Dear Marcia: 

 

I know you have received several responses to your query on Sinemet.  I do not want to add to any confusion, but, rather to clarify some of the statements that have been made by others.  To begin, no question is silly !! 

 

Although Jim responded that nausea is not the nature of Sinemet, it is a medication that indeed can and does cause nausea in many people. It is the levodopa within the Sinemet that can cause terrible nausea and in some instances, vomiting.  The carbidopa portion of Sinemet, among other things, can help reduce the incidence of nausea.  I recently had a conversation with Dr. Lieberman about Sinemet and he told me that the word "Sinemet" actually was derived from two Latin words: 'sine' meaning without and 'emet', referring to emesis, or vomiting. True, the nausea can often be directly related to the dosage of the Sinemet. 

 

As for breaking CR (Controlled Released) Sinemet, one can be broken and the other should not be broken.  The larger dosage, (50/200) can be broken without destroying the controlled release action.  If it needs to be broken, it should be done carefully on the scored portion of the tablet (scored means the line that is indented down a tablet).  The smaller does of Sinemet CR (25/100) cannot be broken without ruining the controlled release action.  This tablet is NOT scored.  Ideally, when 25/100 is ordered, it would be advisable to secure the lower dose tablet.  In situations where the smaller dosage is unavailable, for whatever reason, it is safe to break the larger dose in half.  The Sinemet CR tablets, regardless of strength, should NEVER be chewed or crushed.

 

As far as the dosage is concerned, different people respond differently.  Ideally, starting on a lower dosage is advisable, increasing it if it does not seem to be helping the symptoms. It is very difficult for anyone to put a blanket statement out that a particular dose or frequency is the best for everyone.

 

You mention that your mothers stiffness and balance is becoming worse.  Medication alone will not help that.  It is essential that she partake in exercise.  A physical therapist should evaluate her and can teach her specific exercises to help with the stiffness and the balance.  She should be doing some sort of exercise on a daily basis to be at her optimum functioning level.

 

A Movement DIsorders Specialist is a neurologist that specializes in certain disorders, such as Parkinson's that is not only a neurological disorder, but it affects the way someone moves.  Often, Parkinson's is referred to as a Neuro-Muscular Disorder. There are about 300 Movement Disorders Specialists around the USA.  If you would like me to help you find one that is close to your mother, please contact me directly [log in to unmask]  or  at our toll free number; 1-800-327-4545.  We also have an excellent book on medications that I can send to you if you'd like.  All of the literature from the National Parkinson Foundation (NPF) is free of charge and I will gladly send it to you.

 

Best Wishes,

 

Bonnie Cunningham, R.N.

 

Date:    Sun, 25 Jul 1999 16:40:58 -0400
From:    M Potter <[log in to unmask]>
Subject: Sinemet Again

Hi all,

This may seem like a silly question but I'm trying to learn all I can.
So, who better to ask than you, the experts! My mother just recently
began taking Sinemet, I wrote to you asking about the nausea problem
before. She is taking the 50/200 dosage, she asked her doctor about
cutting the pill in half and he said "no" that it isn't the dosage of
the med making her sick but just the "nature" of the medicine. The silly
part of the question is can a controlled release pill be cut in half
(someone told her that you shouldn't) and if you do cut it in half does
it become the 25/100 dosage?

What she would like to do is start out gradually with this medication.
She has been managing on Segeline alone for years but there is no doubt
it's time to begin the Sinemet. The trembling and stiffness is becoming
worse and balance was starting to become affected. So, we aren't arguing
about that. But, since it is questionable how long you can use this
medication, shouldn't you start out with the lowest dose possible? Half
a pill does ease her symptoms but it really doesn't have much of an
effect on the nausea and just an overall "not right" feeling. Still, she
would feel more comfortable taking the least amount possible.

One more thing, what is a Movement Disorder Specialist, is it different
than a neurologist? Thanks again and best wishes to all, Marcia