Carbodopa levodopa frequency and dosage

[Samaria7]

My fathers neurologist said he can only take 2 levodopa/carbodopa pills at a time but increase the frequency as needed. My father does not have an issue with the frequency, its just that 2 pills at a time are not enough. Is this doctors recommendation correct? It seems he will do so much better with a higher dose less often. Please advise. Thank you!

[WinnieThePoo]

I think the answer must always start with you should ask your doctor. Eric ahlskogs book is recommended and may help you talk to your doctor. The advice normally is, as the disease progresses increase the frequency of the dose, not the amount per dose. The recommended maximum daily dose of carbidopa is 200mg but it is possible to go beyond that

[Juliegrace in reply to WinnieThePoo]

Did you mean 2000mg daily?

[WinnieThePoo in reply to Juliegrace]

No. I meant 200 mg

ncbi.nlm.nih.gov/pmc/articl...

That will be 800mg levadopa in regular sinemet, 2x25/100 qds

[Juliegrace in reply to WinnieThePoo]

Oops. I misread that as levodopa, only just realized it now after reading Hikoi’s comment.

[Hikoi in reply to WinnieThePoo]

Yes but it is levadopa we are mainly interested in. Why the mention of carbidopa?

[WinnieThePoo in reply to Hikoi]

Only because that's what general prescription guidelines and the fda authorisation for C/L refer to.

dailymed.nlm.nih.gov/dailym....

[kevowpd in reply to WinnieThePoo]

HDC?

[Hikoi in reply to WinnieThePoo]

Can’t open link WtheP. I still find you response focusing on the carrier carbidopa rather than the active ingredient levadopa mystifying

[WinnieThePoo in reply to Hikoi]

Whilst there probably isn't a problem with carbidopa doses in excess of 200mg per day, the product licence was based on that maximum dose, so most prescribing physicians will be aware of it. It's why sinemet was also made in a 10/1 ratio

rxlist.com/sinemet-drug.htm

If necessary, the dosage of carbidopa and levodopa 25-250 may be increased by one-half or one tablet every day or every other day to a maximum of eight tablets a day. Experience with total daily dosages of carbidopa greater than 200 mg is limited.

The UK licence holder is organon

Their emc states

"Maintenance

Therapy with 'Sinemet' should be individualised and adjusted gradually according to response. When a greater proportion of carbidopa is required, each tablet of 'Sinemet 10 mg/100 mg' may be replaced with a tablet of 'Sinemet Plus 25 mg/100 mg' or 'Sinemet 12.5 mg/50 mg'.

When more levodopa is required, 'Sinemet 25 mg/250 mg Tablets' should be substituted at a dosage of one tablet three or four times a day. If necessary, the dosage of 'Sinemet 25 mg/250 mg Tablets' may be increased by one tablet every day or every other day to a maximum of eight tablets a day. Experience with a total daily dosage greater than 200 mg carbidopa is limited."

[jeffmayer]

I think it could be to many tablets at once could cause bad dyskinesia

[DeanGreen]

By taking a smaller dose more often, he is able to maintain more steady levels of drug in his system and avoid or minimize "Off" periods and/or dyskinesia. Taking a higher dose less often would cause large fluctuations in drug levels which may contribute to more adverse side effects.

[Curious_Fred]

I agree with DeanGreen. Normal dosage is 1 pill 4 tomes per day (typically a tablet will cover you for 4 hours max). Lower dosages are used when "getting used" to Levadopa. Never near a meal (30 mins before 60 minutes after. Don't worry about Caribidopa. GOLDEN RULE: Keep levels as low a possable. Levadopa is a strong drug. Average dosage daily at start is 200 to 400 mg. 1000mg is a dosage of concern. At the European Parkinson Therapy Centre we underline "DON'T forget that medicines are NOT your only therapy". Indeed QUALITY OF LIFE comes from other therapies .

[Samaria7]

The problem is that even at 2 pills every 3 hours, he never gets to a well-functioning level. I increased it to 2.5 pills every 3 hours and he is like a different person. I just hope I'm not harming him. His doctor doesn't want him to take more than two pills at one time just wants him to take them more frequently, but taking them more frequently doesn't seemed to help him. I could have sworn that his previous doctor said that there are many people who take three four even five pills at once. Whatever you need in order to function. I wish I had a decent doctor that I trusted to give advice. I feel so helpless and I don't know how to best help my father. That's why I'm reaching out to see what everyone's personal experience is

[Condor13]

Samara, I am on Prolopa, which is the Canadian version of Madopar, so not quite the same as Sinemet., but the levodopa is the same . On the 25/100 capsules, I have been on three every there hours for over a year, with few side effects, though I wonder if my poor speech is a form of dyskinesia I get all my advice from a Movement Disorder Clinic as they have vast experience. If I forget a dose, I can hardly walk.

[Samaria7]

Thank you all for the input