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Joe, you got to the answer while I was still thinking about asking the question. Very timely. I was started on regular Sinemet 25/100 about two months ago and when I worked up to full dosage I developed a heavy rash over my body. When I called the doctor he said to quit the Sinemet. Without the drug for three weeks I saw the doctor again yesterday. He said he has never heard of a rash like that from the drug, but it could possibly be from the dye in the pills. He prescribed CR in place of regular Sinemet. My question to you being you sound so knowledgeable about Sinemet is was it logical to stop for the three-week period being you indicated serious problems when stopping.? And is CR the right choice being it is the only drug that I am taking? Thanks. I would like a here from anyone on this. [log in to unmask] ----- Original Message ----- From: J. R. Bruman <[log in to unmask]> To: <[log in to unmask]> Sent: Friday, October 29, 1999 3:43 PM Subject: Sinemet CR vs regular > Sinemet CR vs regular > > The subject of Sinemet CR vs regular comes up fairly often > here, and since it's important to many PD newcomers, I'll > re-plow the terrain; no new data, but perhaps a more easily- > grasped explanation: > > Although Sinemet (even the regular kind) is absorbed rather > slowly, its levodopa dissipates quickly. You might adjust for > that by taking bigger doses, but you know that too much in the > body at once causes dyskinesia, while too little causes the > familiar "end-of dose" cramps and dystonia. So it's desirable > to keep the body level of levodopa as constant as possible. You > might do that by taking tiny doses very often, but that's a > pain, what you want is the longest interval between doses. > > All the regular Sinemet tablets are scored so you can take a > half tablet at a time, but Dupont Pharma, makers of Sinemet, > also offer Sinemet CR (Controlled Release), which comes in > a bigger tablet that dissolves more slowly, and therefore > lasts longer. The 50/200CRs are scored, so they may be taken > whole or as the equivalent of two (not scored) 25/100CRs. > > The rate of dissolving for either type of Sinemet is proportional > to the remaining surface area of the tablet, so it is highest at > first, and then declines as the tablet becomes smaller. But > slower dissolving makes the effect of the CRs last 2 or 3 > times as long as the equivalent amount of regular Sinemet, > and the peak concentration, about 2 hours vice 1/2 hour after > taking, is only about 35% of that from regular Sinemet. So > you can get away with the bigger (50/200CR) tablet, taken > half as often as the regular 25/100 tablets. > > The slow dissolving rate and prolonged sojourn of Sinemet CR > also means more time for the levodopa to be degraded before > it reaches the brain, therefore the total effect is only about > 3/4 as great as regular Sinemet. But, I believe,the total dosage > may be safely increased to compensate, as the excess merely goes > to waste. Most patients find they can reduce their total dosage. > > One final warning: Don't tinker with Sinemet dosage without the > supervision, or at least the full trust and confidence, of your > neurologist. The levodopa component of Sinemet is one of several > drugs whose abrupt withdrawal or dosage change has, on very rare > occasion, led to a life-threatening condition similar to > neuroleptic malignant syndrome. Among the prominent symptoms are > very high fever and mental changes. Cheers, > Joe > -- > J. R. Bruman (818) 789-3694 > 3527 Cody Road > Sherman Oaks, CA 91403-5013