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Hi Bill, I have been using liquid sinemet with permax since mid-1991. I have found that when given with liquid sinemet there are no side effects for me. I take only about 2 mg daily. I have tried to raise it to 4 mg per day, but found it there was no therapuwutic value. You also ask about increasing liquid sinemet since it is not as effective as before. There are three possible variables you can play with. (1) the time interval can be shortened or lengthened. I would not suggest changing this as timing for medication is a habit and changing in difficult (2) change the strength of the medication and/or change the amount of liquid consumed. This is the most common way and the major reason patients are using this system. (3) Change the amount of medications used at start up. It could be the patient is getting too much or too little to start and then maintained at that level. Let me know her current schedule of her medications. Maybe I can help. Regards, Alan Bonander