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In a message dated 6/25/99 7:11:33 PM Central Daylight Time, [log in to unmask] quotes Suzanne M Weiler saying: << I feel like everything I can find out is a plus. Since I started researching the Internet I have found out that controlling his protein diet has help a lot. I feel like all info I can get can help. >> Sue, This was written to be helpful in situations like yours: SINEMET A primer (by WHH) --THINGS I DISCOVERED OVER THE YEARS (ONLY SOME OF WHICH WERE TOLD ME BY DOCTORS) Disclaimer: this represents most of what I know or think I know about the drug Sinemet. It may not work this way for you. In 1999, the chances are that a doctor will start Sinemet with 25/100 tablets. Regular Sinemet also comes in 10/100 and 25/250. Two strengths (25 /100 and 50/200) of time release are also available. In both types, the first number is the mg of Carbidopa, the second, that of L-dopa. The object is to get dopamine into the brain. Levodopa (L-dopa) Normal brains convert certain dietary amino acids into dopamine in a series of enzymatic steps. Producing L-dopa is the brain's last step prior to making dopamine. L-dopa readily crosses the blood -brain barrier (dopamine does not). L-dopa is easily converted into dopamine by the enzyme dopa-decarboxylase (an enzyme little effected in the Parkinson's diseased brain). Supplying this precursor to the brain is what Sinemet does. Oral L-dopa is not absorbed from the stomach. It is rapidly absorbed (Like giving it I.V.) when it reaches the small bowel. Carbidopa Sinemet also contains Carbidopa, a drug that binds to peripheral (outside the brain) dopa decarboxylase to prevent L-dopa to dopamine conversion outside the brain. A PWP needs roughly 150-mg of Carbidopa a day. More than 300 mg of the drug daily is not recommended. This is not a totally benign drug to take in large amounts. Carbidopa does two things: Prevents side effects of dopamine on blood pressure, heart function, stomach, etc. Allows the use of less L-dopa while delivering a similar amount of that drug to the brain. Sinemet Use: Short term effects: Within a week, new users notice the disappearance of symptoms about an hour after taking a dose. The patient (PWP) soon notices the difference between "OFF"(medicine not working acutely) and "ON" (medicine working acutely). Long term effects: When initially started, this medicine tends to build long term improvement in the "Off" state--often for a period of about six months. More frequent doses initially lead to better symptom control. However, more frequent dosing also seems to speed the onset of side effects. Morning "off" improves most. The PWP notices the "sleep effect," awakening "on," (prior to taking the first dose of the day), and maintaining good early morning function for about a half-hour. However, within a couple of years Sinemet begins controlling symptoms for a progressively shorter time. One tablet every one and a half hours within six years is neither uncommon nor desirable. This usually happens when the PWP attempts to always be in the "on "state during waking hours Side effects: Dyskinesias (uncommanded movements) are the most common, usually most troublesome side effect. These are initially mild, but they typically grow over the course of years from a localized curiosity to a major, uncomfortable, generalized flailing of the limbs and torso Dystonia- (uncommanded straining of a muscle or group of muscles-- resembles a cramp) often responds temporarily to another person shaking the affected limb. Mental changes: Dopamine addiction: One's body feels much better after transition from "off" to "on". In addition, one's mental outlook is chemically transformed from depressed and uncomfortable to feeling good (often approaching mania after a few years). Elevated dopamine levels in one's brain stimulates heightened sexuality in many patients. Many patients report hallucinating while on Sinemet, A further complication: Many report an increase in the time to onset and a reduction in the power of Sinemet when taken with protein. This is due to competitive inhibition of L-dopa uptake into the brain. The net effect is to delay and lower the uptake and effect of L-dopa. The same active blood-brain mechanism takes in both and can be maxed out with excess amounts of certain amino acids, leaving a relative shortage of L-dopa in the brain. So What? I believe most expert's agree that it is a good idea to take as little Sinemet (L-dopa) as possible, while still doing the job. To do so, various strategies are employed. Take your symptoms to your local friendly movement disorder specialist for occasional tune-ups. I hope this helps you. Regards, WHH 55/38/37