Sinemet

In Aotearoa New Zealand, the levodopa + carbidopa combination is available in different forms and strengths with different amounts of carbidopa and levodopa in each tablet. This combination is available in 2 forms, tablets and controlled-release tablets (Also called modified-release). Controlled release means that the tablets release the medicine slowly over several hours. This means the effect of the medicine lasts longer than that of standard tablets. Check with your pharmacist which form you are taking. Your doctor may prescribe the tablets and the controlled release tablets, to be taken at different times of the day.

Tablets: Sinemet 25/100; Sinemet 25/250
Controlled-release tablets: Sinemet CR

• The dose of levodopa + carbidopa combination is different for different people. 
• You will be started on a low dose and depending on your response, your doctor will increase your dose to control your symptoms.
• Always take your levodopa + carbidopa exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much levodopa + carbidopa to take, how often to take it, and any special instructions.

• Tablets: swallow the tablet whole, with a glass of water. If you are struggling to swallow the tablets, the tablets can be crushed and mixed with a liquid or soft food such as a spoonful of yoghurt.
• Modified release tablet (has CR after the name): swallow the tablet whole, with a glass of water. Do not crush or chew the tablets because all the medicine will be released at once, increasing your chance of side effects and causing a loss in symptom control.
• Timing: Take your tablet at the same times each day. You can take levodopa + carbidopa combination with or without food, but it is best NOT to take doses immediately after a large meal. Avoid taking levodopa + carbidopa with a high-protein meal because the protein you eat may decrease the effects of this medicine. 
• Missed dose: If you do miss a dose and it is nearly time for your next dose, skip the missed dose and take your next dose at the usual time. Otherwise, take the missed dose as soon as you remember. Do not take two doses at the same time or very close together.
• Keep taking levodopa + carbidopa regularly. Do not stop taking levodopa + carbidopa or lower the dose, without checking with your doctor. Your doctor may want you to gradually reduce the amount of levodopa + carbidopa you are using before stopping completely. This may help reduce the possibility of withdrawal symptoms such as muscle stiffness, fever and mental changes.

For some people with Parkinson’s, protein (which is found mainly in meat, fish, eggs, cheese, beans and pulses) seems to interfere with how well levodopa medications are absorbed by the body. Because of this, you may benefit from taking your medication 30–60 minutes before you eat a meal.

You may also benefit from a protein redistribution diet, where you take most of your daily protein in the evening. This can help the levodopa treatment to be more effective in the daytime, when you are likely to need it more.

Protein is essential for a healthy diet so you should not reduce your overall intake. Talk to your doctor before you make any changes to what you eat.

Like all medicines, levodopa + carbidopa can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Levodopa + carbidopa can interact with some medications, herbal supplements and rongoā Māori, so check with your doctor or pharmacist before starting levodopa + carbidopa and before starting any new products.