COMPOSITION:
Each tablet contains 100 or 250mg Levodopa and 25mg Carbidopa.
MECHANISM OF ACTION:
Parkinson disease is caused by depletion and evacuation of dopamine from corpus striatum in cerebrum. Dopamine does not cross the blood brain barrier، while Levodopa cross the blood brain barrier and is converted to dopamine in cerebrum. Carbidopa inhibits decarboxylation of Levodopa in blood and does not cross the blood brain barrier. It gives more amount of Levodopa that it ready to transfer to the corpus striatum in cerebrum. Therefore it reduces the amount of Levodopa required by about 75%، thus reducing the side - effects.
Studies showed that the peripheral enzyme Dopa-decarboxylase is fully inhibited by Carbidopa at doses between 70 – 100mg daily.
INDICATIONS:
In treatment of Parkinson disease، Cenimed is useful in relieving its symptoms rigidity، bradykinesia، tremor، dysphagia، sialorrhoea and depression.
DOSAGE:
Initial Dose for patients not receiving levodopa:
- For patients starting with Cenimed (100): One tablet 3 times daily. Dosage may be increased by one tablet every day or every other day، as necessary، until a dosage equivalent of 8 tablets daily.
- For patients starting with Cenimed (250): One-half tablet 1 – 2 times daily. If necessary add one-half tablet every day or every other day until optimal response is reached.
Initial Dose for patients receiving levodopa:
Discontinue levodopa at least 12 hours before starting therapy with Cenimed. The easiest way to do this is to give Cenimed as the first morning after a night without any levodopa.
- Patients taking less than 1500mg levodopa daily: One tablet of Cenimed (100) 3 – 4 times daily.
- Patients taking more than 1500mg levodopa daily: One tablet of Cenimed (250) 3 – 4 times daily.
Maintenance Dose:
Therapy with Cenimed should be individualised and adjusted gradually according to response. When more levodopa is required، Cenimed (100) should be substituted at dosage of one tablet 3 – 4 times daily of Cenimed (250). If necessary، the dosage may be increased by ½ – 1 tablet every other day to a maximum of 8 tablets daily.
Safety of Cenimed under 18 years of age، has not been established.
SIDE - EFFECTS:
Dyskinesia، involuntary movements، blepharo/spasm، and insomina. Dosage should be reduced when these effects appear. Nausea، vomiting، anorexia، these effects disappear after few weeks of therapy. Less frequent side-effects such as cardiac arrhythmias، orthostatic hypotension، mental disorder، dry mouth، sialorrhoea، diplopia.
CONTRA - INDICATIONS:
Hypersensitivity to any component of the product، closed-angle glaucoma، patients with a history of melanoma، nor to patients with suspective skin disorders.
DRUG - INTERACTION:
Phenothiazine، butyrophenones، phenytion، papaverine and reserpin remove Levodopa effects. MAO inhibitors result in hypotensive crises and high elevation of body temperature. Therefore، they should be discontinued at least two weeks before starting Cenimed.
PRECAUTIONS:
- It should be used with caution in-patients with cardiovascular disease، psychiatric disturbances، diabetes mellitus، open-angle glaucoma، or a history of gastric or duodenal ulcer.
- Periodic evaluations of hepatic، hematological، renal، and cardiovascular functions have been advised during treatment.
- Treatment with Cenimed should not be stopped abruptly.
USE IN PREGNANCY OR LACTATION:
Cenimed should not be used during the first trimester of pregnancy or during lactation.
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