: Re: Help!

[Guest guest]

Hi :

Sorry to see you have to come here for help , but you did pick the right place to come and get it. This group is very good for support and help. From what I've seen did what this group is good at . Giving all the information that will help with some of the problems that do come out of this awful disease. The one thing that I wanted to help with is the problem your dad is having with the meds. I've found out that it helps sometimes to put it in food. Applesauce or something like that. I also have sent you the information on how to make the sinemet into liquid. You can read that. I'm also sending you a copy of the MSA booklet , but that will be on another posting. Didn't want to make this to long.

Welcome to the group.

Vera Caregiver to Husband Fred

Appendix E

A Formula for Liquid Sinemet®

For patients who have extreme or unpredictable on/off fluctuations despite frequent dosing of carbidopa/levodopa tablets, some physicians have found liquid Sinemet® helpful in controlling symptoms. There is no commercially available liquid preparation. "Sinemet® Soup" or "Sinemet® Suspension," as the preparation is sometimes called, must be prepared by the individual patient or caregiver. The benefit in using a liquid preparation is that it allows for giving a fraction of the usual dose at more frequent intervals. Typically, liquid Sinemet® is given every hour. The solution takes effect rapidly, but lasts a shorter period. It does however, allow some patients to "fine tune" their individual dose responses and can provide an overall greater degree of "on" time during the day. The patient who wishes to try liquid C/L should do so only in collaboration with his or her physician. One regimen for preparing the solution is found on the following page. Preparation of the suspension is not difficult; sterility is not required. It is recommended that a fresh suspension be prepared daily. Common complaints include the need to carry the suspension along when away from home, and that each dose must be measured accurately. Due to these requirements, many individuals are unwilling or unable to use this formulation on a regular basis. It is provided in this manual only as one alternative for physicians and patients with severe motor fluctuations to consider.

LIQUID SINEMET® FORMULA* Mix the following ingredients in a one liter/quart Rubbermaid or other plastic container with lid (do not use metal): o Sinemet® 10/100 or 25/100 tablets

(do not use Sinemet CR®) 10 tablets (1,000 mg. levodopa)

o Ascorbic acid crystals 1/2 tsp. (approx. 2 gms.)

o Tap water or distilled water 1 liter (1,000 ml.)

Note: Final mixture contains levodopa 1 mg./ml., carbidopa 0.10 or 0.25 mg./ml. (depending on strength of tablet used), and ascorbic acid 2 mg./ml. Rotate container or shake gently until tablets dissolve (no need to crush tablets). Formula will maintain full-strength and purity for 24 to 48 hours in refrigerator. DOSE INITIATION FOR LIQUID SINEMET® THERAPY: Morning ("Jump Start") Dose:

60 ml. of the formula, or may use amount comparable to usual tablet dose.

Adjust dose by 5-10 ml. up or down every 3 to 5 days until best "on" state is achieved with least dyskinesias. Hourly Dosing:

30 ml. of the formula on the hour while awake, or hourly proportion of usual tablet dose. (For instance, a patient taking one Sinemet® 25/100 tablet every two hours might try 50 ml. per hour of the liquid.)

Adjust dose by 5-10 ml. up or down every 3 to 5 days until "on" periods are smoother. It is strongly recommended to adjust A.M. jump start dose prior to adjusting the hourly doses for best overall result. Accuracy of the dose and exact hourly timing between doses is critical for optimal benefit from using Sinemet® in liquid form. It is crucial that an individual patient consult his or her physician for specific dosing recommendations prior to trying the liquid formulation. Optimal dosing can vary tremendously from one patient to another. *Adapted from protocol developed by Matthias C. Kurth, MD, PhD.