Mike,
 
I'=92ll try to answer as many of your questions as I can, but I don=92t hav=
e all=20
the answers. Perhaps others were also reluctant to try to answer so many at=
=20
once.
 
> Is a total of one CR 25/100 tablet a day enough ? It doesn't seem so,
> based on my reading....or is this a good starting point ?
 
It=92s a good starting point, but the dosage should be gradually increased =
over=20
a period of a couple of weeks until an effective level is reached. The=20
effective level depends on a variety of factors and there is no way it can =
be=20
predicted.
 
> When is the best time to take the medicine and how long between doses ? I
> started her with half a tablet early in the AM and the other half around
> noon. Is this good ? What is the useful time range for half a 25/100 for =
a >=20
> smaller women.?
 
Again, the answers can only be found by trial and error. Once you find the=
=20
effective level the medication should be spaced equally throughout the day.=
=20
When I first started on Sinemet I took one 25/100 three times a day: mornin=
g,=20
noon, and evening, and one dose lasted about six hours. Now I take one 25/2=
50=20
three times a day and one dose by itself lasts only 1-2 hours (however, I a=
m=20
also taking Pramipexole and that increases the effective time to about four=
=20
hours).
 
> Is Nausea really a problem if the Sinemet is taken well before a meal ?
> Can the lodosyn be reduced after the startup period ?....(relying on the
> carbidopa in the CR 25/100 combination pill to hold down nausea ?)
 
Nausea is the most common side-effect of Sinemet and usually the first one=
=20
encountered (my first dose made me so sick I had to go to bed!), but you=20
eventually get used to it. For the first 6 months I was taking Sinemet I=20
experienced nausea at least once a week, but during the past year I=92ve=20
experienced it only two or three times. Taking the Sinemet with a meal does=
=20
help control the nausea but reduces the absorption rate of the medication.
 
> What's the real issue with milk and dairy products ? I have read that Lom=
a
> Linda recommends against it...yet others seem to say "no problem". Do mil=
k
> or dairy products have this wide a range of effect on different individua=
ls?
 
All I know about dairy products is that they slow down the absorption rate.=
 In=20
fact several people in my support group who are on high doses of Sinemet an=
d=20
who frequently suffer from dyskinesia take dairy products (usually milk and=
/or=20
ice cream) to counteract it.
 
> she must get normal protein levels to maintain weight and body strength b=
ut=20
> how restrictive does one have to be, if the medicines are to be useful ?
 
Various studies that have been conducted suggest that a 1:7 ratio between=
=20
protein and carbohydrates is the most effective for PD patients. The only=
=20
effect of eating a lot of protein is that it is in competition with Ldopa f=
or=20
the enzyme that converts Ldopa to dopamine. Personally, I don=92t pay that =
much=20
attention to it.
 
> What side effects does Sinemet have ? It seems I've read that it causes
> sleep problems ??
 
This is a listing from my Drug Reference Guide:
 
Sinemet-25/250 (Carbidopa/Levodopa) 25/250 Tablet=20
LEVODOPA WITH CARBIDOPA - ORAL=20
(Prescription medication.)=20
Uses:=20
This medication is used to treat symptoms of Parkinson's disease. Carbidopa=
 is=20
used to make levodopa more effective. Carbidopa has no effect when given=20
alone. =20
How to Use This Medication:=20
Take with food or milk to prevent stomach upset, unless your doctor directs=
=20
you otherwise. Take this drug as directed. It may take a few weeks before t=
he=20
full benefits of this medication are observed. =20
Side Effects:=20
May cause drowsiness, dizziness, headache, loss of appetite, stomach upset,=
=20
vision changes, unusual body odor or trembling of the hands. These should=
=20
subside as your body adjusts to the medication. If these symptoms persist o=
r=20
become bothersome, inform your doctor. Notify your doctor if you develop=20
vomiting, difficulty swallowing, difficulty urinating, uncontrollable=20
movements, chest pain, rapid heart rate, skin rash or mood or mental change=
s=20
while taking this medication. May cause darkening of the urine or sweat. Th=
is=20
is not harmful and will disappear when the medication is stopped. May cause=
=20
dizziness especially when rising quickly from a seated or lying position.=
=20
Change positions slowly and be careful on stairs. =20
Precautions:=20
This drug should be used during pregnancy only if clearly needed. Discuss t=
he=20
risks and benefits with your doctor. Levodopa appears in breast milk. Consu=
lt=20
with your doctor before breast-feeding. This medication can cause false=20
results in urine glucose testing in diabetes. TesTape should be used to tes=
t=20
urine for accurate results. =20
Interactions:=20
If you are presently taking: MAO inhibitors or medicine to treat depression=
 or=20
anxiety ("anti-depressants" or Valium-like) drugs, phenytoin (Dilantin), ir=
on=20
vitamins or other drugs to treat Parkinson's disease, tell your doctor as t=
he=20
dose of your new medicine may need to be adjusted or changed. Persons takin=
g=20
levodopa alone should not take vitamin B6 (pyridoxine) since this vitamin c=
an=20
reduce levodopa's effects. Persons taking levodopa with carbidopa do not ne=
ed=20
to observe this precaution. =20
Drug Tips:=20
Be sure your doctor knows your complete medical history and the medications=
=20
you are taking. =20
Missed Dose:=20
If you miss a dose, take as soon as remembered unless the next scheduled do=
se=20
is within 2 hours. If so, skip the missed dose and resume your usual dosing=
=20
schedule. Do not "double-up" the dose to catch up. =20
Storage:=20
Store at room temperature away from sunlight and moisture. Do not store in =
the=20
bathroom. =20
 
Hope this helps.
 
Bruce
 
 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Bruce G. Warr               "Experience is what enables us to recognize
Healthcare Informatics Lab   a mistake the next time we make it."
Information Systems Dept.
University of Maryland Baltimore County
 
http://umbc.edu/~warr/
(V) (410)455-3206
(F) (410)455-1073
 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
=20