Comparison of Sinemet CR4 and standard Sinemet: Double blind and long-term open trial in parkinsonian patients with fluctuations

✍ Scribed by Dr. Joseph Jankovic; Kenneth Schwartz; Chris Vander Linden

• Publisher: John Wiley and Sons
• Year: 1989
• Tongue: English
• Weight: 414 KB
• Volume: 4
• Category: Article
• ISSN: 0885-3185
• DOI: 10.1002/mds.870040403

✦ Synopsis

Wearing-off' effect, the most common form of levodopa-induced fluctuations, seems to be related to the short plasma half-life of the drug. More sustained plasma levodopa levels may be achieved with a new controiledrelease formulation of carbidopdevodopa, Sinemet CR4. We studied 20 patients, 12 men and 8 women, with Parkinson's disease complicated by "wearing-off' phenomenon. Mean age was 61.1 * 8.1 years, duration of symptoms 8.3 * 2.4 years, and the Hoehn-Yahr stage 3.0 2 0.9. In a 12-week double-blind study, the average number of tablets administered per day decreased from 5.7 2 1.2 to 3.8 5 0.7 when Sinemet CR4 (50/200) was substituted for the standard Sinemet (25/100) (p < 0.001). However, this was at the expense of reducing the "on" time (without dyskinesia) from 9.3 2 4.6 to 7.5 * 4.3 (p < 0.05), although the total "on" time did not significantly change. In a long-term follow-up of 18 patients, the "on" time with dyskinesia and morning dystonia significantly increased (p < 0.05). There was no significant change in the total daily dosage of levodopa, but the daily number of doses and tablets significantly decreased (p < 0.001). Despite increased dyskinesia, most patients preferred taking fewer tablets and have elected to continue taking Sinemet CR4 instead of standard Sinemet. Sinemet CR4 seems to offer a new and effective strategy for the management of levodopa-related fluctuations.