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Camilla Flintermann <[log in to unmask]> wrote: <<<I have to confess to some confusion about the Sinemet/food connection. We have had very persuasive info from a number of people to the effect that Sinemet taken with food loses much of its value by the time it gets out of the stomach. It sounds so reasonable--then I notice that Peter's new RX bottle of Sin.CR 50/200 has a label shouting "TAKE WITH FOOD"! So I called the pharmacist and asked about it, telling him what I had learned here. His reply was that this is the instruction from the manufacturer and the FDA requires them to so label it. He stated that the "package insert" is taken right from the PDR, which is the info supplied by the manufacturer. He could not explain it further. Now I wonder, are we correct in believing there's a problem, and that we need to wait 30-60 min. after taking it before eating? Is there something about the CR form that makes a difference in this way? (He could not find ANY info in the PDR about regular Sin. and food, only the CR form.) We would very much appreciate clarification on this issue, which is something Peter and others have to decide about many times a day! Thanks for any help you can give.(We did discuss the need for food if one is nauseated.)... the pharmacist quoted from the PDR that uptake (absorption) of Sin.CR is 25%-50% IMPROVED when taken with food.>>> My understanding is that the residence time in the stomach is time during which the metabolic "destruction" of the levodopa is occurring, but there is no significant absorption of levodopa before it enters the small intestine where the absorption of nutrients, et cetera is done via the blood vessels very near the chyme absorbing molecules small enough to pass through the thin membrane. The levodopa will probably not be enough mass to get carried this far by itself, so the dissolving is what is accomplished by waiting. (The CR will not dissolve completely for several hours.) The pre-dissolving in water with ascorbic acid (vitamin C) antioxidant to retard oxidation of the levodopa eliminates the stomach wait and, IF the stomach is relatively empty, the liquid carries the dissolved levodopa directly to the small iintestine. If that is empty, the liquid carries the medication quite far. The "carrier" is labeled LNAA-carrier. It is not likely to be very active if there is no chyme, so my "prescription" is to use small food intake of optimum sort with the medication(s). Some Large Neutral Amino Acids (LNAAs) will come from most foods. There is also some benefit to have some sugar and some bulk - but avoid: fat, animal protein (especially if you tend to chew only enough to swallow since large chunks reside in the stronger digestive juices and the levodopa is made useless). Dairy fat is not helpful, plant protein is usually not as much harm, but don't eat seeds and nuts then. The small intestine is small in diameter - this causes close proximity to the blood vessels and nutrients, water excess, and many chemicals are absorbed, some resorbed that go later back into the stomach to aid digestion, etc. If there is enough mass of food to carry much of the medication into the small intestine before the main meal actually is put into the stomach, one benefits by optimum absorption of levodopa into the bloodstream. (There is a saturation or concentration limit for LNAAs (levodopa is only one of ? many). More blood moves if digestion-absorption is continuing so that the blood with the levodopa gets to the brain where transporting out of blood into brain takes time also. In short, eat a couple of crackers, a prune perhaps, after taking the meds with water or some orange or other juice. Sucking one peppermint or butterscotch sugar-bomb or piece of ginger may help by chewing, swallowing and saliva generation which aid digestion. You might find less med required following this advice. Or, if you take less more often. The blood plasma concentration peaks rather quickly after the dose reaches the intestine and then is rapidly dropping unless you are using the CR type which apparently dissolves for several hours with decreasing surface area providing decreasing amount as this occurs. The Sinemet CR presentation to the recent meeting in Europe should soon be available as a paper. This may add much to the store of knowledge. I feel that this subject needs further discussion and probably could be aided by those of us interested trying to prepare a monograph or some sort of document that could have the distortions removed over the next few years and yield some pertinent needed educational advice. I did a little with graphical addition plots of concentration in plasma following Bob Naylor's inputs and help, but have not finished what I started. Maybe I will get back to that... ron 1936, dz PD 1984 Ridgecrest, California Ronald F. Vetter <[log in to unmask]> http://www1.ridgecrest.ca.us/~rfvetter