Indications for SINEMET CR:
≥18yrs: Do not crush or chew. Patients not receiving levodopa: initially one Sinemet CR 50–200 tab twice daily, at intervals of at least 6 hrs. Others: see literature. Allow 3 days between dosage adjustments. If given at intervals <4 hrs and/or divided doses not equal: give smaller doses at end of day. May add immediate-release Sinemet 25–100 or 10–100 in advanced disease.
<18yrs: not recommended.
SINEMET CR Contraindications:
During or within 14 days of nonselective MAOIs (eg, phenelzine). Narrow-angle glaucoma. Undiagnosed skin lesions. History of melanoma.
SINEMET CR Warnings/Precautions:
Severe cardiovascular or pulmonary disease. Asthma. Renal, hepatic, or endocrine disorders. History of peptic ulcer or MI with residual arrhythmias. Suicidal tendencies. Psychosis. Orthostatic hypotension. Chronic wide-angle glaucoma. Discontinue levodopa at least 12 hrs before starting Sinemet or Sinemet CR. Sinemet CR not bioequivalent to Sinemet; see literature when switching forms. Monitor renal and liver function, intraocular pressure, blood counts. May stain body fluids. Pregnancy (Cat.C). Nursing mothers.
SINEMET CR Classification:
Dopa-decarboxylase inhibitor + dopamine precursor.
SINEMET CR Interactions:
See Contraindications. Orthostatic hypotension with selegiline, antihypertensives. Antagonized by phenothiazines, butyrophenones, risperidone, phenytoin, papaverine. Hypertension, dyskinesia with tricyclic antidepressants. May be antagonized by iron, high protein diets. May cause false (+) urinary ketone test or false (–) urinary glucose (glucose oxidase) test.
Dyskinesia, GI upset, hallucinations, confusion, psychological disturbances, depression, dizziness, headache, dream abnormalities, dystonia, cardiac arrhythmias, hypotension, dyspnea, on-off phenomenon, back pain, blepharospasm (may indicate excess dosage), hypertension, anticholinergic effects, anorexia, insomnia, leukopenia, renal and liver function disorders, seizures, neuroleptic malignant syndrome.
CR—100, 500; Tabs—100