Indications And Dose
Parkinson’s disease ▶BY MOUTH ▶Adult: Initially 25/100 mg 3 times a day, then increased in steps of 12.5/50 mg once daily or on alternate days, alternatively increased in steps of 25/100 mg once daily or on alternate days, dose to be adjusted according to response; dose increased until 800 mg levodopa (with 200 mg carbidopa) daily in divided doses is reached, then maintenance up to 200/2000 mg daily in divided doses, adjusted according to response, when co- careldopa is used, the total daily dose of carbidopa should be at least 70 mg. A lower dose may not achieve full inhibition of extracerebral dopa-decarboxylase, with a resultant increase in side-effects Parkinson’s disease—alternative regimen ▶BY MOUTH ▶Adult: Initially 12.5/50 mg 3–4 times a day, alternatively initially 10/100 mg 3–4 times a day, then increased in steps of 12.5/50 mg once daily or on alternate days, adjusted according to response, alternatively increased in steps of 10/100 mg once daily or on alternate days, adjusted according to response, dose increased until 800 mg levodopa (with up to 200 mg carbidopa) daily in divided doses is reached, then maintenance up to 200/2000 mg daily in divided doses, adjusted according to response, when co- careldopa is used, the total daily dose of carbidopa should be at least 70 mg. A lower dose may not achieve full inhibition of extracerebral dopa-decarboxylase, with a resultant increase in side-effects DOSE EQUIVALENCE AND CONVERSION ▶The proportions are expressed in the form x/y where x and y are the strengths in milligrams of carbidopa and levodopa respectively. ▶2 tablets Sinemet ® 12.5 mg/50 mg is equivalent to 1 tablet Sinemet ® Plus 25 mg/100 mg. CARAMET ® CR Parkinson’s disease (patients not receiving levodopa/dopa-decarboxylase inhibitor preparations, expressed as levodopa) ▶BY MOUTH USING MODIFIED-RELEASE TABLETS ▶Adult: Initially 100–200 mg twice daily, dose to be given at least 6 hours apart; dose adjusted according to response at intervals of at least 2 days Parkinson’s disease (patients transferring from immediate-release levodopa/dopa-decarboxylase inhibitor preparations) ▶BY MOUTH USING MODIFIED-RELEASE TABLETS ▶Adult: Discontinue previous preparation at least 12 hours before first dose of Caramet ® CR; substitute Caramet ® CR to provide a similar amount of levodopa daily and extend dosing interval by 30–50%; dose then adjusted according to response at intervals of at least 2 days. DUODOPA ® Severe Parkinson’s disease inadequately controlled by other preparations ▶Adult: Administered as intestinal gel, for use with enteral tube (consult product literature) HALF SINEMET ® CR Parkinson’s disease (for fine adjustment of Sinemet ® CR dose) ▶BY MOUTH ▶Adult: (consult product literature) SINEMET ® CR Parkinson’s disease (patients not receiving levodopa/dopa-decarboxylase inhibitor therapy) ▶BY MOUTH ▶Adult: Initially 1 tablet twice daily, both dose and interval then adjusted according to response at intervals of not less than 3 days Parkinson’s disease (patients transferring from immediate-release levodopa/dopa-decarboxylase inhibitor preparations) ▶BY MOUTH ▶Adult: 1 tablet twice daily, dose can be substituted for a daily dose of levodopa 300–400 mg in immediate- release Sinemet ® tablets (substitute Sinemet ® CR to provide approximately 10% more levodopa per day and extend dosing interval by 30–50%); dose and interval then adjusted according to response at intervals of not less than 3 days.
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