Parkinson's Movement
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New information on sinemet

The End for Levodopa Phobia: New Study Shows Sinemet is a Safe Initial Therapy for Treatment of Parkinson’s Disease

You can find out more about NPF's National Medical Director, Dr. Michael S. Okun, by also visiting the NPF Center of Excellence, University of Florida Center for Movement Disorders & Neurorestoration. Dr. Okun is also the author of the Amazon #1 Parkinson's Best Seller 10 Secrets to a Happier Life

In November 2011 we wrote about an important phenomenon called levodopa phobia, or avoidance of dopamine as a treatment for Parkinson’s disease. Many Parkinson’s disease patients and family members have been unnecessarily alarmed by the continuing reports that Sinemet and/or Madopar (European Sinemet) may accelerate disease progression, and that doses and drug intervals should be limited. These reports have unfortunately been fueled by sparse human evidence. Patients need to be aware that dopamine replacement therapies such as Sinemet and Madopar remain the single most effective, and single most important treatment for Parkinson’s disease worldwide. This month’s “What’s Hot” column will update the previous 2011 column, and focus on the new evidence published in the Lancet this month by the PD MED Collaborative Group.

Neurology previously published an article in 2011 citing that there was important evidence that dopamine replacement therapy is not toxic, and does not accelerate disease progression. Parkkinen and colleagues at Queen Square in London examined pathology in 96 post-mortem Parkinson’s disease brains, and paired the tissue with clinical information including levodopa use. The study concluded that in the human condition “chronic use of L-dopa does not enhance progression of Parkinson’s pathology.”

In an accompanying editorial, two prominent neurologists in the field pointed out that there “remains lingering concerns as to whether levodopa is toxic to dopamine neurons and accelerates the degenerative process.” The science quoted to support these claims has included levodopa undergoing auto-oxidation, and forming reactive oxygen species and toxic protofibrils. Additionally, the science includes a classical experiment that showed when levodopa was mixed with brain cells placed in a dish, there was toxicity. The research, however, has fallen short in demonstrating toxicity of the drug in the human form of Parkinson’s disease. There now exist broad levels of evidence from many studies across many countries (including most recently the ELLDOPA study) that levodopa is extremely beneficial to the human patient, and that levodopa has had a positive effect on disease course. Sinemet was recently reported as the most commonly administered drug among 7000+ patients being followed longitudinally in the National Parkinson Foundation Quality Improvement Initiative study. Expert practitioners who reported in this database utilized levodopa more than any other drug-- including dopamine agonists, and they used levodopa more (not less) as disease durations increased.

6 Replies

It's always about what is right for each individual and ldopa has always been the gold standard treatment but short acting. Younger Parkinson's have longer to live with pd and in time need more Andorra ldopa therefore Inducing dyskinesia delaying the start of ldopa and using long acting agonists is more likely to delay the onset of dyskinesia

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Thanks for this. I have been on treatment since March - there was no hesitation on the part of the doctors to use sinemet. I also use Benztropine. You do read so many varying reports about these things...


My gut feeling after reading this is the drug companies are trying to squelch users comments on long time use. I am basing my opinions on what I have been reading on these posts. So far I am only on rasageline and mirapex and am seriously thinking about dropping the mirapex. I DONT want to have long term problems down the road due to medication!


Hi park4me

I agree with you. I was diognosed two years ago and put on Azilect. My problems was left leg tremor when walking and slight problem with balance. Next visit to Neurologist 8 months later showed no deterioration in my condition but was concluded that did not have parkinsons term Atypical was applied and prescribed additional drug, sinemet together with azilect. Followed instructions by increasing sinemet from half pill twice daily up to 4 to6 per day!! Went up to 2 per day with disasterous results - sleepless sweaty nights and a hallunations one night got a fright and swiftly returned to one sinemet per day. Sleep like a baby and have returning hallunations

My latest visit to Neuro in march resulted in a decision to put me on another drug for hallucination (which could affect heart). I was stunned and bluntly said no way..not going down that road. Conclusion was no change in my condition so am back where I want to be 1 azilect and one sinemet. Like you think that this attitude of upping meds on an ongoing basis is madness and seems to escalate the whole thing.

I have invested in a vibrating plate and since using it for three months walking has improved beyond all expectations -at wedding last weekend and danced for hours , am like a spring chicken with renewed hope.

So go with gut and believe in what your own intuition

Don't know anything about the other drug you are on so perhaps you should ask to reduce it to a minimum .

Keep up the fight


The mirapex is a drug often prescribed for RLS. I am on 3 a day and can tell you I most often forget the afternoon pill with no bad results. Thus the reason for thinking about stopping it. My current research has been exploring low dose naltrexone. The only known side effect noted is that some have vivid dreams. I am looking at the best thing possible to help with the rigidity on my right side (leg and arm). Just had carpal tunnel surgery so when I am recovered, that will be my discussion with the doctor. Exercise, particularly walking helps the most and I use an elliptical machine, but havent been able to use for three weeks due to hand surgery. My goal would be to use azilect only and exercise.


To me azilect allows natural production of dopamine where sinemet is forced. Like you azilect and exercise is the where I have more faith and am comfortable with.

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