Special warnings about Sinemet CR
Make sure your doctor knows if you have any of the following:
Cardiovascular or lung disease (severe)
Endocrine (glandular) disorder
History of heart attack or heartbeat irregularity
History of active peptic ulcer
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
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
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 this medication 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 for Sinemet CR
Your doctor will tailor your individual dosage carefully, depending on your response to previous therapy and symptoms.
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.
Use of Sinemet CR in children under 18 is not recommended.
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.