>>> Posting number 277
Date:         Sun, 20 Feb 1994 17:01:20 EST
From:         Alan Bonander
Subject:      Sinemet Usage

Dear Barbara, you have most likely received a lot of help concerning your
trouble with Sinemet.  I thought I would add a different twist to the
problem.

Just some random thoughts on the use of Sinemet.

The name Sinemet means "without throwing up" or something similar.  This was
the major problem with Levodopa by its self.  Adding Carbidopa to Levodopa
smoothed the "throwing up" center and allowed more Levodopa to cross the
blood-brain barrier.  There has been various writings about how much
Carbidopa one needs daily to effectively control the problems and give the
benefit.  Some famous doctors have stated that between 50 and 125 mg of
Carbidopa is needed.  Recently it was reported that 75 to 150 mg were needed.
Then it was reported that if one takes over 300 mg that Carbidopa crosses
over the blood-brain barrier and inhibits conversion of Levodopa to Dopamine.
All this is very confusing to patients.  So here is my current thinking and I
am not a MD.  I have PD.

Carbidopa has some negative side effects.  It inhibits the generation of
Serotonin.  Now Serotonin is required in the process of making natural
dopamine in the brain.  What could be happening is, too much carbidopa could
effectively cause an OFF result by the process above.  At the same time, too
little carbidopa and we start to throw up.  I have found for myself I need
around 125 mg of carbidopa to maximize my response to Levodopa.  Too much and
I have less than optimal response and too little, no response at all.  To
help the response along I take my Sinemet on an empty stomach.  Taking it
with food can cause problems as the same with protein conflicts.

I often suggest that if stomach problems result from taking Sinemet on an
empty stomach, use a cracker or a vanilla wafer cookie, all of which have no
protein, and take the pill with orange juice, 7-up or similar sweet fluid.
If you want to speed things along, put the Sinemet pill in the sweet fluid
for about 60 seconds and than drink it.  The pill will dissolve and will pass
through the pylorus into the small intestine.  This is were it needs to be to
enter the blood system, etc.  One warning, this method will send a lot of the
medication to the brain quickly.  As a result, you could actually be
overdosed for a short time.  It is very effective for the first pill in the
morning, when one needs an extra boost.

Another consideration for those of you taking Sinemet CR and having stomach
problems with the first dose.  It turns out that Levodopa in the CR actually
releases faster than the Carbidopa.  The result is nausea, etc.  The
recommended alternative is to ask your doctor for a FREE drug call Lodosyn.
Yes I said FREE.  This is the name of a Carbidopa only pill that is  25 mg of
Carbidopa.  DuPont gives these to doctors free for asking.  You can not get a
prescription as drug stores do not carry free meds.  Anyway, taking a 25 mg
Lodosyn with the first CR in the morning seems to solve the nausea problems.
I might also add that it takes about two weeks of taking Sinemet for it to
build to a "therapeutic level" according to one famous neurologist.  Maybe
after two weeks some of the initial problems go away.

Now I don't know how much added confusion I have contributed to with this
little bit of noise.  If it doesn't work for you, fine.  If it does work,
fine.
Any other comments would be appreciated.  Like a said, I am not a MD.
I have had PD for 10 years and take about 800 mg of Levodopa, 125 mg of
Carbidopa, 2 mg of Permax and 20 mg of Paxil.  When I was diagnosed, the
doctor gave me Sinemet 25/250 and said take 4 or 5 of these a day and you
will feel better.  I did and I did.  No problems initially, the problems came
later when the ON/OFF started.  That is another story for another time.

Alan Bonander  <[log in to unmask]>

janet paterson, an akinetic rigid subtype, albeit perky, parky
PD: 54/41/37 CD: 54/44/43 TEL: 613 256 8340 EMAIL: [log in to unmask]
"A New Voice" home page: http://www.geocities.com/janet313/     .
"New Voice News" latest posts: http://groups.yahoo.com/group/nvnNET/     .

----------------------------------------------------------------------
To sign-off Parkinsn send a message to: mailto:[log in to unmask]
In the body of the message put: signoff parkinsn