Greg...what concerns me most, i.e., other than, of course, the possibility of your having pursued this terrible thing to its end, is that this SEEMED to come "out of nowhere"...that it "struck" you so insiduously. My pwp takes both Sinemet and Comtan and, rest assured, I thank you so much for being so forthright about this..to have alerted me (and others) to the possible potential of what you experienced...and certainly, to what could well have been a very real tragedy.

Thank you so much, Greg...and I'm happy to know that you have already taken steps to keep you safe. Only God knows how many you may have saved by sharing your "story".

Take good care, Greg...
Therese

Thanks for your bravery in sharing your story. I believe it takes a great deal of courage to admit to others, even those that may understand, these deep moments of pain and suffering. I am thankful that you caught yourself in time and did the appropriate thing in recognizing the situation and seeking help. Your post will surely help others, as well as remind us all that we need to be keenly aware of the changes that this insidious disease and the medications force upon our brain. And we need to make this information known to the important people in our daily lives as well.

Thank you very much and I'm glad to hear that you're okay! It's nice having you around...

Greg I find this very scary. We have enough to worry about without being afraid of the drugs we take. Thank you for sharing your experience.
paulie

My MDS called me this morning. She apologized for taking so long to get back to me. She wanted to pull my file and refresh herself with my case before talking with me. I really thought that was a good idea.
As I mentioned earlier, I am taking an antidepressant. Paxil. She felt that this was the cause of my problem. She wants me to slowly titrate off of the paxil. I have an appointment to see her in July anyhow.
I asked her about the possibility of the Comtan and Sinemet causing something like this. She said that even though Stalvo has had some bad effects, taking Comtan and Sinemet really would not have this type of effect on someone my age and general health. She said that it was possible but very very unlikely.

GregD

I recently heard a biochemist say that every drug we take has the potential to affect every other function of our bodies, directly or indirectly. Sure made sense to me.

On the subject of antidepressants going bizirk...I have been having some upredictable and extremely intense off time over the last year, and it's occurring with increasing intensity, duration and frequency. It is more than a concern to me andgetting very scary. The Neurologist thinks its one of my meds. We know it's not the benzodiazapine and my money was on the regular sinemet as the culprit. My Neuro thought it was my antidepressant, Mirtazipine (Remeron). So I cut it back and eventualy eliminated it. I was so out of it after a few days, not sleeping etc that I realized what a big part it played in my ability to function...so I started it up again planning to tell the Neuro that it was not the misbehaving drug, and I needed to be back on it. I had 3 great nites sleep and my days were good too...everything looked peachy, untill this last saturday night. I woke up in the middle of the night shaking and sweating like crazy...but I got it back under control. Then Sunday night it happened again. Today it happened twice! I'm thinking this Neuro is right! I've been on this drug for 5 + years. No problem till this last year. Gotta sign off now, I'm fallin asleep at the keyboard., Greg, sooooo glad your okay.

dear gregd,
here is some information about Paxil, they gave it to my nephew as a teenager, and he started shaking like a PD patient, it did damage to him.

Special warnings about Paxil


In clinical studies, antidepressants increased the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Paxil or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Paxil has not been studied in children or adolescents and is not approved for treating anyone less than 18 years old.

Additionally, the progression of major depression is associated with a worsening of symptoms and/or the emergence of suicidal thinking or behavior in both adults and children, whether or not they are taking antidepressants. Individuals being treated with Paxil and their caregivers should watch for any change in symptoms or any new symptoms that appear suddenly—especially agitation, anxiety, hostility, panic, restlessness, extreme hyperactivity, and suicidal thinking or behavior—and report them to the doctor immediately. Be especially observant at the beginning of treatment or whenever there is a change in dose.

Paxil should be used cautiously by people with a history of manic disorders and those with high pressure in the eyes (glaucoma).

If you have a history of seizures, make sure your doctor knows about it. Paxil should be used with caution in this situation. If you develop seizures once therapy has begun, the drug should be discontinued.

If you have a disease or condition that affects your metabolism or blood circulation, make sure your doctor is aware of it. Paxil should be used cautiously in this situation.

Paxil may impair your judgment, thinking, or motor skills. Do not drive, operate dangerous machinery, or participate in any hazardous activity that requires full mental alertness until you are sure Paxil is not affecting you in this way.

Antidepressants such as Paxil could potentially cause stomach bleeding, especially when combined with nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and ketoprofen (Orudis KT). Consult your doctor before combining Paxil with NSAIDs or blood-thinning drugs.

Paxil contains paroxetine, which is associated with serotonin syndrome. Symptoms include agitation, confusion, sweating, hallucinations, abnormal reflexes, muscle spasms, shivering, rapid heartbeat, and tremors. Contact your doctor immediately if you experience any of these symptoms.

It's best to avoid an abrupt discontinuation of Paxil therapy. It can lead to symptoms such as dizziness, abnormal dreams, and tingling sensations. To prevent such problems, your doctor will reduce your dose gradually.


--------------------------------------------------------------------------------

Possible food and drug interactions when taking Paxil


Remember that Paxil must never be combined with Mellaril or MAO inhibitors such as Nardil and Parnate, or taken within 2 weeks of starting or stopping an MAO inhibitor.

If Paxil is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Paxil with any of the following:

Alcohol
Antidepressants such as Elavil, Tofranil, Norpramin, Pamelor, Prozac
Aspirin
Cimetidine (Tagamet)
Diazepam (Valium)
Digoxin (Lanoxin)
Flecainide (Tambocor)
Linezolid (Zyvox)
Lithium (Eskalith)
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and ketoprofen (Orudis KT)
Phenobarbital
Phenytoin (Dilantin)
Pimozide
Procyclidine (Kemadrin)
Propafenone (Rythmol)
Propranolol (Inderal, Inderide)
Quinidine (Quinaglute)
St. John's wort
Sumatriptan (Imitrex)
Theophylline (Theo-24, Uniphyl)
Thioridazine (Mellaril)
Tramadol (Ultracet, Ultram)
Triptans (a class of medication used to treat migraines; examples include sumatriptan and zolmitriptan)
Tryptophan
Warfarin (Coumadin)


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Sinemet CR Sustained-Release Tablets

Generic Name: Carbidopa/Levodopa Sustained-Release Tablets (CAR-bih-doe-puh/LEE-voe-doe-puh)
Brand Name: Sinemet CR


Sinemet CR Sustained-Release Tablets is used for:
Treating symptoms associated with Parkinson disease and parkinsonism-like symptoms caused by other conditions. It may also be used to treat certain conditions as determined by your doctor.

Sinemet CR Sustained-Release Tablets is an antidyskinetic combination. Levodopa is transformed by the body and the brain into a substance which helps to decrease tremors and other symptoms of Parkinson disease. Carbidopa helps levodopa to reach the brain.

Do NOT use Sinemet CR Sustained-Release Tablets if:
you are allergic to any ingredient in Sinemet CR Sustained-Release Tablets
you have narrow-angle glaucoma, undiagnosed skin growths, skin cancer, or a history of skin cancer
you have taken a monoamine oxidase (MAO) inhibitor (eg, phenelzine) within the last 14 days
Contact your doctor or health care provider right away if any of these apply to you.

Before using Sinemet CR Sustained-Release Tablets:
Some medical conditions may interact with Sinemet CR Sustained-Release Tablets. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding
if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
if you have allergies to medicines, foods, or other substances
if you have an irregular heartbeat, heart disease, ulcer, mental/mood disorders, seizures, blood pressure problems, asthma, lung problems, liver or kidney problems, blood or hormone problems, stomach or intestinal bleeding, glaucoma, or history of heart attack
Some MEDICINES MAY INTERACT with Sinemet CR Sustained-Release Tablets. Tell your health care provider if you are taking any other medicines, especially any of the following:

Butyrophenones, (eg, haloperidol), isoniazid, papaverine, phenothiazines (eg, phenergan), phenytoin, or risperidone because the effectiveness of Sinemet CR Sustained-Release Tablets may be decreased
MAO inhibitors (eg, phenelzine) because risk of severe high blood pressure may be increased
Tricyclic antidepressants (eg, amitriptyline) because risk of high blood pressure or unusual muscle movements may be increased
Metoclopramide because side effects may occur
Blood pressure medicines or selegiline because risk of severe dizziness on standing may be increased
This may not be a complete list of all interactions that may occur. Ask your health care provider if Sinemet CR Sustained-Release Tablets may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Sinemet CR Sustained-Release Tablets:
Use Sinemet CR Sustained-Release Tablets as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Take Sinemet CR Sustained-Release Tablets on an empty stomach at least 1 hour before or 2 hours after eating.
Carefully follow the dosing schedule given to you by your health care provider. It may take several weeks to a few months to notice benefit from use because the dose is carefully adjusted over time.
Swallow whole. Do not break, crush, or chew before swallowing.
If you are also taking iron salts (eg, ferrous sulfate), separate the administration of these medicines by at least 2 hours.
Take Sinemet CR Sustained-Release Tablets regularly to receive the most benefit from it. Taking Sinemet CR Sustained-Release Tablets at the same times each day will help you to remember to take it.
Continue taking Sinemet CR Sustained-Release Tablets even if you feel better. Do not miss any doses.
If you have been taking levodopa, do not start taking Sinemet CR Sustained-Release Tablets until at least 12 hours after your final dose of levodopa.
If you miss a dose of Sinemet CR Sustained-Release Tablets, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.
Ask your health care provider any questions you may have about how to use Sinemet CR Sustained-Release Tablets.

Important safety information:
Sinemet CR Sustained-Release Tablets may cause drowsiness, dizziness, or lightheadedness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Sinemet CR Sustained-Release Tablets. Using Sinemet CR Sustained-Release Tablets alone, with certain other medicines, or with alcohol may lessen your ability to drive or to perform other potentially dangerous tasks.
Avoid drinking alcohol or taking other medications that cause drowsiness (eg, sedatives, tranquilizers) while taking Sinemet CR Sustained-Release Tablets. Sinemet CR Sustained-Release Tablets will add to the effects of alcohol and other depressants. Ask your pharmacist if you have questions about which medicines are depressants.
Before you have any medical or dental treatments, emergency care, or surgery, tell the doctor or dentist that you are using Sinemet CR Sustained-Release Tablets.
Diabetes patients - Sinemet CR Sustained-Release Tablets may affect your blood sugar. Check blood sugar levels closely and ask your doctor before adjusting the dose of your diabetes medicine. Sinemet CR Sustained-Release Tablets may interfere with urine tests for ketones and cause inaccurate test results. Check with your doctor before you adjust your dose of your diabetes medicine or change your diet.
Neuroleptic malignant syndrome (NMS) is a potentially deadly syndrome associated with Sinemet CR Sustained-Release Tablets. Symptoms may include: increased body heat; muscle rigidness; altered mental abilities, including lack of response to your surroundings; irregular or fast heartbeat; sweating. Contact your doctor at once if any of these symptoms occur.
Do not suddenly stop taking Sinemet CR Sustained-Release Tablets. Some conditions may become worse when Sinemet CR Sustained-Release Tablets is suddenly stopped. Your dose may need to be slowly lowered by your doctor to avoid side effects.
Alcohol, hot weather, exercise, and fever may increase the risk for drowsiness, dizziness, and lightheadedness. To prevent these effects, sit up or stand slowly, especially in the morning. Also, sit or lie down at the first sign of dizziness, lightheadedness, or weakness.
Gradually increase physical activity as your symptoms improve.
A dark color (red, brown, or black) may appear in your saliva, urine, or sweat after taking Sinemet CR Sustained-Release Tablets. This is not harmful.
The effects of Sinemet CR Sustained-Release Tablets might start to wear off between doses. Talk with your doctor if Sinemet CR Sustained-Release Tablets stops working well or if your condition worsens.
Sinemet CR Sustained-Release Tablets may affect certain lab test results. Make sure laboratory personnel and your doctors know you use Sinemet CR Sustained-Release Tablets.
LAB TESTS, such as complete blood cell counts and liver function tests, may be performed to monitor your progress or to check for side effects. Be sure to keep all doctor and lab appointments.
Use Sinemet CR Sustained-Release Tablets with caution in ELDERLY patients because they may be more sensitive to its effects.
Sinemet CR Sustained-Release Tablets is not recommended for use in CHILDREN; safety and effectiveness have not been confirmed.
PREGNANCY and BREAST-FEEDING: If you become pregnant, discuss with your doctor the benefits and risks of using Sinemet CR Sustained-Release Tablets during pregnancy. It is unknown if Sinemet CR Sustained-Release Tablets is excreted in breast milk. If you are or will be breast-feeding while you are using Sinemet CR Sustained-Release Tablets, check with your doctor or pharmacist to discuss the risks to your baby.
Possible side effects of Sinemet CR Sustained-Release Tablets:
All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Confusion; constipation; diarrhea; dizziness; drowsiness; dry mouth; headache; increased sweating; loss of appetite; nausea; taste changes; trouble sleeping; upset stomach; urinary tract infection; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur:
Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black, tarry stools; blood in vomit; chest pain; confusion; depression; fast or irregular heartbeat; fever; hallucinations; mental or mood changes; muscle pain or unusual stiffness; severe abdominal pain; severe lightheadedness or fainting; sore throat; thoughts of suicide; unexplained fever or sweating; unusual bruising or bleeding; unusual or painful movements or spasms of the face, eyelids, mouth, tongue, arms, hands, or legs; vision changes (blurred/double vision); yellowing of the skin or eyes.

This is not a complete list of all side effects that may occur. If you have questions or need medical advice about side effects, contact your doctor or health care provider. You may report side effects to the FDA at 1-800-FDA-1088 (1-800-332-1088) or at http://www.fda.gov/medwatch.

If OVERDOSE is suspected:
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center (http://www.aapcc.org/findyour.htm), or emergency room immediately.

Proper storage of Sinemet CR Sustained-Release Tablets:
Store Sinemet CR Sustained-Release Tablets at room temperature, between 59 and 86 degrees F (15 and 30 degrees C), in a tightly closed container. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Sinemet CR Sustained-Release Tablets out of the reach of children and away from pets.

General information:
If you have any questions about Sinemet CR Sustained-Release Tablets, please talk with your doctor, pharmacist, or other health care provider.
Sinemet CR Sustained-Release Tablets is to be used only by the patient for whom it is prescribed. Do not share it with other people.
If your symptoms do not improve or if they become worse, check with your doctor.
This information is a summary only. It does not contain all information about Sinemet CR Sustained-Release Tablets. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: November 1, 2006
Database Edition 06.4.1.002
Copyright © 2006 Wolters Kluwer Health, Inc.

Abnormal laboratory findings occurring at a frequency of 1% or greater in approximately 443 patients who received SINEMET CR and 475 who received SINEMET (Carbidopa-Levodopa) during controlled clinical trials included: decreased hemoglobin and hematocrit; elevated serum glucose; white blood cells, bacteria and blood in the urine.

The adverse experiences observed in patients in uncontrolled studies were similar to those seen in controlled clinical studies.

Other adverse experiences reported overall in clinical trials in 748 patients treated with SINEMET CR, listed by body system in order of decreasing frequency, include:

Body as a Whole: Asthenia, fatigue, abdominal pain, orthostatic effects.

Cardiovascular: Palpitation, hypertension, hypotension, myocardial infarction.

Gastrointestinal: Gastrointestinal pain, dysphagia, heartburn.

Metabolic: Weight loss.

Musculoskeletal: Leg pain.

Nervous System/Psychiatric: Chorea, somnolence, falling, anxiety, disorientation, decreased mental acuity, gait abnormalities, extrapyramidal disorder, agitation, nervousness, sleep disorders, memory impairment.

Respiratory: Cough, pharyngeal pain, common cold.

Skin: Rash.

Special Senses: Blurred vision.

Urogenital: Urinary incontinence.

Laboratory Tests: Decreased white blood cell count and serum potassium; increased BUN, serum creatinine and serum LDH; protein and glucose in the urine.

The following adverse experiences have been reported in post-marketing experience with SINEMET CR:

Cardiovascular: Cardiac irregularities, syncope.

Gastrointestinal: Taste alterations, dark saliva.

Hypersensitivity: Angioedema, urticaria, pruritus, bullous lesions (including pemphigus-like reactions).

Nervous System/Psychiatric: Neuroleptic malignant syndrome (see WARNINGS), increased tremor, peripheral neuropathy, psychotic episodes including delusions and paranoid ideation, increased libido.

Skin: Alopecia, flushing, dark sweat.

Urogenital: Dark urine.

Other adverse reactions that have been reported with levodopa alone and with various carbidopa-levodopa formulations and may occur with SINEMET CR are:

Cardiovascular: Phlebitis.

Gastrointestinal: Gastrointestinal bleeding, development of duodenal ulcer, sialorrhea, bruxism, hiccups, flatulence, burning sensation of tongue.

Hematologic: Hemolytic and nonhemolytic anemia, thrombocytopenia, leukopenia, agranulocytosis.

Hypersensitivity: Henoch-Schonlein purpura.

Metabolic: Weight gain, edema.

Nervous System/Psychiatric: Ataxia, depression with suicidal tendencies, dementia, euphoria, convulsions (however, a causal relationship has not been established); bradykinetic episodes, numbness, muscle twitching, blepharospasm (which may be taken as an early sign of excess dosage; consideration of dosage reduction may be made at this time), trismus, activation of latent Horner's syndrome, nightmares.

Skin: Malignant melanoma (see also CONTRAINDICATIONS), increased sweating.

Special Senses: Oculogyric crises, mydriasis, diplopia.

Urogenital: Urinary retention, priapism.

Miscellaneous: Faintness, hoarseness, malaise, hot flashes, sense of stimulation, bizarre breathing patterns.

Laboratory Tests: Abnormalities in alkaline phosphatase, SGOT (AST), SGPT (ALT), bilirubin, Coombs test, uric acid.


Overdosage
Management of acute overdosage with SINEMET CR is the same as with levodopa. Pyridoxine is not effective in reversing the actions of SINEMET CR.

General supportive measures should be employed, along with immediate gastric lavage. Intravenous fluids should be administered judiciously and an adequate airway maintained. Electrocardiographic monitoring should be instituted and the patient carefully observed for the development of arrhythmias; if required, appropriate antiarrhythmic therapy should be given. The possibility that the patient may have taken other drugs as well as SINEMET CR should be taken into consideration. To date, no experience has been reported with dialysis; hence, its value in overdosage is not known.

Based on studies in which high doses of levodopa and/or carbidopa were administered, a significant proportion of rats and mice given single oral doses of levodopa of approximately 1500-2000 mg/kg are expected to die. A significant proportion of infant rats of both sexes are expected to die at a dose of 800 mg/kg. A significant proportion of rats are expected to die after treatment with similar doses of carbidopa.

The addition of carbidopa in a 1:10 ratio with levodopa increases the dose at which a significant proportion of mice are expected to die to 3360 mg/kg.

Levadopa -carbidopa Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

More common...?

Abnormal thinking: holding false beliefs that cannot be changed by fact; agitation; anxiety; clenching or grinding of teeth; clumsiness or unsteadiness; confusion; difficulty swallowing; dizziness; excessive watering of mouth; false sense of well being; feeling faint; general feeling of discomfort or illness; hallucinations (seeing, hearing, or feeling things that are not there); hand tremor, increased; nausea or vomiting; numbness; unusual and uncontrolled movements of the body, including the face, tongue, arms, hands, head, and upper body; unusual tiredness or weakness
Less common

Blurred vision; difficult urination; difficulty opening mouth; dilated (large) pupils; dizziness or lightheadedness when getting up from a lying or sitting position; double vision; fast, irregular, or pounding heartbeat; hot flashes; increased blinking or spasm of eyelids; loss of bladder control; mental depression; other mood or mental changes; skin rash; unusual weight gain or loss

Rare

Back or leg pain; bloody or black tarry stools; chills; convulsions (seizures); fever; high blood pressure; inability to move eyes; loss of appetite; pain, tenderness, or swelling of foot or leg; pale skin; prolonged, painful, inappropriate penile erection; sore throat; stomach pain; swelling of face; swelling of feet or lower legs; vomiting of blood or material that looks like coffee grounds

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

More common

Abdominal pain; dryness of mouth; loss of appetite; nightmares; passing gas

Less common

Constipation; diarrhea; flushing of skin; headache; hiccups; increased sweating; muscle twitching; trouble in sleeping

This medicine may sometimes cause the urine, saliva, and sweat to be darker in color than usual. The urine may at first be reddish, then turn to nearly black after being exposed to air. Some bathroom cleaning products will produce a similar effect when in contact with urine containing this medicine. This is to be expected during treatment with this medicine. Also, this medicine may cause a bitter taste, or a burning sensation of the tongue.

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

drug interactions - (side effects) of
Remeron -
http://www.drugs.com/drug_interactions.php

also if you look up paxil it has a drug interaction with
Interactions between paxil (paroxetine) and Robitussin dry cough (dextromethorphan)
dextromethorphan and paroxetine (Major Drug-Drug)

MONITOR CLOSELY: Concomitant use of agents with serotonergic activity such as serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, 5-HT1 receptor agonists, ergot alkaloids, lithium, St. John's wort, phenylpiperidine opioids, dextromethorphan, and 5-hydroxytryptophan may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A receptors.

MANAGEMENT: In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Close monitoring is recommended for signs and symptoms of excessive serotonergic activity such as CNS irritability, altered consciousness, confusion, myoclonus, ataxia, abdominal cramping, hyperpyrexia, shivering, pupillary dilation, diaphoresis, hypertension, and tachycardia. Particular caution is advised when increasing the dosages of these agents. The potential risk of serotonin syndrome should be considered even when administering one serotonergic agent following discontinuation of another, as some agents may demonstrate a prolonged elimination half-life. For example, a 5-week washout period is recommended following use of fluoxetine before administering another serotonergic agent.