In patients without motor fluctuations, 'Sinemet CR' under controlled conditions, provided the same therapeutic benefit with less frequent dosing than with 'Sinemet'.
The dose-adjusted bioavailability for one 'Half Sinemet CR' tablet was equivalent to that for one 'Sinemet CR' tablet. 'Sinemet CR' or 'Half Sinemet CR' is contraindicated in patients with known hypersensitivity to any component of this medication, and in patients with narrow-angle glaucoma.Because levodopa may activate a malignant melanoma, 'Sinemet CR' or 'Half Sinemet CR' should not be used in patients with suspicious undiagnosed skin lesions or a history of melanoma.When patients are receiving levodopa monotherapy, levodopa must be discontinued at least eight hours before therapy with 'Sinemet CR' or 'Half Sinemet CR' is started (at least 12 hours if slow-release levodopa has been administered).Dyskinesias may occur in patients previously treated with levodopa alone because carbidopa permits more levodopa to reach the brain and, thus, more dopamine to be formed. In such patients, cardiac function should be monitored with particular care during the period of initial dosage administration and titration.Levodopa has been associated with somnolence and episodes of sudden sleep onset. 'Sinemet CR' and 'Half Sinemet CR' may only be administered as whole tablets. © Merck Sharp & Dohme Limited 2017.
'Sinemet CR' and 'Half Sinemet CR' are not recommended for the treatment of drug-induced extrapyramidal reactions or for the treatment of Huntingdon's chorea.Based on the pharmacokinetic profile of 'Sinemet CR' the onset of effect in patients with early morning dyskinesias may be slower than with conventional 'Sinemet'. 'Sinemet CR' or 'Half Sinemet CR' should not be given when administration of a sympathomimetic amine is contraindicated.Non-selective monoamine oxidase (MAO) inhibitors are contraindicated for use with 'Sinemet CR' or 'Half Sinemet CR'. The information provided here is for informational purposes only. 'Sinemet CR' and 'Half Sinemet CR' are a combination of carbidopa, an aromatic amino acid decarboxylase inhibitor, and levodopa, the metabolic precursor of dopamine, in a polymer-based controlled-release tablet formulation, for use in the treatment of Parkinson's disease. Dosages that provide up to 30% more levodopa per day may be necessary.A guide for substitution of 'Sinemet CR' treatment for conventional levodopa/decarboxylase inhibitor combinations is shown in the table below:'Half Sinemet CR' is available to facilitate titration when 100 mg steps are required.Levodopa must be discontinued at least eight hours before therapy with 'Sinemet CR' is started. Patients taking these drugs with 'Sinemet CR' or 'Half Sinemet CR' should be observed carefully for loss of therapeutic response. The possibility that the patient may have taken other drugs as well as 'Sinemet CR' or 'Half Sinemet CR' should be taken into consideration. Generally, there was no further improvement of other symptoms of Parkinson's disease.The pharmacokinetics of levodopa following administration of 'Sinemet CR' were studied in young and elderly healthy volunteers. The advanced form of motor fluctuations ('on-off' phenomenon) is characterised by unpredictable swings from mobility to immobility. The possibility that the patient may have taken other drugs as well as 'Sinemet CR' or 'Half Sinemet CR' should be taken into consideration. Most patients have been adequately treated with two to eight tablets per day of 'Sinemet CR' administered as divided doses at intervals ranging from four to twelve hours during the waking day. The dosing interval between doses should be prolonged by 30 to 50% at intervals ranging from 4 to 12 hours. If therapy is interrupted temporarily, the usual dosage should be administered as soon as the patient is able to take oral medicine.Epidemiological studies have shown that patients with Parkinson's disease have a higher risk of developing melanoma than the general population (approximately 2-6 fold higher). Dosage adjustment of Sinemet CR may be necessary when these agents are added. The mean peak plasma levodopa levels were 60% lower with 'Sinemet CR' than with 'Sinemet'. Furthermore a reduction of dosage or termination of therapy may be considered.As with levodopa, 'Sinemet CR' or 'Half Sinemet CR' may cause involuntary movements and mental disturbances. The reduction of the 'off'-time is rather small (about 10%) and the incidence of dyskinesias increases slightly after administration of 'Sinemet CR' compared to standard 'Sinemet'. Slow-release; Note: this lollipop delivery system requires the patient to slowly allow dissolution.
The reduction of the 'off'-time is rather small (about 10%) and the incidence of dyskinesias increases slightly after administration of 'Sinemet CR' compared to standard 'Sinemet'. This tool may not cover all possible drug interactions. The whole e r tablet of sinemet lasts for 3 hrs.
Higher doses (up to 12 tablets) and shorter intervals (less than four hours) have been used, but are not usually recommended.When doses of 'Sinemet CR' are given at intervals of less than four hours, or if the divided doses are not equal, it is recommended that the smaller doses be given at the end of the day.
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