Sinemet CR

Sinemet CR can be used by itself or with other medications to help treat symptoms of Parkinson's disease, like stiffness or tremors in adults.

Sinemet CR is also used in adults for Parkinson's disease caused by infection, carbon monoxide poisoning, or manganese intoxication.

Sinemet CR may also be used for reasons not mentioned in this medication guide.

Follow all instructions on your prescription label and read all medication guides or instruction sheets. Your doctor may change your dose from time to time. Use the medicine exactly as directed.

Stop taking any other medications that contain Sinemet CR when you start taking the extended-release version.

Your dose may change if you switch to a different brand, strength, or form of this medicine. Avoid mistakes by using it exactly as directed on the label, or as prescribed by your doctor.

Take this medicine at evenly spaced times. Follow your doctor's instructions on whether to take it with food or on an empty stomach.

Swallow the capsule whole and do not crush, chew, break, or open it. The tablet may sometimes be split in half to provide the correct dose. Always swallow a whole or half tablet without chewing or crushing.

If you cannot swallow an extended-release capsule whole, open it and mix the medicine with applesauce. Swallow the mixture right away without chewing.

Remove an orally disintegrating tablet from the package with dry hands only when you are ready to use it. Allow the orally disintegrating tablet to dissolve in your mouth without chewing.

It may take several weeks for your symptoms to improve. Tell your doctor if your symptoms do not improve or if the effects of this medicine wear off quickly between doses.

Sinemet CR will likely darken the color of your saliva, urine, or sweat to an orange or red color. This is a normal effect and is not harmful. It may also cause stains to your underwear that may be permanent.

You may need frequent medical tests, and your doctor will need to check your progress regularly.

This medicine can affect the results of certain medical tests. Inform any doctor who treats you that you are using Sinemet CR.

Do not stop using Sinemet CR suddenly, or you could experience unpleasant withdrawal symptoms (such as agitation, confusion, tingling). Ask your doctor before stopping the medicine.

You may need to follow a special diet. Learn about the foods you should eat or avoid.

Store tightly closed at room temperature, away from moisture, heat, and light.

Do not use this medicine if you have taken a MAO inhibitor in the last 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, or tranylcypromine.

Some people may have thoughts of suicide while taking Sinemet CR. Inform your doctor immediately if you notice any sudden changes in your mood or behavior, or if you have thoughts about suicide.

You should not use Sinemet CR if you are allergic to it or any of its ingredients, or if you have narrow-angle glaucoma.

Do not use Sinemet CR if you have used a MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, and tranylcypromine. Wait at least 14 days after stopping a MAO inhibitor before you take this medicine.

If you already take levodopa, you must stop taking it at least 12 hours before you start taking Sinemet CR.

Tell your doctor if you have or have ever had:

• an endocrine disease, heart disease, high blood pressure, or heart attack;
• asthma, chronic obstructive pulmonary disease (COPD), or other breathing disorder;
• skin cancer (melanoma), a stomach or intestinal ulcer;
• glaucoma, depression, mental illness, or psychosis;
• if you received general anesthesia; or
• liver or kidney disease.

The orally disintegrating tablet may contain phenylalanine and could be harmful if you have phenylketonuria (PKU). Ask your doctor about your risk.

Some people have thoughts about suicide while taking Sinemet CR. Stay alert to changes in your mood or symptoms. Your family or caregivers should also watch for sudden changes in your behavior.

People with Parkinson's disease may have a higher risk of skin cancer (melanoma). Ask your doctor about skin symptoms to watch for.

It is not known if Sinemet CR will harm an unborn baby. The benefit of this treatment may outweigh any risks to the mother and baby. Tell your doctor if you are pregnant or plan to become pregnant.

Ask a doctor if it is safe to breastfeed while using Sinemet CR.

Get emergency medical help if you notice signs of an allergic reaction: hives, trouble breathing, swelling of your face, lips, tongue, or throat.

Tell your doctor right away if you experience new or sudden changes in mood or behavior, including depression or anxiety, panic attacks, difficulty sleeping, or if you feel impulsive, irritable, agitated, aggressive, more active or talkative, or have thoughts about suicide or self-harm.

Some people taking Sinemet CR have fallen asleep during normal daytime activities such as working or driving after starting Sinemet CR and up to a year later. Inform your doctor if you have any issues with daytime sleepiness.

Sinemet CR may lead to serious side effects. Call your doctor immediately if you have:

• signs of stomach bleeding--bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;
• uncontrolled muscle movements, blurred vision, eye pain or redness, seeing halos around lights; or
• severe nervous system reaction--very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling faint.

You may experience increased sexual urges, unusual urges to gamble, or other intense urges while taking this medicine. Discuss this with your doctor if it happens.

Your dose may be lowered or stopped permanently if you have certain side effects.

Common side effects of Sinemet CR may include:

• uncontrolled muscle movements;
• dry mouth, anxiety, headache, dizziness;
• drops in blood pressure or feeling light-headed when standing up;
• sleep problems (insomnia), strange dreams, muscle contractions; or
• nausea, vomiting, constipation.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Take the medicine as soon as possible, but skip the missed dose if it is nearly time for your next dose. Do not take two doses at once.

Get your prescription refilled before you completely run out of medicine.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Avoid driving or doing any dangerous activities until you know how Sinemet CR will affect you. Dizziness or drowsiness can lead to falls, accidents, or serious injuries. Also, be careful not to get up too quickly from a sitting or lying position, or you may feel dizzy.

Drinking alcohol with this medicine can lead to side effects.

Avoid taking iron supplements, high-fat, or high-calorie meals before or after taking Sinemet CR. These can make it harder for your body to absorb this medicine.

Using Sinemet CR with other medications that cause drowsiness can make you feel even more tired. Talk to your doctor before taking opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.

When you start or stop taking Sinemet CR, your doctor might need to change the doses of other medicines you take regularly.

Inform your doctor about all your other medicines, especially:

• phenytoin, metoclopramide;
• papaverine, isoniazid, selegiline, reserpine, tetrabenazine;
• vitamin or mineral supplements that contain iron; or
• medicine for blood pressure, nausea or vomiting, anxiety, mood disorders, or mental illnesses like schizophrenia.

This list is not complete. Other drugs may interact with Sinemet CR, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are mentioned here.