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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]>