英文药名: Sinemet CR(Carbidopa/Levodopa Sustained Release Tablets) 中文药名: 息宁(卡比多巴~左旋多巴缓释片) 生产厂家: Not available 规格 药品名称 药物名称:息宁 神经内科用药。 震颤麻痹,震颤麻痹综合征。 口服,0.5~1片/次,2~4次/日,按病情需要逐渐增量,一般每日不超过卡比多巴75mg,左旋多巴750mg。 常见运动障碍、恶心、呕吐、抑郁、失眠和幻觉等,偶有消化道出血。 与单胺氧化酶抑制药合用可致血压骤升。 妊娠C类。狭角型青光眼、皮肤癌患者禁用。 包装规格 注意:以下产品不同规格和不同价格,购买时请以电话咨询为准! ·100/10mg 100 片(Bristol-Myers Squibb生产) SINEMET 25/100 scored tablets containing 25mg of carbidopa + 100mg of levodopa supplied in bottles of 100. SINEMET 25/250 scored tablets containing 25mg of carbidopa + 250mg of levodopa supplied in bottles of 100. SINEMET CR is a controlled-release formulation of carbidopa, MSD, and levodopa, MSD, in a ratio of 1:4. 50/200mg, tablet SINEMET CR 50/200 is available in bottles of 100 tablets Controlled-release carbidopa/levodopa and immediate-release C/L are equally effective in treating the symptoms of Parkinson's disease. Some patients prefer the controlled-release (CR) formulation due to the convenience of less frequent dosing based on its longer duration of action. After taking carbidopa/levodopa immediate-release for several years, a patient may find that the effect of the medication begins to wear off before it is time for the next dose. One response is to shorten the intervals between doses (or add an additional dose if needed); another choice is to switch from immediate-release C/L to Sinemet CR®. Sinemet CR® contains the same medications as C/L, but is formulated to dissolve gradually in the gut. Composition Used as prescribed and thanks to it's Levodopa content. Sinemet improves general therapeutic response. It's lower dosage (approximately 80% less than that of Levodopa alone), provides effective and lasting plasmatic concentrations of Levodopa. While it is known that pyridoxine hydrochlorate (Vitamin B6), accelerates the periferic metabolism of Levodopa to Dopamine, Carbidopa inhibits this action. In an experiment in which patients received from 100 to 500mg of pyridoxine on a daily basis, no alteration was seen in the anti- Parkinson effect of the Levodopa, while they were treated with the Carbidopa and Levodopa combination. It has been reported that the combination of Sinemet with the inhibitors of the Monoamine Oxydase B (such as Deprenyl) increases the effectiveness of Sinemet in patients with difficulty or slowness of movement. Clinical Advantages Sinemet provides fast therapeutic relief. Response to Sinemet has been seen in as little as a day's time, often after a single dose. Sinemet minimizes the need for the prolonged individual dosages required in Levodopa treatment. Fully effective dosages are usually carried out within seven days, in contrast to the weeks or months needed for Levodopa. Following the Sinemet treatment, the plasmatic levels from Levodopa are five times greater than those obtained with the same dosage of Levodopa applied on it's own. Subjects responding to Levodopa can receive Sinemet treatment. Sinemet reduces the fluctuations, often seen in the use of Levodopa on it's own, in the patient's response. Sinemet may be used with other anti-Parkinson medicine (see directions). Information for Users By reducing certain side effects produced by the use of Levodopa on it's own. Sinemet enables a greater number of patients to obtain an adequate remission from the symptoms of Parkinson's disease. Sinemet is recommended for patients suffering from Parkinson's disease or syndrome, who have been taking Vitamin complexes containing B6. Directions for Use General Considerations Involuntary movement especially can occur more rapidly with Sinemet than with Levodopa. The onset of involuntary movement may require a reduction of the dosage. In certain patients the blepharospasm may be a useful early warning sign of excessive dosage. In the case of general anaesthetic, Sinemet may be continued as long as the patient is allowed to take liquids and medicines by mouth. If treatment is temporally interrupted, the regular daily dosage can be administered as soon as the patient is able to take medicine orally. Patients who are Not Receiving Levodopa Treatment Patients Being Treated with Levodopa Follow up Treatment Contraindications Precautions Sinemet is not recommended for the treatment of medicinal drug induced extrapyramidal reactions. Patients known for psychotic behavior or amanuensis should be treated with caution. As with Levodopa, Sinemet may cause involuntary movements and mental disturbances. Patients with a history of serious involuntary movements and psychotic conduct when treated with Levodopa should be closely watched when Sinemet substitutes this. It is thought that such reactions are due to an increase in cerebral Dopamine following the administration of Levodopa and that the use of Sinemet may cause a relapse. All patients should be carefully supervised regarding the development of mental modifications, depression and suicidal tendencies, or other such serious antisocial behavior. The most rapid appearance of high Dopamine levels obtained with Sinemet treatment compared to that of Levodopa alone might cause premature problems of movement. Such disturbances require a reduction in the dosage of Sinemet. Sinemet must be administered with care to asthma, renal, hepatic and endocrine disorders. Attention should be paid to the administration of Sinemet to patients who have a history of arrhythmias. In such patients, cardial functions must be controlled with particular care during the period of dosage adjustment. As with Levodopa, there is a chance of hemorrhaging with patients with a history of peptic ulcers. A complex symptomatology has been reported which is similar to the malignant neuroleptic syndrome with muscular stiffness, high body temperature, mental modifications and the increase in the silky creatine phosphate when the anti- Parkinson treatment is suddenly stopped. Thus the patient should be attentively observed when the Sinemet dosage is suddenly reduced or halted, especially if the patient is being treated with care. As with Levodopa, in the case of prolonged treatment, it is wise to undergo periodic tests, regarding the haematic formula and the hepatic, renal and cardiocirculatory functions. Patients with chronic open angle glaucoma can be treated with caution with Sinemet, providing intra-ocular pressure is controlled and the patient is kept under close observation for signs of change during the treatment. Pharmacological Interaction There have been reports, although admittedly few, concerning undesirable reactions including hypertension and difficulty in movement, derived from the concomitant use of tricyclic antidepressants and Sinemet. Phenothiazines and butyrophenones may reduce the therapeutic effects of Levodopa. It has also been reported that phenitoine and papaverine also canceled out the beneficial effects of the latter. Patients who take this medication with Sinemet should be carefully advised concerning the eventual loss of its therapeutic properties. Given that Levodopa competes with certain amino acids. Its absorption may be compromised in certain patients by a high protein diet. Side Effects While Carbidopa allows for a higher Levodopa content in the Brain, difficulty in movement has been seen with Sinemet at a lower dosage than preparations containing only L-Dopa. Other serious side effects are mental alterations, including tendencies towards paranoia and psychotic behavior, depression accompanied or not by suicidal tendencies, dementia. Convulsions are so rare as to not be considered directly relating to Sinemet. Another common but none the less unappealing side effect is nausea. Other less frequent side effects are cardia unevenness and/ or palpitations, cases of orthostatic, hypertension, bradykinesia (the on/ off phenomenon), anorexia, vomiting and vertigo. Rare cases have been reported of gastrointestinal hemorrhaging, duodenal ulcer, hypertension, phlebitis, leucopenia, agranulcytosis, Thrombocytopenia, hemolytic and non hemolytic anemia. Positive Comb's Tests have been carried out both with Sinemet and with Levodopa on it's own. Lab tests have shown the following abnormalities- - Alkaline phosphates, SGOT, SGPT, lactic- dehyrogenase, bilirubin, azotaemia, iodine left in protein. Other side effects described in conjunction with Levodopa are the following- - Psychiatric: Ataxia, fainting, increased trembling of the hands, muscular spasms, muscular cramp, trismus, activation of a latent hroner syndrome. In the Case of Overdose |