Sinemet 25/100/Sinemet 25/250 Dosage/Direction for Use

The optimum daily dosage of Sinemet must be determined by careful titration in each patient. Sinemet tablets are available in a 1:4 ratio of carbidopa to levodopa (Sinemet 25/100) as well as a 1:10 ratio (Sinemet 25/250). Tablets of the 2 ratios may be given separately or combined as needed to provide the optimum dosage.
Each tablet of Sinemet is designed to be divided in ½ with minimal pressure.
General Considerations: Dosage should be titrated to individual patient needs and this may require adjusting both the individual dose and the frequency of administration.
Studies show that peripheral dopa decarboxylase is saturated by carbidopa at approximately 70-100 mg/day. Patients receiving less than this amount of carbidopa are more likely to experience nausea and vomiting.
Usual Initial Dosage: Dosage is best initiated with 1 tab of Sinemet 25/100 3 times/day. This dosage schedule provides carbidopa 75 mg/day. Dosage may be increased by 1 tab everyday or every other day, as necessary, until a dosage equivalent of 8 tabs of Sinemet 25/100 a day is reached.
For patients starting with Sinemet 25/250, the initial dose is ½ tab taken once or twice daily. However, this may not provide the optimal amount of carbidopa needed by many patients. If necessary, add ½ tab everyday or every other day until optimal response is reached.
Fully effective doses usually are reached within 7 days as compared to weeks or months with levodopa alone.
Maintenance: Therapy should be individualized and adjusted according to the desired therapeutic response. At least 70-100 mg of carbidopa/day should be provided for optimal inhibition of extracerebral decarboxylation of levodopa.
When more levodopa is required, Sinemet 25/250 should be substituted for Sinemet 25/100. If necessary, the dosage of Sinemet 25/250 may be increased by ½ or 1 tab everyday or every other day to a maximum of 8 tabs a day. Experience with total daily dosages of carbidopa >200 mg is limited.
Maximum Recommended Dose: 8 tabs of Sinemet 25/250/day (carbidopa 200 mg and levodopa 2 g). This is about 3 mg/kg of carbidopa and 30 mg/kg of levodopa in a patient weighing 70 kg.