The dose needs to be titrated further depending on clinical response, as indicated below under 'Titration'.
It is recommended to give the smaller dose, if divided doses are not equal, at the end of the day.
The dosing interval between doses should be prolonged by 30 to 50% at intervals ranging from 4 to 12 hours. Patients currently treated with conventional levodopa/decarboxylase inhibitor combinationsĭosage with 'Sinemet CR' should be substituted initially at an amount that provides no more than approximately 10% more levodopa per day when higher dosages are given (more than 900 mg per day). Since carbidopa prevents the reversal of levodopa effects caused by pyridoxine, 'Sinemet CR' or 'Half Sinemet CR' can be given to patients receiving supplemental pyridoxine (vitamin B6). Standard antiparkinson drugs, other than levodopa alone, may be continued while 'Sinemet CR' or 'Half Sinemet CR' are being administered, although their dosage may have to be adjusted. So that the controlled release properties of the product can be maintained, tablets should not be chewed, crushed, or halved. 'Sinemet CR' and 'Half Sinemet CR' may only be administered as whole tablets. Patients should be monitored closely during the dose adjustment period, particularly with regard to appearance or worsening of nausea or abnormal involuntary movements, including dyskinesias, chorea and dystonia. The daily dosage of 'Sinemet CR' must be determined by careful titration. 'Sinemet CR' and 'Half Sinemet CR' tablets contain a 1:4 ratio of carbidopa to levodopa ('Sinemet CR': carbidopa 50 mg/levodopa 200 mg, 'Half Sinemet CR' 25 mg/100 mg per tablet). Date of first authorisation/renewal of the authorisation 6.6 Special precautions for disposal and other handling.4.7 Effects on ability to drive and use machines.4.5 Interaction with other medicinal products and other forms of interaction.4.4 Special warnings and precautions for use.4.2 Posology and method of administration.
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