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Therapy should be individualized and adjusted according to the desired therapeutic responseAt least 70 to 100 mg of carbidopa per day should be providedWhen a greater proportion of carbidopa is requiredone tablet of SINEMET 25-100 may be substituted for each tablet of SINEMET 10-100When more levodopa is requiredSINEMET 25-250 should be substituted for SINEMET 25-100 or SINEMET 10-100If necessarythe dosage of carbidopa levodopa 25-250 may be increased by onehalf or one tablet every day or every other day to a maximum of eight tablets a dayExperience with total daily dosages of carbidopa greater than 200 mg is limited.

Hallucinations and psychotic-like behavior have been reported with dopaminergic medicationsIn generalhallucinations present shortly after the initiation of therapy and may be responsive to dose reduction in levodopaHallucinations may be accompanied by confusion and to a lesser extent sleep disorderinsomniaand excessive dreaming.

There have been reports of patients experiencing intense urges to gambleincreased sexual urgesand other intense urgesand the inability to control these urges while taking one or more of the medications that increase central dopaminergic tone and that are generally used for the treatment of Parkinson’s diseaseincluding SINEMETAlthough it is not proven that the medications caused these eventsthese urges were reported to have stopped in some cases when the dose was reduced or the medication was stoppedPrescribers should ask patients about the development of new or increased gambling urgessexual urges or other urges while being treated with SINEMETPatients should inform their physician if they experience new or increased gambling urgesincreased sexual urgesor other intense urges while taking SINEMETPhysicians should consider dose reduction or stopping the medication if a patient develops such urges while taking SINEMETSee PRECAUTIONSImpulse ControlCompulsive Behaviors

Carbidopa may also reduce nausea and vomiting and permit more rapid titration of levodopa.

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