Disease Information for Carbidopa-levodopa (Sinemet/Atamet) adm

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Clinical Manifestations
Signs & Symptoms
Myoclonus/Myoclonic jerks on exam
Nightmares/excess dreaming (Paroniria)
Laboratory Tests
Abnormal Lab Findings - Increased
URINE VMA
Associated Diseases & Rule outs
Associated Disease & Complications
Carbidopa toxicity
Drug induced Dreaming/nightmares (Paroniria)
Drug induced Movement disorder
Oculogyric Crisis
Disease Mechanism & Classification
Drugs
DRUG/Anti-parkinsons medication (examples)
DRUG/Dopamine agonist/CNS drug (example)
DRUG/Dopaminergic Anti-Parkinson's medication
Process
PROCESS/Medication/Drug (CONFIRM dose/before treatment)
Synonyms
Synonym
( ) L alpha Hydrazino 3,4 dihydroxy alpha methylhydrocinnamic Acid, alpha Methyldopa hydrazine, alpha Methyldopahydrazine, Benzenepropanoic Acid alpha hydrazino 3,4 dihydroxy alpha methyl ,(S), Benzenepropanoic acid alpha hydrazino 3,4 dihydroxy alpha methyl monohydrate (S), carbidopa, Carbidopa (product), Carbidopa (substance), CARBIDOPA PREPARATION, CBD, methyldopahydrazine, Brand name/Atamet (Carbadopa-Levodopa) comb., Brand name/Parcopa (Carbidopa-Levodopa), Brand name/Sinemet (Carbadopa-levodopa)
Treatment
Drug Dosage
DRUG/.$$$ Expensive medication
DRUG/Dose TID Medication
DRUG/Generic available
DRUG/Oral medication (ex)
Definition

Anti-parkinsonism drug;Dopamine precursor;oral preparation combined with carbodopa which is a peripheral inhibitor of dopa-decarboxylase;improved CNS levels of dopamine;---------------------------------

Carbidopa, which inhibits the enzyme responsible for the breakdown of levodopa to dopamine, does not cross the blood-brain barrier. When levodopa is given in combination with carbidopa, the extracerebral breakdown of levodopa is diminished. This reduces the amount of levodopa required daily for beneficial effects, and it lowers the incidence of nausea, vomiting, hypotension, and cardiac irregularities. Such a combination does not prevent the development of the "on-off phenomenon," and the incidence of other side effects (dyskinesias or psychiatric complications) may actually be increased.

Sinemet, a commercially available preparation that contains carbidopa and levodopa in a fixed ratio (1:10 or 1:4), is generally used. Treatment is started with a small dose—eg, one tablet of Sinemet 25/100 (containing 25 mg of carbidopa and 100 mg of levodopa) three times daily—and gradually increased depending on the response. Sinemet CR is a controlled-release formulation (containing 25 or 50 mg of carbidopa and 100 or 200 mg of levodopa). It is sometimes helpful in reducing fluctuations in clinical response to treatment and in reducing the frequency with which medication must be taken. The commercially available combination of levodopa with both carbidopa and entacapone (Stalevo) may also be helpful in this context and is discussed in the following section on COMT inhibitors. Response fluctuations are also reduced by keeping the daily intake of protein at the recommended minimum and taking the main protein meal as the last meal of the day.

The dyskinesias and behavioral side effects of levodopa are dose-related, but reduction in dose may eliminate any therapeutic benefit.

[current dxrx 2005 accessmedicine]

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External Links Related to Carbidopa-levodopa (Sinemet/Atamet) adm
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Harrison's Online (accessmedicine)
NEJM (The New England Journal of Medicine)
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