Select one or more newsletters to continue. Dopamine agonists, such as bromocriptine, and muscle relaxants, such as dantrolene, are often used in the treatment of NMS; however, their effectiveness has not been demonstrated in controlled studies.As with levodopa, periodic evaluations of hepatic, hematopoietic, cardiovascular, and renal function are recommended during extended therapy.Patients with chronic wide-angle glaucoma may be treated cautiously with Sinemet CR provided the intraocular pressure is well-controlled and the patient is monitored carefully for changes in intraocular pressure during therapy.Levodopa alone, as well as Sinemet CR, is associated with dyskinesias. 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. No overall meaningful differences in safety or effectiveness were observed between these subjects and younger subjects, but greater sensitivity of some older individuals to adverse drug reactions such as hallucinations cannot be ruled out. It is designated chemically as (—)-L-α-amino-β-(3,4-dihydroxybenzene) propanoic acid. The SINEMET CR tablet is a polymeric-based drug delivery system that controls the release of carbidopa and levodopa as it slowly erodes. Intravenous fluids should be administered judiciously and an adequate airway maintained. Neurological findings, including muscle rigidity, involuntary movements, altered consciousness, mental status changes; other disturbances, such as autonomic dysfunction, tachycardia, tachypnea, sweating, hyper- or hypotension; laboratory findings, such as creatine phosphokinase elevation, leukocytosis, myoglobinuria, and increased serum myoglobin have been reported.The early diagnosis of this condition is important for the appropriate management of these patients. In order to reduce adverse reactions, it is necessary to individualize therapy. SINEMET caused both visceral and skeletal malformations in rabbits at all doses and ratios of carbidopa/levodopa tested, which ranged from 10 times/5 times the maximum recommended human dose of carbidopa/levodopa to 20 times/10 times the maximum recommended human dose of carbidopa/levodopa.There are no adequate or well-controlled studies in pregnant women. Select one or more newsletters to continue.

Sinemet CR should not be chewed or crushed.Standard drugs for Parkinson's disease, other than levodopa without a decarboxylase inhibitor, may be used concomitantly while Sinemet CR is being administered, although their dosage may have to be adjusted.Since carbidopa prevents the reversal of levodopa effects caused by pyridoxine, Sinemet CR can be given to patients receiving supplemental pyridoxine (vitamin BDosage with Sinemet CR should be substituted at an amount that provides approximately 10% more levodopa per day, although this may need to be increased to a dosage that provides up to 30% more levodopa per day depending on clinical response (see Following initiation of therapy, doses and dosing intervals may be increased or decreased depending upon therapeutic response. Although the color appears to be clinically insignificant, garments may become discolored.The patient should be informed that a change in diet to foods that are high in protein may delay the absorption of levodopa and may reduce the amount taken up in the circulation.

This increase is not considered a clinically significant impact.Sinemet CR is indicated in the treatment of Parkinson's disease, post-encephalitic parkinsonism, and symptomatic parkinsonism that may follow carbon monoxide intoxication or manganese intoxication.Nonselective monoamine oxidase (MAO) inhibitors are contraindicated for use with Sinemet CR. The patient should be cautioned not to change the prescribed dosage regimen and not to add any additional antiparkinson medications, including other carbidopa levodopa preparations, without first consulting the physician.If abnormal involuntary movements appear or get worse during treatment with Sinemet CR, the physician should be notified, as dosage adjustment may be necessary.Patients should be advised that sometimes the onset of effect of the first morning dose of Sinemet CR may be delayed for up to 1 hour compared with the response usually obtained from the first morning dose of SINEMET.

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