*this would be great to copy it and carry it with you*

If you have any of these symptoms -it may be a "Side effect" of the medicine,
carbidopa levodopa - "they" endearingly term -"the gold standard"...
and I am starting to see the "Gold Standard = money".


____________________

ADVERSE REACTIONS

The most common adverse reactions reported with carbidopa and levodopa therapy have included dyskinesias, such as choreiform, dystonic, and other involuntary movements and nausea.

The following other adverse reactions have been reported with carbidopa and levodopa:

Body as a Whole: chest pain, asthenia.

Cardiovascular: cardiac irregularities, hypotension, orthostatic effects including orthostatic hypotension, hypertension, syncope, phlebitis, palpitation.

Gastrointestinal: dark saliva, gastrointestinal bleeding, development of duodenal ulcer, anorexia, vomiting, diarrhea, constipation, dyspepsia, dry mouth, taste alterations.

Hematologic: agranulocytosis, hemolytic and non-hemolytic anemia, thrombocytopenia, leukopenia.

Hypersensitivity: angioedema, urticaria, pruritus, Henoch-Schonlein purpura, bullous lesions (including pemphigus-like reactions).

Musculoskeletal: back pain, shoulder pain, muscle cramps.

Nervous System/Psychiatric: psychotic episodes including delusions, hallucinations, and paranoid ideation, neuroleptic malignant syndrome (see WARNINGS),

bradykinetic episodes (“on-off” phenomenon), confusion, agitation, dizziness, somnolence, dream abnormalities including nightmares, insomnia, paresthesia, headache, depression with or without development of suicidal tendencies, dementia, increased libido. Convulsions also have occurred; however, a causal relationship with carbidopa and levodopa has not been established.

Respiratory: dyspnea, upper respiratory infection.

Skin: rash, increased sweating, alopecia, dark sweat.

Urogenital: urinary tract infection, urinary frequency, dark urine.

Laboratory Tests: decreased hemoglobin and hematocrit; abnormalities in alkaline phosphatase, SGOT (AST), SGPT (ALT), lactic dehydrogenase, bilirubin, blood urea nitrogen (BUN), Coombs test; elevated serum glucose; white blood cells, bacteria, and blood in the urine.

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

Body as a Whole: abdominal pain and distress, fatigue.

Cardiovascular: myocardial infarction.

Gastrointestinal: gastrointestinal pain, dysphagia, sialorrhea, flatulence, bruxism, burning sensation of the tongue, heartburn, hiccups.

Metabolic: edema, weight gain, weight loss.

Musculoskeletal: leg pain.

Nervous System/Psychiatric: ataxia, extrapyramidal disorder, falling, anxiety, gait abnormalities, nervousness, decreased mental acuity, memory impairment, disorientation, euphoria, blepharospasm (which may be taken as an early sign of excess dosage; consideration of dosage reduction may be made at this time), trismus, increased tremor, numbness, muscle twitching, activation of latent Horner’s syndrome, peripheral neuropathy.

Respiratory: pharyngeal pain, cough.

Skin: malignant melanoma (see also CONTRAINDICATIONS), flushing.

Special Senses: oculogyric crises, diplopia, blurred vision, dilated pupils.

Urogenital: urinary retention, urinary incontinence, priapism.

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

Laboratory Tests: decreased white blood cell count and serum potassium; increased serum creatinine and uric acid; protein and glucose in urine.

http://www.druglib.com/druginfo/carb.../side-effects/

Scary. But how to tell the difference between muscle pain caused by the PD and muscle pain as a result of sinemet?

also, what can one do-there is no real alternative to levodopa that we know of. Mucuna, tried it, too inconsistent and unreliable (example: have an important meeting, need to be sure meds are working...not so sure if only using mucuna). Also over several days mucuna caused some major stomach aches. So what to do when the rx is the only one out there (and here I lump all Pd drugs in together, because many of them either have levodopa in them, or agents that act on levodopa). Suggestions?

That's what we are trying to figure out - the answer to your question. It has been revealing thus far; but we can't wait for anyone else to do it for us. They are too slow.

Anyone reading with knowledge and skills will know our needs to pull this together.

or - DBS?

paula

I've had the following before I started with Sinemet and its relations. Overall the Sinemet is helping me. Even if there were more side-effects, I would never know it at this time. Like lurkingforacure says, how can we tell the difference between what's the side-effect, and what's part of this syndrome.

Body as a Whole: chest pain

Cardiovascular: cardiac irregularities, hypotension, orthostatic effects including orthostatic hypotension, syncope, palpitation.

Gastrointestinal: vomiting, diarrhea, constipation, dyspepsia, dry mouth, taste alterations --- lack of taste. Lobster tasted like salt water to me last week!

Musculoskeletal: back pain, shoulder pain, muscle cramps.

Confusion, agitation, dizziness, somnolence, dream abnormalities including nightmares, insomnia, paresthesia, headache, depression with or without development of suicidal tendencies.

Respiratory: Upper respiratory infection. - Pneumonia 3x

Skin: Increased sweating,

Urogenital: Urinary frequency, dark urine.

Laboratory Tests: White blood cells, bacteria, and blood in the urine.

Body as a Whole: Abdominal pain and distress, fatigue.

Gastrointestinal: Gastrointestinal pain, Flatulence, hiccups.

Musculoskeletal: leg pain.

Nervous System/Psychiatric: ataxia, extrapyramidal disorder, falling, anxiety, gait abnormalities, nervousness, increased tremor, numbness, muscle twitching.

Respiratory: pharyngeal pain, cough.

Special Senses: Diplopia, blurred vision --- glasses not working well anymore.

Urogenital: Urinary retention, urinary incontinence, priapism.

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

Laboratory Tests: decreased white blood cell count and serum potassium; increased serum creatinine and uric acid.

John

Sorry Paula,

Much occupied but will tell you all I know about asap.
Moderation must be the main word, because all is not due to and/or against the use of levo-dopa with carbidopa (or benserazide).
It depends on....several considerations


1. Pharmacology, kinetics of drugs; chronopharmacology

When we talk about any drug and then more specially about dopaminergic ones , we have to consider different topics, parameters, factors and situations and of course to separate as far as possible, PD factors from drugs effects.

So for Levodopa and Carbidopa
- the molecules by themselves (pharmacology, effects in brain, in body)
- the two types of levo-dopa-carbidopa (standard CR)
- the pharmacokinetics data ( time to maximal concentration, intestinal and BBB crossing, duration of effects, elimination from body)
- the medical case it is given to (the case of the patient , the stage and complications of PD, of drug, of PD+drug )
- the way it is prescribed (dosages, schedule of intakes, schedule and type of meals, association to other drugs)
- the way it is taken, alternative drugs intakes
- the way it is understood by patients and carers and helpers (this means first explained, taught)
- and then the way it is adapted to the patient daily conditions, variability of levels, threshold and all or nothing effect, circadian rhythms...


2. Scientific data about CNS PNS body, in PD, and with Levodopa

The most shocking is first of all the "absence of consideration" to any other place in body and brain except substantia nigra,
and thus to the proper balance of several main regulations in CNS and PNS

2.1 upon neurotransmitters sytems in CNS
- CNS dopaminergic systems other than Substantia Nigra
- CNS norepinephrin (NE) systems, as in these, Dopamine is 'only' a precursor to release of NE, and as so, L-Dopa
- CNS balance of neurotransmitters, neuroplasticity, neurogenesis, neurophicity, neuroendocrine and immune functions, stress regulation...
- and their relations to general immunity, to enteric nervous system, etc....

2.2 upon neurotransmitters sytems in PNS
-Peripheral Nervous System effects L-Dopa upon DA and NA in autonomous system
-Peripheral effects of Levo-dopa and of carbidopa upon heart,vessels, kidneys, adrenals..

2.3 upon muscles, nerves, sensory receptors....


3. Levodopa + Carbidopa and other drugs

- Levodopa and carbidopa, and benserazide
- Same with ICOMT (stalevo) , with IMAO
-...and with agonists...


Excellent works to understand the complex regulation of balance of neurotransmitters systems in Brain
are those of Roshan Cools and allied teams she collaborates with
Chemistry of the adaptive brain (2004) and following ones.

More to come, depending on own possibilities...

As for the question, "Gold Standard drug: yes, but who gets the gold?",
I bet everyone will find who takes the standard drug and who gets the Gold...


Yours
Anne.