Sinemet

[nik.sego]

My doc said no to the Hydrocodone but said he would let me try Sinemet. Ropinorole (generic Requip) is not working for me. My questions are these: Have you/do you take Sinemet and did/does it work? At what dosage? How long have/were you on it?

Thanks!

[mackjergens]

I have copied and pasted info on Sinemet that you need to read and make sure your Dr knows exactly how this med can affect you.
I suggest that you read as much as you can about this med and other parkinson meds, for many RLSer's they are very helpful but you need to know that they can cause your rls to become worse.

The best advise you can ever recieve is to read and educate yourself about every thing there is to know about RLS.

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www.rlshelp.org

Sinemet (Carbidopa/LevoDopa)
This medication has 2 components; LevoDopa (L-Dopa), the active Parkinson's medication (this is a precursor drug and turns into dopamine in the brain), and Carbidopa, an inhibitor of the enzyme (decarboxylase) which inactivates L-Dopa. The short acting form of this medication comes in 3 strengths: 25-100, 10-100, and 25-250. The first number indicates the amount of Carbidopa and the second number is the amount of L-Dopa in the pill. The Sinemet pill most often used for RLS is the 25-100.

Sinemet can be started at half a pill (25-100) 30-60 minutes before bedtime. It can be increased to about 3 tablets before bedtime, and will last about 3-4 hours. For early morning awakenings, another half to one pill can be added to help finish the night's sleep. Keep the nighttime total dose to a maximum of 3 pills. The medication generally works better for nighttime RLS than on daytime RLS symptoms.

Sinemet also comes in a sustained release long acting formulation called Sinemet CR, in both 25-100 and 50-200 strengths. This slow release tablet comes to peak action in two hours, so it is often combined with a short acting Sinemet to get relief within 30 minutes. Sinemet CR can be used in the morning also (in patients who get daytime benefit from this medication) for sustained daytime relief.

The main side effects of Sinemet include nausea, mental effects (confusion, hallucinations, dizziness), and dyskinesia (abnormal involuntary movements which occur with long term usage). The nausea can be avoided often if the medication is taken with food (this can however delay absorption of the drug). Dyskinesias are the most common serious side effect to occur in Parkinson's disease patients taking this drug, but occurs rarely in RLS patients. Periodic monitoring of CBC, hepatic and renal function is suggested.

Two main problems for patients with RLS using Sinemet are rebound and augmentation. Rebound occurs as the drug's action is wearing off with the symptoms coming back even worse than they were before treatment. Augmentation is an increase in RLS problems in general, not just as the drug's effects are wearing off and is the most common reason for discontinuing Sinemet. With augmentation, the intensity of the RLS symptoms can increase, can onset earlier and even spread to the upper limbs. Raising the dose of Sinemet may temporarily help the augmentation symptoms, but in a short while the increased dose just leads to further augmentation. Keeping the Sinemet 25-100 dose at no more than 2-3 tablets per day reduce the chances of getting augmentation (it is rarely seen with 1-2 tablets). Augmentation occurs more readily when RLS symptoms are present before 6:00 p.m. (off therapy).

Sinemet CR generally prevents the rebound problem but does not avoid augmentation. The augmentation effect of worsening RLS symptoms lasts for several days after discontinuing the medication. Mirapex or Requip (see below) can be used to treat Sinemet augmentation by giving one of the lowest strength tablets at bedtime, then adding another tablet every 2 days to that dose if needed. The Sinemet can be discontinued abruptly (especially at the lower doses), but may cause an increase in RLS symptoms for a few days as noted above. Mirapex or Requip (as above) will prevent some of this, or the Sinemet can be tapered off over several days.

NOTE: Due to the problems of augmentation which may occur in 50-80% of patients, Sinemet is likely better for mild intermittent cases of RLS, in which the dose of medication can be kept low enough or on an intermittent basis to avoid these side effects. Another use might be in cases where the other medications do not last through the night, a dose of Sinemet CR added to the other Parkinson's disease drugs at bedtime (and only at that time) may provide all night relief from RLS. Now that there are other better Parkinson's disease drugs available, Sinemet should not be used for RLS (except by RLS specialists who are very well versed with the problems with this drug).
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you might wish to print off the info from the Mayo Clinic site which is posted on this web site in the sticky notes! Most Drs will usually read info from Mayo Clinic.

[ViewsAskew]

Great info in the post from Mackjergens, but I'll add my two cents.

Sinemet should ONLY be used 1-4 days per week, but never more than that. Now, some people had success using it everyday, but they were the vast minority. In some cases, a full 90% augmented using Sinemet.

If Requip isn't working, there are many alternatives; I personally believe that working through the Algorithm (link to it in my signature) is the best method. Alternately, get the book written by Hening, Buchfurer and Lee - it guides the doctor through treatment. The doctor will have a hard time arguing against these treatment suggestions.

Lastly, since this doctor is suggesting Sinemet, I'd be concerned that they aren't well-versed in RLS. That may mean you need to help them get educated...it may mean you need a new doctor. There are lots of past posts to help with both of those things.