This is the same question put more simply...requiring a more simple response. Re: Sinemet CR (25/00)..."regular" Sinemet (25/100):

(1) Does anyone take Sinemet CR ONLY and not as an adjunct to "regular" Sinemet? If so, what is your dosing schedule?

(2) Does anyone take "regular" Sinemet AND Sinemet CR?
If so, what is your dosing schedule?

I'm still looking for some responses that could help me with our discussion with Doreen's neurologist on Friday.

Thank you for any help you may be able to provide.

Therese

I don't know if this will help you, but I do take both Sinemet 25/100 and Sinemet CR 50/200. I take regular Sinemet 25/100 5 times per day along with other meds. I take 1 Sinemet CR 50/200 only once per day - the last dose before bed. The idea is that the CR stays in my system longer than regular Sinemet so I can stay asleep longer. It really does seem to have helped with my sleep problem although I still can't stay asleep through the entire night.

Approximate Schedule:

6:00am Sinemet 25/100, Mirapex 1mg, Comtan 200mg, Amantadine, and 2 tablets of an experiemental drug.

9:00am Sinemet 25/100, Mirapex, Comtan

12:00pm Sinemet 25/100, Mirapex, Comtan, Amantadine

3:30pm Sinemet 25/100, Mirapex, Comtan

7:00pm Sinemet 25/100, Mirapex, Comtan, Amantadine

10:30pm Sinemet CR 50/200, Mirapex, Comtan

3am Parcopa if needed due to sleeplessness

http://www.pdrhealth.com/drugs/rx/rx...&contentId=526

Sinemet CR
Generic name: Carbidopa, Levodopa
Brand names: Sinemet CR

Why is Sinemet CR prescribed?
Sinemet CR is a controlled-release tablet that may be given to help relieve the muscle stiffness, tremor, and weakness caused by Parkinson's disease. It may also be given to relieve Parkinson-like symptoms caused by encephalitis (brain fever), carbon monoxide poisoning, or manganese poisoning.

Sinemet CR contains two drugs, carbidopa and levodopa. The drug that actually produces the anti-Parkinson's effect is levodopa. Carbidopa prevents vitamin B6 from destroying levodopa, thus allowing levodopa to work more efficiently.

Parkinson's drugs such as Sinemet CR relieve the symptoms of the disease, but are not a permanent cure.

Most important fact about Sinemet CR
There is also a regular, non-controlled-release form of Sinemet CR, which is called Sinemet. Over a period of hours, Sinemet CR, the controlled-release form, gives a smoother release of the drug than regular Sinemet. If you have been taking regular Sinemet, be aware that you may need a somewhat higher dosage of Sinemet CR to get the same degree of relief. Your first morning dose of Sinemet CR may take as much as an hour longer to start working than your first morning dose of regular Sinemet.

How should you take Sinemet CR?
Take Sinemet CR after meals, rather than before or between meals. Swallow the tablets whole without chewing or crushing them.

Sinemet CR releases its ingredients slowly over a period of 4 to 6 hours. It is important to follow a careful schedule, taking your doses at the same time every day.

You should not change the prescribed dosage or add another product for Parkinson's disease without first consulting your doctor.

Sinemet CR works best when there is a constant amount in the blood. Try not to miss any doses, and take them at evenly spaced intervals day and night.

--If you miss a dose...

If you forget to take a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at once.

--Storage instructions...

Store at room temperature in a tightly closed container.

What side effects may occur?
Side effects from Sinemet CR cannot be anticipated. If any develop or change in intensity, inform your doctor immediately.

Only your doctor can determine if it is safe for you to continue taking Sinemet CR.

More common side effects may include:Confusion, hallucinations, nausea, uncontrollable twitching or jerking
Why should Sinemet CR not be prescribed?
Do not take Sinemet CR if you are sensitive to or have ever had an allergic reaction to its ingredients.

Sinemet CR should not be prescribed if you have a suspicious, undiagnosed mole or a history of melanoma.

Special warnings about Sinemet CR
Make sure your doctor knows if you have any of the following:

Bronchial asthma
Cardiovascular or lung disease (severe)
Endocrine (glandular) disorder
History of heart attack or heartbeat irregularity
History of active peptic ulcer
Kidney disorder
Liver disorder
Wide-angle glaucoma (pressure in the eye)

Your doctor will monitor your liver, blood, kidney and heart functions during extended therapy with Sinemet CR.

If you have been taking levodopa alone, you should stop taking levodopa for at least 12 hours before starting to take Sinemet CR.

The carbidopa contained in Sinemet CR cannot eliminate side effects caused by levodopa. Since carbidopa helps levodopa reach your brain, Sinemet CR may, in fact, produce some levodopa side effects--particularly twitching, jerking, or writhing--sooner and at a lower dosage than levodopa alone or even regular Sinemet. If such involuntary movements develop while you are taking Sinemet CR, you may need a dosage reduction.

Like levodopa, Sinemet CR may cause depression. Make sure your doctor knows if you have mental or emotional problems.

Muscle rigidity, high temperature, rapid heartbeat or breathing, sweating, blood pressure changes, and mental changes may occur when Sinemet CR is reduced suddenly or discontinued. If you stop taking Sinemet CR abruptly, your doctor should monitor your condition carefully.

You may see a red, brown, or black coloration in your saliva, urine, or sweat. This is not harmful, but may stain your clothes. Too much stomach acid can interfere with absorption of the medication.

Possible food and drug interactions when taking Sinemet CR
If Sinemet CR 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 Sinemet CR with the following:

Antacids such as Di-Gel, Maalox, and Mylanta
Antiseizure drugs such as Dilantin
Antispasmodic drugs such as Artane and Cogentin
Antihypertensives such as Aldomet and Clonidine
High-protein foods
Isoniazid (Nydrazid)
Major tranquilizers such as Haldol, Mellaril, Risperdal, and Thorazine
MAO inhibitors such as the antidepressants Nardil and Parnate and the Parkinson's drug Eldepryl
Methionine drugs such as Pedameth
Metoclopramide (Reglan)
Papaverine (Pavabid)
Pyridoxine (Vitamin B6)
Tranquilizers such as Dalmane, Valium, and Xanax
Tricyclic antidepressants such as Elavil and Tofranil

If you have been taking an MAO inhibitor such as Nardil or Parnate, you must discontinue it at least 2 weeks before starting to take Sinemet CR.

A high-protein diet may impair the effectiveness of Sinement CR. Iron supplements can also reduce its effect.

Special information if you are pregnant or breastfeeding
If you are pregnant or plan to become pregnant, inform your doctor immediately. Sinemet CR should be used during pregnancy only if the benefit outweighs the potential risk to the unborn child. It is not known whether Sinemet CR appears in breast milk. If Sinemet CR is essential to your health, your doctor may advise you to stop nursing your baby until your treatment with Sinemet CR is finished.

Recommended dosage
Your doctor will tailor your individual dosage carefully, depending on your response to previous therapy and symptoms.

ADULTS

For patients with mild to moderate symptoms, the initial recommended dose is 1 tablet of Sinemet CR taken 2 times a day.

Starting doses should be spaced out every 4 to 8 hours and then adjusted to each patient's individual response.

The usual long-term dose is 2 to 8 tablets per day, taken in divided doses every 4 to 8 hours during the waking day.

Higher doses (12 or more tablets per day) and shorter intervals (less than 4 hours) have been used, but are not usually recommended.

When doses of Sinemet CR are given at intervals of less than 4 hours, and/or if the divided doses are not equal, it is recommended that the smaller doses be given at the end of the day.

An interval of at least 3 days between dosage adjustments is recommended.

Dosage adjustment of Sinemet CR may be necessary if your doctor prescribes additional medications.

CHILDREN

Use of Sinemet CR in children under 18 is not recommended.

Overdosage
Too much Sinemet CR may cause muscle twitches, inability to open the eyes, or other symptoms of levodopa overdosage. Like other medications, Sinemet CR taken in excess can have serious consequences. If you suspect symptoms of a Sinemet CR overdose, seek medical attention immediately.

Peace to you,
Vicky

I dont think this is going to help you much Therese, but I take Sinemet CR 50/200 twice a day, and thats the only Sinemet I take..I have never had dyskenisia yet..I was taking regular Sinemet 25/100 3 times daily before, but found that the CR 50/200 works better for me

I take my first dose at 9:00 am, and my second dose at 4:00 pm

hello therese,
this is what you need to hear... but you do not want to hear it?

you may need to just go with what you have -because you can look up all the levodopa / carbidopa side effects online because dopa is the very oldest drug we have... and they call it the gold standard for PD,

and they do not call it the gold standard no absolutely no reason,

you may need to have a spect scan done on her, to get a very good look at the brain itself...

you might also order blood tests to check her potassium, and her B-12 level,
those are two things the Levodopa /carbidopa zap from the body...
so if you have a good doctor who knows about vitamins and minerals,
have her blood tested for these,

I had a girlfriend pass away this summer almost 34 years of age, she started taking these meds, and started going down hill, had the brain surgery,
that gave her a few good months and then down hill, and the doctors
at the big hospital in TX, couldn't help her for very long, she passed away
only 7 years after her diagnosis,

what I am trying to tell you is -you saw her do well on the quick sinemet
and the SR is not filling in the gapsshe is having too many on /offs... and all they will give you is more drugs
I am telling you this not to hurt you, but the doctor may work with you better
if you don't go in the office with a loaded barrell?

you may also go see another specialist - movement disorder specialist.

that CR only works for 25% of those who try it. Most of us need the "Rush" of dopa to get us moving.
CR, as DJM1 points out, is good for adding a few much needed hours of sleep to our night.

Charlie

DJM1 and Vicky...

DJM1...thank you so much for taking the time to give me your medication regimen...and specifically as it relates to the Sinemet...Sinemet CR aspect. Your response was exactly as I requested...thank you so much...

Vicky...thank you so much for a most informative response to my question(s). Though somewhat technical, still, it provided some very important information. I have printed your post and will highlight important specifics to be discussed with the neurologist on Friday.

Your responses provide me with information and support that makes me feel more comfortable and more assured when discussing possible solutions to the "medication maze" that confronts all of us. I can't thank you enough.

Therese

I have been on sinemet mfore than 10 years and have tried many combos.

I now take CR 25/100 ...up to 10 a day. Some days I get by on 7 or 8
and some days 10 or 12...I just do what I need to do to keep going.

The regular sinemet, my body/brain just burns up like candy and only lasts me 2-3 hours maxz ...I get wired and have way toooo much adrenaline in my system. The Neuro's have no idea why this happens. The CR provides a sort of rationing and I cruise along nicely most days on a 2 hour schedule. The Mvmt disorder clinic doesn't like the way I do things, but has to admit I'm doing better than they would have expected, no real problems with dyskinesia, UNLESS I've eaten a lot of high sugar/high fat foods.

This is a disease that definitley does not follow any set of rules. What works for one does not work for another. Try all the options and document all the responses, then pick the one that works the best for you...until it doesn't anymore, then start again. Welcome to Wonderland!

Steve....any and all information is important/useful for me, Steve...thank you so much...

Tena...I understand completely what you said. I am always
very careful and use a great deal of tact whenever
I approach Doreen's neurologist with any ideas that may have (either of my own or from the many good
caring people here). Fortunately, he is a doctor
who has made it very clear to me that he
appreciates my input and, in fact, he has told me
that I am in the best position to know what's
happening with Doreen. I know so well that I must
not appear arrogant, but rather I must be perceived
as one who is genuinely interested in helping
Doreen...he seems to understand that. Thank you
so much for your response and your "caution"...
much appreciated...

Chasmo...very interesting and informative about your
friend...MDS telling him that CR works for 25%
only...that most need the "rush" of dopa to get
moving. Interestingly, that is what I perceived
during the two-day only trial on the CR...that
Doreen just didn't have the "get-up-and-go" that
she had had...AND, I noticed a very slight amount
of not being "quite with it" which really upset
me in that we went through such a horrendous time
with cognitive impairment while she was taking
Cogentin. Now, as for helping with sleep...very
thankfully, Doreen has NO problem sleeping and,
in fact, she seems to sleep too much, but I think
part of that is related to the fact that while
sleeping, she gets some respite from the PD...its
symptoms and its medications. I keep telling her
how fortunate she is that she's able to sleep so
well because it has been my observation ever
since we started this PD journey that so many
pwp's have such a terribly difficult time
sleeping...thank you, Chasmo

...and thanks to all of you who have responded to me and who have really helped me so much.

Therese

Therese, I, too must apologize for waiting so long to share how I use sinemet CR (actually generic carbi/levo CR 50/200). Each morning, immediately after rising, I take one-half of a regular generic carbi/levo 25/100, along with the CR. Usually, I lose the "shuffles" after about 30-40 min. I repeat that dose in the middle of the afternoon, with good symptom control. The half a regular gives me a little "bump" to take me until the CR does its thing. My neuro is happy with that approach.

If Doreen is having no trouble sleeping, she might be better off not taking another CR at bedtime. Some people, like Steve, take CR before bed with good results, but it is probably best to take the least amount that effectively controls symptoms.

Robert