1:10 ratio, a person could take eight to ten tablets and stay within the range.

The article I read didn't discuss levodopa as explicitly as it described carbidopa. Perhaps the limitations aren't as specific. It did mention that sometimes doctors will prescribe carbidopa and levodopa as separate tablets to be taken at the same time. Someone else will need to address levodopa.

Personally, I try to stay on schedule and only take the prescribed amount. I don't have an "as needed" prescription. In my opinion, this is a conversation to have with your doctor, especially if you're taking the CR variety, which I do not.

Karl

[boann]

I am just an ol' lay person, not a doctor, but this is what it says on a Sinemet CR package insert dated 2002:

Following initiation of therapy, doses and dosing intervals may be increased or decreased depending upon therapeutic response. Most patients have been adequately treated with doses of SINEMET CR that provide 400 to 1600 mg of levodopa per day, administered as divided doses at intervals ranging from 4 to 8 hours during the waking day. Higher doses of SINEMET CR (2400 mg or more of levodopa per day) and shorter intervals (less than 4 hours) have been used, but are not usually recommended.

Over time, levodopa loses efficacy and it become necessary to take more per day, often in smaller doses taken more frequently.

The following passages from the package insert are also of interest - to me, at least. They are interesting in view of the widely held theory that continuous administration of levodopa will eliminate dyskinesia and/or motor fluctuations:

With SINEMET CR there is less variation in plasma levodopa levels than with SINEMET* (Carbidopa-Levodopa), the conventional formulation. However, SINEMET CR (Carbidopa-Levodopa) Sustained-Release is less systemically bioavailable than SINEMET (Carbidopa-Levodopa) and may require increased daily doses to achieve the same level of symptomatic relief as provided by SINEMET (Carbidopa-Levodopa).

and

In clinical trials, patients with moderate to severe motor fluctuations who received SINEMET CR did not experience quantitatively significant reductions in ‘off’ time when compared to SINEMET (Carbidopa-Levodopa).

and

Patients receiving SINEMET CR may develop increased dyskinesias compared to SINEMET (Carbidopa-Levodopa).

In fact, the prevalence of dyskinesia in the clinical trial cited in the package insert is 35% higher with sinemet CR than with plain old sinemet.

Hope that helps.

boann

[Ling2]

Thanks to K.Ibsen and Boann for the information and input. I will look carefully on the safety intake of different ingredients of each dosage.

Best

LING

[chasmo]

CR does not give you that blast of levodopa many of us need to get well and truely "on".
Chasing an "ON" with extra sinemet is usually a bad idea, becuse you wind up over-dosing on sinemet. You know you have "OD"ed by headache or dyskinesia. Additional sinemet will throw off your subsequent doses too. It is better to find your theraputic dosing amount and schedule and adhere to that.

Charlie

[Ling2]

Charlie, Thanks and I have not tried on regular sinemet as my doctor told me that CR and/ or Stalevo are safer alternatives to regular sinemet as the formers will offer a longer sustained "on" time and require lesser dosages! Could you enlighten me on this?

Actually, I have tried my best to avoid overdosing.

Best

LING

[ol'cs]

I don't think that there is one correct answer to your question, which is a good question. All that can be said is the different experiences that different members have had over the years with sinemet, so i will tell you my personal atory, for whatever it's worth.
During my first 3 years i had the "honeymoon period", where 3 25/100 regular release did fine to keep me medicated well enough all day long. But I also took 200mg of Amantadine /day and 10mg of selegiline/day too.
From about year four to year six, I had problems with on/off syndrome and those were the years that i tried all the agonists, Permax. Requip and Mirapex. i stopped selegline no problem but carried on with the Amantadine. I had some "not too bad " results with Permax and Mirapex, but Reqip was definitely not for me. Comtan "threw me in a loop" it made me terribly dyskinetic. Eventually ,i figured agonists were "just not for me".
Then we tried to mess with sinemet intake. At one point in year 6 to 7, I went up to 1800 mg total sinemet normal release /day. I found this to be a bit overwhelming and so, lowered my sinemet intake, month by month, down to 800-900mg of total l-dopa/ day, along with 200mg of amantadine.
Well, here I am, Just finishing year 10 and take 2, 50/200 controlled release/day, and from 4 to 6 25/100 per day of normal release/day, and 200mg of Amantadine. I have now "stabilized" on this dose which means 800 to 1000mg of l-dopa per day. This has kept me "happy" , for about a year.
That's all i can tell you except that up to 2 grams of L-dopa/day is, or can be, tolerated well by the human body, before dyskinesia limits its usefullnes. That's from reading PD literature.
Interestingly there was a report of two people taking up to 25 grams!!! of dopamine/ day, just to get "high" from it. It didn't kill them but they had wild dyskinesias. Hope this enlightens you a little bit. cs

[chasmo]

Originally Posted by LING

Charlie, Thanks and I have not tried on regular sinemet as my doctor told me that CR and/ or Stalevo are safer alternatives to regular sinemet as the formers will offer a longer sustained "on" time and require lesser dosages! Could you enlighten me on this?

Actually, I have tried my best to avoid overdosing.

Best

LING

Chuck is right, we're all unique in our requirements. Having said that, what your doc said is usually true of Stalevo but NOT true of CR. This has been confirmed to me by several Mmovement Disorder Specialists, including the co-inventor of CR. CR works for most of us at night time to give us a better sleep.
Your brain needs that "Rush" of Sinemet to get things going.

Charlie

[Ling2]

Dear Ol'cs, Thanks for sharing your experience with sinemet. Your unreserved biography of sinemet really enlighten me of what to ask my neurologist in my next visit, which is scheduled to be on coming Saturday. Here's my story: In the first two years after dx, I only took 5mg selegiline per day and it kept me symptom free! On third year, I was put on requip but did not have "too good response" (neither did I have those adverse effects). On the forth year, I started sinemet cr 25/100 x 3 per day and it served me well. on the fifth year, I switched to stavelo 100 x 3 per day and until 8 months ago, neupro patch 6mg was added (dosing up from 2mg/ 4mg).

Dear Charlie, I always found your input to be very technical and inspiring, and will ask my neurologist to add one CR for a good sleep.

Good luck to all!

LING