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Divi,

Great question. The maximum daily dose if Sinemet, set by the FDA, is 200mg Carbidopa and 2,000mg of Levodopa. This is truly just a guideline.

Sinemet is dosed based on symptom relief and I have seen doses that far exceed the above dose. Sinemet is very unique because it has its own stop-lose mechanism. By this I mean that Levodopa is added to the Carbidopa to limit vomiting. Originally Carbidopa was given to a patient in small amount about every hour until they vomited. Their dose was then the amount of medication used prior to the final dose. Since some patients did require a higher dose of Carbidopa to relieve symptoms, Levodopa was then added to combat the vomiting. It was also found to help Carbidopa work better and absorbed to a greater extent.

Sorry for the history lesson. Sinemet is most effective when it is dosed for symptom relief. That dose can be extremely high in some patients. If a patient dose get too high of an amount they will probably experience dyskensia. Dyskensia is the abnormal jerking movements of the extremities, mainly the arms and sometimes the head/neck.

I hope this helps and please keep me posted.

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Many thanks, Dr Comes.

I'm 35 and currently 12 weeks pregnant and on sinemet easily going to 700 mg every day with one 50/200 cr in the morning and another at  night to manage RLS n the rest of the day managing with two or three 25/100. My doc says take as much as necessary to manage the day, I feel the off period are terrible and I'm working full time. I was on pramipexole before pregnancy. Any pearls of wisdom would be great. Thanks!

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Also, shall I wait till the symptoms begin or take sinemet when I first feel the restlessness? Thank you.

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Divi,

It is optimal to take Sinemet before symptoms start. It can be difficult to determine when this will happen but the best way is to keep a journal.

To start this process you should take your morning dose and write it down in a journal. Also remember that Sinemet is best absorbed on an empty stomach, which is 1 hour before a meal or 2 hours after a meal.

When you start to feel off you should take your next dose and write down the time when you took it. You should do the same for the remaining doses of medication.

You will then use the times you wrote down to dose your next days tablets. 

The next day you start with your morning medication as you had previously done. You then want to look and see the time when your symptoms started to the previous day and try to take today's dose about 30 minutes before. For example, if you took your morning Sinemet at 8:00am and your symptoms started at 12:30pm, then you want to take your next dose at Noon. You should also keep track of the time you take the Sinemet and the time of any off periods you may have. This way you can use these times as a guide for the following days doses.

It may seem a little hectic but after 5-7 days you should be close to controlling your off times. Many people have noticed that their off times occur at around the same times every day.

I hope this helps and please keep me posted.

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Many thanks , Dr Comes for guiding me. Yes, I’m keeping a journal but timings aren’t matching Everyday As depending on my schedule, it keeps on changing. On a hectic day, I might need more than on a weekend.

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Divi,

This is understandable. Stress, exertion, exercise, or increased muscle movements can cause the body to use more dopamine in order to control muscle movements. On these specific days you may need more Sinemet to control your symptoms.

I hope this helps and please keep me posted.

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Thanks Mark,

i have been wondering about this and discussing it with other posters in a different thread. So far I’m noticing that taking a dose of Rytary before exercise is better for me... now if I could figure out what to do on those days when I sleep more than my normal 5 or 6 hours, and my dosing schedule is thrown off...

 

Edited by Superdecooper

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Super,

As you know, Dopamine is the main contributor to muscle control. If we exert ourselves more, whether it be working out, exercise, house work, lawn work, walking, etc... our bodies will deplete our Dopamine stores faster. I recommend that if someone experiences this on a consistent basis that they may want to try to take a little more Carbidopa/Levodopa before exercise, whether it be with regular release Simemet or Rytary. If a patient is to do this I recommend that they try to increase the smallest dose available so they do not experience such side effects as dyskensia. As always I suggest that you run this idea by your Doctor before trying it. 

I hope this helps and please keep me posted.

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My MDS is pretty flexible in the area of dosage timing. He said I’m the boss, not the “damn” medicine.  He just wants me to live as symptom free as possible and is not a stickler for timetables..

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Super,

I 100% agree with your MDS and that is how i recommend dosing be handled. We first like to start with a standard dosing schedule, like 3 times a day, and then work towards symptom relief. Your 3 times a day may be different than someone else's, but this is a starting point that we can use as a baseline for further fine tuning of your overall dosing regime

I hope this helps and please keep me posted.

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Divi,

I do agree with your Doctor on the dosing of your Sinemet. from previous conversations it sounds like you have a good  handle on when your off times are. It sounds like you may not be receiving enough Sinemet to have greater control over the off periods. I have a couple of suggestions 

One suggestion may be to add a Sinemet CR in the early to later morning. Many people will start the day with regular Sinemet to get a jump start on covering the symptoms because the regular Sinemet can have a faster release than the CR. If Sinemet Cr is added, I would advise taking the Sinemet CR about 60-90 minutes after taking the regular Sinemet. If the regular Sinemet morning dose lasts longer than 2 hours, I would recommend taking the Sinemet Cr about 90-120 minutes after the regular Sinemet. Sinemet CR can be taken 3 times a day so you will have a little wiggle room in dosing.

My second suggestion would be to increase the daily dosages of regular Sinemet. An increase of as low as 1/2 tablet can have a great impact on symptoms. As always, the dose should be started low and slowly increased to avoid any side effects. The dosage should optimally be taken about 30-45 minutes prior to off symptoms coming on. I know this may differ throughout the day, but keeping a journal may help narrow down the time range.

I hope this helps and please keep me posted.

 

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