Sinemet IR or Sinemet CR??

[Nurse7]

For those of you on sinemet, do you prefer sinemet immediate release or sinemet controlled release? My neuro is taking me off mirapex( due to bad side effects) and wants me to try sinemet. I don’t know which one I should try.

[park_bear]

For me there is absolutely no comparison - the CR version is far better. It provides an even flow of levodopa. The immediate release version I find causes me overdose at first and then underdose.

Some people prefer the immediate release version. I have the impression these are more advanced cases require a lot of levodopa at once.

[Nurse7 in reply to park_bear]

I’m just thinking the cr would be easier to take. My neuro says the cr doesn’t release evenly but I’m leaning more toward it

[Mogul1 in reply to park_bear]

I have had some nice improvements over the years, but there have been bumps in the road. I wasn't taking Brand name Sinemet, I was taking CR from Mylan Industries, Ropinirole, and quick release 25-100 as needed. I found that the 25-100 could cause dyskinesia which , to me, constituted an overdose. Then, along came Azilect. I take 1 tablet, 1mg every morning. Began this about 4 years ago. My pharmacy switched me to the generic when it became available. My stomach did not like it. It took quite a bit of work to get back to Azilect. Part of it was the cost. Through my insurance company, I pad $50.00 for 30 (1 months supply). When I had the stomach problems I went after the pharmacy, but it turned out it was costing them more than $50.00. They actually suggested a competing pharmacy that has a larger national presence, and that worked.

This was my first experience with prescription generic drugs. The combination of stomach cramps and financial games skyrocketed my apprehension and suspicion.

When the hurricane hit Puerto Rico, it apparently took out Mylan's manufacturing facility. Do to no availability, the pharmacy switched me to a different generic 50-200.

Stomach blew up again!

I have struggled with insomnia, and right now I am taking Rytary 4 times a day replacing the 50-200, and Azilect. I then take melatonin and Ropinirole about 2 hours before bedtime. I have just started this combo and so far have found out that if I wake up around 3AM and can't get back to sleep, 1 25-100 and I Rytary will help me get back to sleep until the alarm goes off.

The release mechanism in Rytary is inconsistent. There are times when I feel it running out a half hour to one hour before my scheduled dosage. That is frustrating because even if I take a 25-100 I can't predict when or to what degree ii is going to kick in.

[park_bear in reply to Mogul1]

"quick release 25-100 ... could cause dyskinesia"

Precisely the problem with quick release.

[laglag]

I use Parcopa, which is a disintegrating tab that dissolves under your tongue. I've used it for several years. You can take it without water so you can take it anywhere and it gets in your system faster.

[Rosabellazita in reply to laglag]

Does parcopa help tremors

[laglag in reply to Rosabellazita]

Yes it helps when i'm "on".. It lasts about 3 hrs & usually takes about 20-45 minutes to kick in.

[Rosabellazita in reply to laglag]

What amt. Do u take that helps with tremor?

[laglag in reply to Rosabellazita]

The bottle says:

Carbidopa/Levo Odt tabs 25/100

Generic for: Parcopa 25/100 Odt tabs

I think Odt is oral disintegrating tabs

They are a minty flavor. I take 4 or 5 a day depending on what time I get up and/or go to bed.

[johntPM]

The difference is that, if all goes well, CR has a half-life of 137 minutes against about 90 minutes for the IR version. This gives more stable levodopa levels. But as Nurse7's doctor points out, an even release can't be guaranteed.

It is common to have an IR first thing in the morning in order to get you "on" asap.

100mg of CR equates to 70mg of IR.

You may wish to graph levodopa levels against time for the two types. See:

parkinsonsmeasurement.org/t...

I would adopt an experimental approach to find the regimen that suits you best.

John

[JANVAN in reply to johntPM]

Thanks !!!

Explained clearer than my neurologist.....

[Kevin51]

CR I find much more convenient - but it can be variable; you can always add in a small dose of IR to deal with dips though it takes a while to hit. I take 2 x 100mg CR after breakfast (Have given up milk - yoghurt is fine) and sometimes use 50mg IR during the day. I take mucuna at night (120mg) just to take a break from the carbidopa add on! John is right - you have to find out what works best for you.

[Hikoi]

The majority of people are on immediate release, neuros internationally seem to favour it. I used immediate release for about 9 years before going on controlled release. I find controlled release can take quite a while to kick in and doesnt give me quite as good on time,. Feeling a little under pa is OK now after 10 years bt it wasnt OK in the beginning.

[jackedmonston]

I started with IR (generic) and near switched me to three CR and one dissolvable IR per day, plus roprinerole and rasagelene (sp?) . I have done well on that combination for a couple of years now. But I agree with others, you gotta find what works for you.

[DianeF]

I really struggled with the immediate release. The extended (ER or CR)release works much better for me. I do have to take it on an empty stomach though. My neurologist said it delivers a smaller but constant amount of c/l so there is always some level of it in your bloodstream.

[ancee]

I take one 25/100 and one. 50/200 four times a day. Had PD 16yrs. This works very well. Also use Neupro 6, one patch every other day.

[heidle in reply to ancee]

Hello Ancee, I'm trying to help my 96 year old mum with her meds. Looking at all options. She's currently taking IR 100/25 every 3 hours but her ups and downs are horrible. I can't work out if her downs are too much meds or too little. Are you referring to CR tablets that you take please ??

[ancee in reply to heidle]

Yes, we call them ER (extended release) but it would be the same thing. It sure made a difference for me as far as getting that "hit the wall" feeling when the dopamine wears off. Sometimes I take an extra 1/2 of the 25/100 between my regular doses if I'm going to be extra busy or I know I'll be doing more demanding activities than usual.

[Hidden]

Nurse7, I cannot stress enough how much I support the answer of park_bear. The very first tablet in the morning can be slow to take off, so I take 2 curcumin capsules and 2 olive leaf extract tablets at the same time. The combination enhances the absorption of my first Sinemet CR for the day. The CR or controlled release version is so much better than the normal Sinemet, and it can be taken with or without food. Because it is slow release, there is no reason to be concerned about foods or timing of meals.

[buzbyc in reply to Hidden]

Hi, I've been on CR since diagnosis and in the last 6 months have also used 50 IR as a recovery tablet if the CR isn't working. Interestingly I've been struggling recently with the effectiveness of the tablets in the afternoon/evening, which I can only attribute to lunch/dinner getting in the way, as I tend to try and leave a >1-2hr gap before having my breakfast after having my first dose. Interestingly my neurologist had the opinion that CR can sometimes be a bit more unpredictable in its uptake than IR. Having said all that I would still recommend using CR, although I've not met many PWP who take that as their only medication. Nick

[Hidden in reply to buzbyc]

buzbyc, I take Sinemet CR 200/50, you did not mention your dosage, also people sometimes have problems with generic versions. The manufacturer states that it can be taken with or without food. It is not only my idea. My personal experience leads me to believe that the Sinemet CR is smoother. I have seen on another website in the UK, that a neurologist there stated that it is more unpredictable, but that is not my experience. The plain Sinemet is unpredictable and should be taken about one hour before eating, and may clash with some foods and the B vitamins according to some pharmacists. Speak with your doctor about dosage and timing, try a different dosage or timing, but speak to your doctor first.

[buzbyc in reply to Hidden]

Thanks for your reply. I'm generally taking half-sinemet CR, but double up first thing in the morning, although I'm just considering whether to have 1 CR and 1 IR first thing. Interestingly I found the following on the patient info for CR which I find rings true:

Taking Sinemet CR with food and drink

Try to avoid taking your tablets with a heavy meal. If your diet contains too much protein (meat, eggs, milk, cheese) Sinemet CR may not work as well as it should.

I'd be interested to hear your rationale about the curcumin, I guess you have found it helpful adding it in?

[Hidden in reply to buzbyc]

On a couple of occasions, (well meaning, I assume) pharmacists have added their own instructions like that on the label for me. It is the general PD meds advice. My experience is that the food and timing are not important with the controlled release form, and the manufacturer is of the same opinion. I suspect that there were a lot of trials in the beginning. I am a lacto-vegetarian, and love cheese, and my breakfast is whole wheat cereal biscuits with bee pollen and milk kefir, and cinnamon. It is a very nutrient dense breakfast that keeps my gut bacteria happy. Everybody is different, but I suspect that the general PD meds wisdom does not apply to the controlled release product. It might be true about eggs and meat, but I would not know, having been a vegetarian for many years. For me, life without cheeses or milk kefir or plain Greek style yoghurt would not be worth living.

[Hidden]

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