We have successfully been reducing my dad's sinemet intake and replacing it with mucuna. We started off with the raw powder but for convenience sake, have switched to the now brand 15% capsules.
I am just trying to figure out equivalent doses. Can anyone clarify?
Please see attached screenshot from Dr. Rafael Gonzalez's paper. In his book, he shows that 200/50 sinemet is equivalent to 6 teaspoons of mucuna which would be 1000mg mucuna levodopa. So in this paragraph, i think he is referring to this size of a tablet.
Someone please confirm, thank you!
Written by
pdkid
To view profiles and participate in discussions please or .
According to the label of Now Dopa Mucuna,one capsule is 400mg mucuna with 60mg levodopa. The closest equivalent dose to a 200mg Sinemet would be three capsules which would deliver 180mg of levodopa. Where do you come up with 16.5 capsules? And for the mucuna powder you need some sort of base measurement (usually measured in mg) such as what percentage of levodopa is in 100mg of the powder and then how many mg is in a teaspoon.
I've taken mucuna 20% levodopa, mucuna 40% levodopa and mucuna 99% levodopa. For each one I needed an equivalent between 50-100mg of levodopa to have a beneficial effect. For each one at those levels of levodopa I had dyskinesia the same as I do with carbidopa/levodopa. For me there was no difference. I currently take c/l 10/100 3-4x daily.
Carbidopa is assumed to deliver about 5 times the amount of levadopa to the brain so you need 5 times the pure levadopa to be equivalent to the levadopa in a c/l administration. 200g sinemet is therefore equivalent to 1000g levadopa therapeutically. So you need 1000/60 capsules or 16.5. 17 for cash.
"Carbidopa is assumed to deliver about 5 times the amount of levadopa to the brain"
5 times = 500% more?
Don't think it is even remotely close to that level on an individual dose basis. Better go back and understand the primary purpose of carbidopa with levadopa/L-Dopa..
Something we have to consider when making statements like that is the following --- Depending on the individual's gut biome efficiency, I would guess regular Sinemet C/L or the CR version probably never reaches even close to 100% increase per does (vs. just 100% levadopa/L-Dopa alone) for anyone over 65 years of age in an early stage of PD. even at its delivery peak. Beyond 5 years of PD, the increase probably decreases significantly for most PD patients. The result ends up requiring the patient to consume significant increases in their medication at more frequent intervals.
"Rtfq" Typical response Winnie. I did read it Winnie and here is your quote.... "Carbidopa is assumed to deliver about 5 times the amount of levadopa to the brain"which is totally impossible. How you arrive at these types of conclusions amazes me...truly.
Rtfq was to remind my kids to read and answer the actual question and not just splurge everything they think they know about a subject they noticed in the question. Basic exam technique. The question Julie asked was "Where do you come up with 16.5 capsules?"
I have the same response to mucuna-levodopa without carbidopa that I have to c/l, so for me it's one to one. I based my calculations on my experience. I would recommend to anyone trying mucuna that they err on the side of caution and try smaller doses. If I took the equivalent of 100mg (8.25 capsules) I suspect I would end up hospitalized or at least very sick from over-medication. My extreme sensitivity to levodopa is why I do better on 10/100 than 25/100.
Obviously in this snowflake disease individuals respond differently and any number of other factors complicate the comparison but the reason pdkid got 16.5 was the convention that there is a 5 to 1 ratio.
Levodopa is absorbed from the small intestine by the active transport mechanism for large neutral amino acids. A similar transport system transfers levodopa across the blood–brain barrier. Levodopa is extensively decarboxylated to dopamine in peripheral tissues such as the gut wall, liver and kidney. This reduces the amount of levodopa that reaches the brain to about 1% of an oral dose, while the peripheral dopamine that is generated produces unwanted effects. To minimise peripheral metabolism, levodopa is given in combination with a DOPA decarboxylase inhibitor that does not cross the blood–brain barrier. The two available inhibitors are carbidopa (combined with levodopa as co-careldopa) and benserazide (combined with levodopa as co-beneldopa). Inhibition of the peripheral metabolism of levodopa increases the amount that crosses the blood–brain barrier to 5–10% of the oral dose. Since the DOPA decarboxylase inhibitor does not cross the blood–brain barrier, it has no effect on the required conversion of levodopa to dopamine by DOPA decarboxylase within the central nervous system (CNS).
Use of Carbidopa simply, in no way, increases levodopa/L-Dopa crossing the BBB by 500%. Impossible.
What the ratio is between Sinemet and MP will depend on the percentage of levodopa/L-Dopa in the MP. Thus, the ratio will vary considerably.
Per your source (sciencedirect):
"Inhibition (by carbidopa - sharon) of the peripheral metabolism of levodopa increases the amount that crosses the blood–brain barrier to 5–10% of the oral dose." Hardly significant.
"Transition from an immediate-release levodopa formulation to a modified-release formulation is not straightforward, because the latter has a lower bioavailability, which makes it difficult to estimate the equivalent dose." Difficult to estimate is the key point.
1% of an oral dose of 200mg straight levadopa crosses the blood brain barrier. That's 2mg.
Inhibition by carbidopa increases that TO (not by) 5% to 10% . That's 10 to 20 mg levadopa crossing the blood brain barrier. 10mg is 500% bigger than 2mg. 20mg is 1000% bigger than 2mg.
Welcome to the miracle of Sinemet. (I first learnt it in the late 60s from my Dad who worked for MSD and was involved with the UK launch)
I explained its intention in an earlier reply to sharon. It's "Read The F##king Question". In this case, having asserted erroneously that the long established well known pharmacokinetics of C/L were impossible, she went on to discuss the variability of ldopa concentration in macuna, which was superfluous padding given the discussion was specifically about Now dopa capsules stated to be 15% providing 60mg ldopa per capsule. She then referenced further irrelevant issues about CR mentioned in the link i provided. This is a standard tactic to fog and distract from the error about carbidopa increasing the brain availability of levadopa by 500%.
Hi Julie that seems like a low dose per day which is great. Just wondering if you ever took more and then lowered it. If so how did you lower it? Thanks, Connie
What is driving the desire to drop the sinemet?
I'd be nervous about eating 17 of anything. There could be something in there amongst the ingredients that you mightnt actually want to injest 50 times a day. Something thats insignificant when consumed in accordance with the label (which probably says something like a max of 6 tablets a day).
The NOW label doesn't have any max warnings. After 12 years, sinemet just doesn't work for my dad anymore. Further, it seems to be deteriorating his body. A few months ago he had to increase his dose to 2.5 sinemet tablets every 2 and a half hours to avoid frequent freezing episodes. But barely worked. Sinemet just doesn't work for my dad anymore. His neurologist is recommending DBS, but its quite a process and we aren't quiet sure if we want to go that route yet.
In desperation, we started weaning my dad off of sinemet and started using mucuna powder instead. It's not perfect, but it has definitely worked wonders for him. Less freezing, less dyskinesias, less hallucinations, improved appetite, barely any nightmares and better bowel movements. Consuming a tablespoon of the powder every 3 hours (with sinemet) isn't ideal though, so we have been exploring the mucuna extract pills. I understand that the mucuna extract pills are not as nutrient filled as the raw powder, but the powder really became too expensive and inconvenient. One sinemet tablet with seven 15% NOW pills every 3 hours worked for him, but not as well as the powder.
We just got our order of Barlowe's 40% mucuna extract pills. One sinemet tablet with two barlowe's pills is so far doing wonders for him. Our goal is to see if we can eliminate the sinemet altogether, and replace with amino acids found in the hinz protocol. (5HTP, L-Tyrosine, etc). We started at 2grams of HDT B1 last week. It was too much for him (terrible side effects) but restarting this week with 100mg of sublingual.
You cannot take Mucuna powder alone to replace Sinemet. we need something like carbidopa to prevent the peripheral, i.e. extra brain conversion of l dopa into dopamine. Without this the patient will get side effects like vomiting which can cause additional problems. One way to do this will lower partially the dose of Sinemet; cut down the dose of Sinemet by one fourth and add some Mucuna. You will need to titrate the dose of Mucuna that works like the dose of Sinemet. The combination of both works longer than Sinemet alone. I use Mucuna 40% made by CHK labs. This why I need less of Mucuna.
The other method is to use caffeine free green tea extract that works like carbidopa and you titrate your dose of Mucuna according to your symptoms. Switching from Sinemet to this combination will take time and patience.
The article states that natural Mucuna powder in reference is 3.33% levodopa, and the natural Mucuna powder in the absence of DCC inhibitor is the reason why you need 4 to 5 times the amount of the drugs such as Sinemet 250/25 or Madopar 200/50. This is because you need pretty high dose of l-dopa to get it into the central nervous system that translates to pretty high dopamine level peripherally that degrade into homocysteine, and to get that down, a lot of B6 will need to get exhausted (beware of the induced B6 deficiency). It's because of the DCC inhibitors PD patients can take less L-dopa for the same amount of relief without the side effects of nausea, arrhythmias/techycardia (increased epinephrine), psychosis, etc.
The NOW Dopa Mucuna states under the supplement fact that 2 capsules contain 120mg L-dopa (15% of 800mg), so your calculation is roughly correct in terms of pure equivalent L-dopa amount.
I don't know how long your father has been with the prescription, but if your goal is to go more natural, you're better off lowering/halving the Sinemet for the portion of DCC inhibitor and titrate the L-dopa amount for the needed relief carefully rather than jumping to pure l-dopa equivalent and risk l-dopa not reaching the brain, and you can easily overdose on l-dopa alone near 1000mg. The article also concludes that carbidopa enhances the clinical efficacy of Mucuna, and you'll absolutely need to be cautious especially when you plan to combine L-theanine/green tea, Tyrosione & Rhodiola that potentiate the effect.
The label of BIOVEA’s mucuna dopa states that each capsule contains 250mg of mucuna puriens seed extract standardized to 40% or 100mg of L-dopa. Typically I will substitute three or four capsules of BIOVEA’s mucuna dopa for one tablet of 25-100mg carbidopa/levodopa. I seem to experience much less dyskinesia with mucuna. At times I will use one or two mucuna capsules. I wish I could be more precise but depending on my level of stress, amount and quality of sleep as well as the amount and timing of protein consumption I will substitute as few as one capsule of mucuna to as many as four.
Some of these comments just whizzed right over my head, but I do know that my naturopathic doctor works along with my neurologist in regulating my mucuna dosage, and a very important factor to her is for me to take Green Tea extract with 94% EGCG to aid in breaking the BBB. So I take 266 mg Mucuna and 100 mg green tea extract (94% EGCG) 3 X daily. My neuro dr. calculated the Mucuna dosage based on my weight. (I'm supposed to be taking 250 mg rather than 266, but I have difficulty finding combinations to equal that.) Was diagnosed 2 years ago and have been using mucuna 1 1/2 years.
It's Teavigo. I get it from my naturopathic doctor and it's very expensive. I'm searching for a cheaper version and found some at Vitacost. I'm going to ask her about it.
Ya need be careful with extract as too much could potentially cause liver problems. I presently use Match but need 1000 mg to be noticeable. I believe a higher % of ecgc may warrant a lower dosage of mucuna or extract. But as Despe said, “Be careful “!
do you know if its ok to take the green tea extract with sinemet? as we are still slowly weaning off the sinemet, we still have one tablet (down from two and a half), in the mix with the 40% mucuna extract pill. thanks!
Taking the green tree extract with Sinemet will increase the duration of action of the Ldopa in the Sinemet. but it is better to use the extract than using the carbidopa in the tablet. But remember it has to be decaffeinated.
Unless he is on statins or other meds that they are contraindicated with grapefruit juice (GJ), GJ extends the bioavailability of Sinemet and MP. You can also try green tea. I would be very cautious on green tea extract, unless it is for a short period of time. Not a doctor, but this is my personal experience with my husband.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Mucuna puriens 1000mg
Mucuna Pruriens 
Looking for people who have phased out Carbidopa/Levodopa in favor of an all-mucuna program
