Select one or more newsletters to continue. Patients should be monitored closely during the dose adjustment period, particularly with regard to appearance or worsening of involuntary movements, dyskinesias or nausea. Ideally, periodic skin examinations should be performed by appropriately qualified individuals (e.g., dermatologists).The patient should be informed that SINEMET CR is a sustained-release formulation of carbidopa levodopa which releases these ingredients over a 4- to 6-hour period. Intravenous fluids should be administered judiciously and an adequate airway maintained. Don't drive or do anything that requires your full concentration until you know how Sinemet CR (carbidopa / levodopa extended release) affects you.
Its characteristic features include resting tremor, rigidity, and bradykinetic movements. The occurrence of dyskinesias may require dosage reduction.All patients should be observed carefully for the development of depression with concomitant suicidal tendencies.SINEMET CR should be administered cautiously to patients with severe cardiovascular or pulmonary disease, bronchial asthma, renal, hepatic or endocrine disease.As with levodopa, care should be exercised in administering SINEMET CR to patients with a history of myocardial infarction who have residual atrial, nodal, or ventricular arrhythmias. According to Merck, Sinemet® CR 50/200 mg will remain available in the US until on or near November 2019 and Sinemet® CR 25/100 mg until on or near February 2020; however, demand may cause those dates to change. Administration of dopamine is ineffective in the treatment of Parkinson's disease apparently because it does not cross the blood-brain barrier. The possibility that the patient may have taken other drugs as well as SINEMET CR should be taken into consideration. Applies to: DepressionCaution and observation is recommended when treating patients with carbidopa, as depression with concomitant suicidal tendencies may develop or be exacerbated.Moderate Potential Hazard, Low plausibility. Therapy with dopamine agonists should be monitored carefully in patients with Parkinson's disease since they may have an impaired ability to respond to an orthostatic challenge, and also in patients receiving antihypertensive drugs.Major Potential Hazard, Low plausibility. In addition, certain medications used to treat psychosis may exacerbate the symptoms of Parkinson's disease and may decrease the effectiveness of these drugs.Major Potential Hazard, High plausibility. There are 316 drug interactions with Sinemet CR (carbidopa / levodopa) Sinemet CR (carbidopa / levodopa) alcohol/food interactions.
Additionally, mean value of Cmax for levodopa was increased by 24% in elderly patients (≥ 65 yr) compared to young patients (< 65 yr) (see The AUC of carbidopa was increased in elderly subjects (n=10, 65-76 yr) by 29% compared to young subjects (n=24, 23-64 yr) following IV administration of 50 mg levodopa with carbidopa (50 mg). According to Merck, Sinemet® CR 50/200 mg will remain available in the US until on or near November 2019 and Sinemet® CR 25/100 mg until on or near February 2020; however, demand may cause those dates to change. The extent of availability and the peak concentrations of levodopa were comparable in the elderly after a single dose and at steady state after t.i.d. The daily dosage of SINEMET CR must be determined by careful titration. Iron salts can form chelates with levodopa and carbidopa and consequently reduce the bioavailability of carbidopa and levodopa.Although metoclopramide may increase the bioavailability of levodopa by increasing gastric emptying, metoclopramide may also adversely affect disease control by its dopamine receptor antagonistic properties. Applies to: Hypotension, HypotensionDopamine agonists may impair the systemic regulation of blood pressure, with resultant orthostatic hypotension, especially during dose escalation. Applies to: Neuroleptic Malignant SyndromeThe use of dopamine agonists is contraindicated in patients with neuroleptic malignant syndrome (NMS). Inactive ingredients are hydroxypropyl cellulose, magnesium stearate, and hypromellose. Therefore, patients should be observed carefully when the dosage of levodopa is reduced abruptly or discontinued, especially if the patient is receiving neuroleptics.NMS is an uncommon but life-threatening syndrome characterized by fever or hyperthermia.
The most effective treatment for bipolar disorder is a mood stabilizing agent.