Sinemet
Sinemet is a medication that is commonly prescribed to treat the symptoms of Parkinson's disease. It is a combination drug that contains two active ingredients: levodopa and carbidopa. Levodopa is converted into dopamine in the brain, which helps to alleviate the motor symptoms of Parkinson's disease, such as tremors, stiffness, and difficulty with movement. Carbidopa is included in the medication to enhance the effectiveness of levodopa by preventing its breakdown before it reaches the brain. This combination of levodopa and carbidopa allows for better control of Parkinson's symptoms and helps improve the quality of life for individuals with the condition. Sinemet is available in different formulations and dosages.
Drug Uses
An antidyskinetic combination, Sinemet comes with Levodopa and Carbidopa. Levodopa acts on the cells of the brain and helps in getting relief from the various symptoms of Parkinson disease. It is Carbidopa that helps Levodopa to reach the brain.
Dosage and administration route
Sinemet is administered orally to adults. The dosage regimen is determined by the physician individually depending on the severity of the disease, concomitant pathology, and therapeutic effect for adult patients who have previously been treated with the drug. To achieve optimal effect, it is best to take the drug daily without taking a break in use.
Patients not receiving levodopa: for patients starting treatment with Sinemet, the initial dose is ½ tablet once or twice daily after meals. If necessary, the dose should be increased by gradual addition of ½ tablet daily or every other day until the optimal therapeutic effect is achieved. The therapeutic response to the drug is observed within one day, and sometimes after one dose. The full effective dose of the drug is achieved within 7 days compared to weeks and months of levodopa alone.
Patients receiving levodopa: levodopa should be discontinued at least 12 hours (24 hours for slow release) prior to starting therapy with Sinemet. The dose should contain approximately 20% of the previous daily dose of levodopa.
Initial dose: for patients receiving less than 1500 mg of levodopa per day, the initial daily dose should be 75-100 mg of carbidopa and 300-400 mg of levodopa (use the drug with a carbidopa/levodopa ratio of 1:4) in 3-4 doses per day. Patients who receive more than 1500 mg of levodopa per day should start with a dose of 1 tablet 3-4 times per day.
Maintenance therapy: therapy with Sinemet combination should take into account individual patient characteristics, and the dosage can be gradually changed depending on the therapeutic effect.
If a larger amount of levodopa is required, the dose of the drug can be increased by ½ or 1 tablet each subsequent day up to a maximum daily dose of 200 mg carbidopa and 2 g levodopa (8 tablets in 3-4 doses) for patients with a body weight of 70 kg.
When switching a patient from levodopa to Sinemet is combined with other decarboxylase inhibitors, their use should be discontinued at least 12 hours before starting Sinemet.
For patients taking other antiparkinsonian drugs concomitantly with Sinemet, it may be necessary to adjust the dose of these drugs.
The combination of the drug with MAO type B inhibitors (MAO-B) can increase the effectiveness of the drug in controlled cases of akinesia and/or dyskinesia.
Elderly patients: this medicine should be used in elderly patients.
Children
The safety and efficacy of the drug in children have not been established, so it should not be used in patients under 18 years of age.
Overdose
The precautions for Sinemet overdose are the same as for levodopa overdose, but pyridoxine is not effective in reducing the effect of Sinemet.
Symptoms: involuntary movements, blepharospasm, arterial hypertension, increased heart rate, heart rhythm disturbance, confusion, anxiety, insomnia, anxiety.
Treatment: artificially induce vomiting, emergency gastric lavage.
Symptomatic therapy: administer infusions with caution, pay attention to airway patency; in case of arrhythmia, use appropriate treatment with ECG monitoring. The value of dialysis for the treatment of overdose has not been studied.
Missed Dose
You will have good results only if Sinemet is taking on a regular basis. Never give up taking Sinemet once you feel well. Well, it is better never to miss any dosage. But if you have forgetten a dose, you can take the medicine once you remember it. Well, take care that the missed dose is not taken if he time for the scheduled dosage is so near. Never take two dosages of Sinemet.
If you feel of having taken an overdose of Sinemet, better consult the doctor in no time.
More Information
Before the drug is scribbled, discuss with your physician about all the problems related to your health. It is only when the doctor know your complete health history will he be able to prescribe the right prescription.
Tell your doctor if you are having any heart disease, irregular heartbeat, ulcer, mood disorders, blood pressure, seizures, asthma, liver or lung or kidney problems, Hormone problems, stomach problems or intestinal bleeding and glaucoma.
It is good not to get pregnant while taking Sinemet. In case you become pregnant, inform your doctor immediately as sometimes the drug may cause harm to the unborn babe. Though it is not yet known if Sinemet passes into breast milk, the drug should only be taken after checking with your doctor.
Elderly people should use Sinemet tablet with caution, as they are more prone to the side effects. The drug is not prescribed for children.
Doctors normally do not prescribe Sinemet if you have any allergies to the ingredient in the drug, undiagnosed skin growths, narrow angle glaucoma and skin cancer. The drug is also not given if you have taken a monoamine oxidase inhibitor (MAOI) in the last 14 days.
Warnings/Precautions
Some persons can come across drowsiness and dizziness while taking the tablets. So be careful not to drive or perform any hard task after taking the Sinemet. While taking Sinemet, do not drink alcohol as it only increases the side effects.
When you talk with your doctor, you should also inform him about all the medications, including prescription and non-prescription drugs that you take. Some drugs like MAOIs, Tricyclic antidepressants, Metoclopramide and Butyrophenones, are known to interact with Sinemet.
Side effects
When using levodopa/carbidopa, the most common side effects are caused by the central neuropharmacological activity of dopamine: dyskinesia (including chorea-like), dystonic and other involuntary movements, nausea. Muscle twitching and blepharospasm may be early signs for a dose reduction. They disappear when the dose is reduced or during treatment.
Other serious side effects include mental changes, including paranoia and psychosis, depression with or without suicidal tendencies, and dementia. There have been cases of pathological gambling, increased libido and hypersexuality among patients, especially with high doses; these manifestations disappear with a dose reduction or discontinuation of therapy.
Other adverse effects reported in connection with the use of levodopa or its combination with carbidopa are systematised by organ system.
From the nervous system: dyskinesia, including chorea, dystonia, bradykinesia, bradykinetic episodes ("on-off" phenomenon), (may occur several months and even years after the start of treatment with levodopa and is probably associated with disease progression (in such cases, it may be necessary to adjust doses and intervals between them)), ataxia, asthenia, disorientation, numbness, blepharospasm, trismus, dizziness/vertigo, drowsiness, including very rarely excessive daytime sleepiness and sudden episodes of falling asleep, paresthesia, syncope, dementia, hand tremor, extrapyramidal and movement disorders, movement coordination disorders, fatigue, headache, activation of latent Horner's syndrome, fainting, respiratory depression, falls, gait disturbance, irritability. Very rarely - convulsions.
On the part of the psyche: sleep disturbances, psychotic episodes, including delusions, nightmares, hallucinations, and paranoid thinking, decreased thinking ability, depression with or without suicidal intentions, confusion, insomnia, anxiety, changes in mental status, including mania, impulse control disorders, such as pathological gambling, increased libido, hypersexuality, possible symptoms of impulse control disorder and compulsive behaviour (overeating, oniomania (impulsive desire to buy) have been observed in patients treated with dopamine agonists, including carbidopa/levodopa, especially in high doses). These adverse effects were mostly reversible after dose reduction or discontinuation of treatment. Fear, euphoria, dysregulated dopamine syndrome.
Benign, malignant and other neoplasms (including cysts and polyps): benign, malignant and undiagnosed neoplasms, including cysts and polyps, malignant melanoma.
Blood system: leukopenia, haemolytic and non-haemolytic anaemia, thrombocytopenia, agranulocytosis.
Immune system: angioedema.
Metabolic disorders: anorexia, weight gain or loss, edema.
Visual organs: diplopia, mydriasis, oculomotor crisis (tonic spasms of the external muscles of the eyeball), blurred vision.
Cardiovascular system: heart rhythm disturbances/ palpitations, orthostatic effects, including arterial hypotension, arterial hypertension, chest pain, phlebitis, tendency to fainting, syncope, flushing, flushing to the face.
Respiratory system: dyspnoea, hoarseness, abnormal breathing, dyspnoea.
Digestive tract: nausea, vomiting, diarrhoea, constipation, abdominal pain, dark saliva, dyspepsia, dry and bitter taste in the mouth, hypersalivation, dysphagia, bruxism, hiccups, gastrointestinal bleeding, flatulence, burning sensation on the tongue, duodenal ulcer.
Skin and subcutaneous tissues: hypersensitivity reactions, including angioedema, urticaria, purpura, Schönlein-Genoch disease, hair loss, rash, dark-coloured sweat, itching, excessive sweating, activation of malignant melanoma.
Musculoskeletal system: muscle cramps, muscle spasm.
Urinary system disorders: urinary retention, urinary incontinence, dark coloured urine, priapism.
Other: oedema, general weakness and malaise, irritation, malignant neuroleptic syndrome.
Laboratory parameters: increased liver function tests, such as alkaline phosphatase, alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase, bilirubin, blood urea nitrogen, creatinine, uric acid, positive Coombs test.
Rarely, a decrease in haemoglobin and haematocrit, an increase in serum glucose, leukaemia, bacteriuria, haematuria were noted.
Description of some adverse reactions
DDS are addictive disorders that have occurred in some patients taking carbidopa/levodopa. Compulsive behaviour was observed in patients as a result of drug abuse, which in some cases could cause acute dyskinesia.
Features of application
allowed
from the age of 18
not allowed not allowed with caution allowed not allowed