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AVFerris: Sinemet (carbidopa/levadopa) is a potent drug and its side effects do increase over time and neurologists usually don't prescribe it in the early stages of PD. When a patient finds that slowness and rigidity interferes too much with what needs to be done at work or home, Sinemet is usually started at low doses like 25/100 two or three times a day. If the patient doesn't expect to be symptom free and is satisfied with feeling some better, and can keep the dosage low, he can often go for at least two to five years without too many side effects. This depends upon the person - some don't do as well and some can go for more than five years without side effects. Sometimes other PD drugs are added and Sinemet is cut lower to lessen the untoward effects. In the event of Sinemet problems there are a number of drugs that can do a decent job if given with lowered doses of Sinemet. You need to see a doctor who is up to date on PD and treats a lot of PD patients. It is important to learn all you can about the disease. There are some really good PD handbooks and of course getting on the mailing list for all the PD organization newsletters keeps you pretty well up to date. Join a support group as well - you can learn a lot from other patients on how they cope with PD symptoms and medicine side effects. You need to find out about the controlled release Sinemet as compared with regular Sinemet. I'm on controlled release and I'm not sold on it although I think most PD specialists are using CR now on many of their patients. I just don't think we know enough about its long term effect. THEY say it helps prevent the wearing off and the on/off syndrome. CR is fairly new - two or three years - and I question its effectiveness. It certainly can be slow starting. I've only been taking CR for eight months so maybe someone on the list who knows something more can jump right in here and give us the straight poop on Sinemet and COMT (I understand this is like fowling up of spark plugs or yellow build-up on waxed floors). There is no question that Sinemet is about all we've got - it is good but we need something better - a better Sinemet CR. Maybe instead of a matrix it should be "hundreds of tiny time tablets" that dissolve more evenly. Barbara Yacos <[log in to unmask]>