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This is to the lady who was taking 8 CRs and a few regular sinemet daily. I noticed reference to PSP in your signoff. If there has been a diagnosis of PSP then Sinemet is often ineffective and may only give a little relief if any. I still believe you are taking too much Sinemet. If the CR is the 50/200 size you are taking way too much meds. Eight CRs is 8 x 50/200 = 400/1600 and add to that 4 x 25/100 = 100/400 and you are taking 500/2000. This is 500 mg of carbidopa and 2000 mg of levodopa. The recommended level of carbidopa daily is 75 to 200 mg. Carbidopa is known to have two adverse effects: it inhibits production of serotonin and it also lowers the level of Nicine. Patients taking high doses of carbidopa should have their Nicine level tested. For some, increasing Nicine has made all the difference in the world. The other concern is that some patients taking high carbidopa and levodopa amounts have reported that increasing sinemet actually turns them OFF. This was the case with a man in the west who was taking 30 25/100 pills daily. Any more and he would start going OFF. He was recently converted to Permax and now takes 6 25/100 and 6 .25 mg permax. He is doing well. He would say he tried Permax, but it didn't agree with him. The problem was that the doctor did not reduce sinemet as he started with Permax. The result was very strong dyskinesia. When starting on Permax, Sinemet must be reduced at the sa me time. FInally, large amounts of Sinemet can be toxic to other systems in the body. You must realize that only about 5 - 10 percent of the levodopa we take actually gets converted to dopamine in the brain. The rest is processed outside of the blood brain barrier. Excess dopamine in the brain can cause dyskinesia, paranoid behavior, excess talking without earing anyone else, and it goes on. The only way to reason with a person so medicated is to wait until the meds start to wear off. High amouts of dopamine outside of the brain can cause heart related problems. Dopamine is a heart stimulant. There are four main catagories of meds and I believe is taking something from each: 1) Dopamine suppliments: Sinemet 2) Dopamine agonists: Permax and Parlodel 3) MAO-B inhibitor: Eldepryl 3) Anti-depression: (something that increases the level of serotonin in the system) such as Paxil, Zoloff and Prozac Regards, Alan Boander ([log in to unmask])