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Sinemet absorption with applesauce

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I've recently developed difficulty swallowing liquids and am taking my medications including Sinemet with applesauce .  I previously drank a lot of water and often took my Sinemet with sparkling water to enhance absorption .  I'm wondering how this might now be affecting the absorption of Sinemet.  I'm concerned about my fluid intake in general and will be seeing a speech pathologist soon to hopefully get some help.  But it seems as if sinemet's effectiveness has decreased further since I started taking it with applesauce.  I'm taking it still as whole pills, not crushed.  How much does water affect the absorption of Sinemet? Would crushing the pills or any other strategies likely help? Thank you!

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The first thing we have to remember is that Sinemet is broken down in the stomach and is absorbed in the small intestine. So medication that is in a liquid form does not need to be broken down in the stomach, therefore it will be absorbed the fastest. A controlled release tablet has a coating that will slowly be broken down in the stomach, thus it will be absorbed in small amounts over a longer period by the intestines.

Taking Sinemet with any type of food, even apple sauce, can decrease the absorption of the medication. The less solid the food, the better the absorption. If absorption of Sinemet can be greatly reduced, or even nullified, if it is taken with protein. This is due to the fact that the protein will be metabolized in the liver before the Sinemet will. 

Now onto the amount of water you drink and Sinemet absorption. If you drink a large amount of water, greater than 6-8 oz's, with each dose of Sinemet then it may take longer to get into the system. Taking Sinemet with 4-6 oz's of water should give the best results. 

There is a recipe to make your Sinemet into a drink formula, but this is only for patients who may need to maintain a constant level in order to control their symptoms. If you would like that recipe, please let me know.

I hope this helps and please keep me posted.

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I would appreciate the recipe for putting Sinemet into a drink formula.  I'm also wondering if chewing an immediate release Sinemet (maybe one of my two pills per dose) could help with absorption .  Thank you.

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Yes, chewing or dissolving the tablet under the tongue will have a very quick onset of action. The only issue may be is that the full dose might not be absorbed. 

Also when I stated that she could take 1 tablet every 3 hours, I believe you asked how could food be consumed with such tight time restraints. As long as Sinemet is taken anywhere from 30 to 60 minutes prior to a meal OR 90 minutes after a meal she should be fine. Many PD patients on such a schedule usually eat many small meals, or snacks, throughout the day.

The recipe I usually recommend is with orange juice. This is how the Mark's Liquid Sinemet is made.

 
1- Count the total tablets of regular 25/100 she is taking daily. I believe you said it was 3.


2- Take the number of tablets and multiply by 100 ml's.
(So you would need 3 x 100 ml's= 300 ml's)

 
3- For every 100 ml's of liquid you need 200 mg's of Vitamin C. Orange juice usually does not have enough Vitamin C to help the levodopa work so, we add Vitamin C tablets. The amount of Vitamin C needed will be 150 mg.


4- Now crush the 4 tablets of Sinemet. You can either use a pill crusher that you can purchase at most pharmacy or you can place the tablets in a tablespoon and use the bottom side of a teaspoon to crush them. You want to get as fine of a powder as possible. 


5- Crush the 150 mg. of Vitamin C. Since Vitamin C comes in strengths of 250 mg., 500 mg., and 1,000 mg., it may be difficult to get exactly 150 mg. So what you could use 1/2 tabs of Vitamin C 250 mg. which is 125 mg. The 25 mg. difference will not affect the efficacy of the final product. **Note: Use plain Vitamin C tablets. Do not use coated tablets, extended release tablets, or Vitamin C with Rose Hips.


6- Place the crushed Sinemt tablets and the  crushed Vitamin C into the 300 ml's of Orange juice. The entire bottle now contains 1 day's  worth of Sinemet


7- It can be consumed in two different ways:  
    a) it can be sipped throughout the day
        just as long as the entire contents.          are consumed before bedtime.

    B)the mixture can also be.                            consumed by drinking 100 ml's.                3 times a day. 

8- The mixture can be refrigerated to make it more palatable.

9- ALWAYS  shake well every time.              before drinking.

I hope this helps and please keep me posted.
 

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Noah, 

Since the orange juice is acidic, it is believed that will aid in the breakdown of the medication which, in turn, may speed up digestion. If someone is having trouble with the quickness of which the symptoms are relieved, then I may recommend they take it with orange juice. It is not known how much faster, if any, the absorption is with the use of orange juice.

I hope this helps and please keep me posted.

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If more acidity helps with breakdown of Sinemet, what is the effect of taking proton pump inhibitors (PPIs)?  Does this further diminish the absorption of Sinemet?  What about other treatments for GERD (eg Pepcid, ranitidine , etc?). Thank you.

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Great question. Any medication that decreases the stomach acidity can decrease the absorption of Sinemet. That would include PPI's and antiacids. Also, anything that slows bowel movements, such as antidiarrheal's, can also slow the absorption of medication.

I hope this helps and please keep me posted.

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The recipe for Marks liquid Sinemet says for every 25/100 tab x 100mls. In the example it was 3; so = 300mls.  And for every 100mls of liquid you need 200mg of vit c. Then says you need 150 mg vitamin c. I’m asssuming the 100mls is liquid, so that would be 300ml  for 3 tabs. That would then be 3 x 200mg = 600 mg of vit c needed. Then it says to crush the 4 Sinemet tabs.  Can you clarify how you came up with 150 mg of vit c needed? Is it taking into consideration the anoount of vit. C already in 300 ml of orange juice, and means you need to add an additional 150 mg of vit c to the oj? Where does 4 tabs come from? 

Edited by laj2017

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I'm sorry, my mistake. It should be 600mg of Vitamin C. I was working on a different formula.

Here is the correct recipe:

The recipe I usually recommend is with orange juice. This is how the Mark's Liquid Sinemet is made.

 
1- Count the total tablets of regular 25/100 she is taking daily. I believe you said it was 3.


2- Take the number of tablets and multiply by 100 ml's.
(So you would need 3 x 100 ml's= 300 ml's)

 
3- For every 100 ml's of liquid you need 200 mg's of Vitamin C. Orange juice usually does not have enough Vitamin C to help the levodopa work so, we add Vitamin C tablets. The amount of Vitamin C needed will be 600mg.


4- Now crush the 3 tablets of Sinemet. You can either use a pill crusher that you can purchase at most pharmacy or you can place the tablets in a tablespoon and use the bottom side of a teaspoon to crush them. You want to get as fine of a powder as possible. 


5- Crush the 600mg. of Vitamin C. Since Vitamin C comes in strengths of 250 mg., 500 mg., and 1,000 mg., it may be difficult to get exactly 600mg. So what you could use 1 of the 500mg tablets and 1/2 tabs of Vitamin C 250 mg. which is 125 mg. The 25 mg. difference will not affect the efficacy of the final product. **Note: Use plain Vitamin C tablets. Do not use coated tablets, extended release tablets, or Vitamin C with Rose Hips.


6- Place the crushed Sinemt tablets and the crushed Vitamin C into the 300 ml's of Orange juice. The entire bottle now contains 1 day's worth of Sinemet


7- It can be consumed in two different ways:  
    a) it can be sipped throughout the day
 just as long as the entire contents.               are consumed before bedtime.

the mixture can also be.                      consumed by drinking 100 ml's.  3 times a day. 

8- The mixture can be refrigerated to make it more palatable.

9- ALWAYS  shake well every time.              before drinking.

I hope this helps and please keep me posted.

Edited by MComes RPH

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Hello!  I know I'm late responding, but I hope my suggestion helps you.  It works for me.  I swallow a Tablespoon of raw honey immediately before swallowing a pill.  The meds go down my esophagus much easier and I don't need as much water.

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dmCwolfe,

Great idea. Since  swallowing/choking is one of the primary issues with PD, this is a great alternative.

I hope this helps and please keep me posted.

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