Sindopa, tablets 250 mg+25 mg 50 pcs

Antiparkinsonian combined agent is a combination of carbidopa (aromatic amino acid decarboxylase inhibitor) and levodopa (dopamine precursor). It eliminates hypokinesia, rigidity, tremor, dysphagia, salivation. Antiparkinsonian action of levodopa is caused by its conversion into dopamine directly in CNS, which leads to replenishment of dopamine deficiency in CNS.

Dopamine formed in peripheral tissues does not participate in realization of the antiparkinsonian effect of levodopa (it does not penetrate into CNS) and is responsible for the majority of levodopa side effects. Carbidopa is a peripheral dopa-decarboxylase inhibitor and reduces dopamine formation in peripheral tissues, which indirectly leads to increased amount of levodopa entering CNS. The optimal combination of levodopa and carbidopa is 4:1 or 10:1.

The action of the drug is seen within the first day of administration, sometimes after the first dose. The full effect is achieved within 7 days.

Indications

Active ingredient

Composition

1 tablet contains:

levodopa – 250 mg;

carbidopa – 25 mg

Supplementary substances:

Corn starch,

Microcrystalline cellulose,

lactose,

Ponceau 4R lake dye,

povidone K30,

butylhydroxyanisole,

/p>

purified talc,

magnesium stearate,

silicon dioxide colloidal anhydrous,

sodium starch glycolate,

dried corn starch.

How to take, the dosage

Ingestion, with a small amount of food or after a meal, with water and without chewing. Because there is competition between aromatic amino acids and levodopa for absorption, consumption of large amounts of protein should be avoided during the use of the drug. The average daily dose of carbidopa necessary to inhibit the peripheral conversion of levodopa is 70-100 mg. Exceeding 200 mg of carbidopa does not entail further enhancement of the therapeutic effect. The daily dose of levodopa should not exceed 2000 mg.

The starting dose is 1/2 tablet 2 times a day; if necessary, it can be increased by 1/2 tablet a day. As a rule, at the beginning of substitution therapy, the daily dose should not exceed 3 tablets a day (1 tablet 3 times a day). Use in this dosage is recommended at the beginning of treatment of severe cases of parkinsonism. Daily dose of the preparation can be increased during monotherapy in exceptional cases, but it should not exceed 8 tablets (1 tablet 8 times a day). The use of more than 6 tablets a day should be carried out with great caution.

Tidomet forte when replacing levodopa

The intake of levodopa should be stopped 12 hours before starting treatment with Syndopa, and in the case of prolonged forms of levocarbidopa 24 hours before. The dosage of Syndopa in this case should be no more than 20% of the previous dose of levodopa. The maintenance dose is 3-6 tablets per day for most patients.

Interaction

In concomitant use of levodopa with beta-adrenergic stimulants, ditiline and drugs for inhalational anesthesia, there may be an increased risk of cardiac rhythm disturbances; with tricyclic antidepressants – reduced bioavailability of levodopa; with diazepam, clozepine, phenytoin, clopheline, m-cholinoblockers, antipsychotic drugs (neuroleptics) – butyrophenone derivatives, diphenyl butylpiperidine, thioxanthene, phenothiazine, and also with pyridoxine, papaverine, reserpine a decrease of antiparkinsonian action is possible; With Li+ drugs, there is an increased risk of dyskinesias and hallucinations; with methyldopa, an aggravation of side effects.

The concomitant use of levodopa with MAO inhibitors (except MAO-B inhibitors) may cause circulatory disorders (MAO inhibitors should be discontinued 2 weeks in advance). This is due to the accumulation of dopamine and norepinephrine under levodopa influence, which inactivation is inhibited by MAO inhibitors, and high possibility of agitation, high blood pressure, tachycardia, facial flushing and dizziness.

In patients receiving levodopa, there is an increased risk of markedly decreased BP when using tubocurarine.

Special Instructions

Should not be used in cases of secondary Parkinsonism (Parkinson’s syndrome) caused by the use of antipsychotic drugs (neuroleptics).

The treatment should be stopped gradually, because if the drug is stopped suddenly, a symptom complex reminiscent of malignant neuroleptic syndrome (muscle rigidity, increased body temperature, increased serum CPK content) may develop. Patients requiring sudden dose reduction or discontinuation of the drug should be monitored. Absorption of levodopa is higher in elderly patients than in younger patients. These data support the evidence of decreased dopadecarboxylase activity in tissues with age, as well as with long-term levodopa administration.

In erosive ulcerative lesions of the stomach and/or duodenum, history of epileptic seizures, myocardial infarction with rhythm disturbances in the anamnesis, heart failure, diabetes, bronchial asthma, endocrine disorders, mental disorders, and severe liver or kidney function disorders the drug should be used with caution. In such cases, patients should be closely monitored.

In long-term treatment, periodic monitoring of liver, kidney, hematopoietic and cardiovascular function should be performed, and the patient’s mental status should also be monitored.

In general anesthesia for surgical procedures, Sindopa is administered without reducing the dose if the patient is able to take medications and fluids orally. When halothane and cyclopropane are used, administration of the drug is stopped at least 8 hours before surgery. Treatment continues after surgery at the same dose.

Patients with glaucoma should have their intraocular pressure monitored regularly while taking the drug.

Influence on driving and operating machinery

Participants should refrain from driving vehicles and activities requiring rapid psychomotor reactions.

Contraindications

With caution: myocardial infarction with arrhythmia (in anamnesis), chronic heart failure and severe cardiovascular disease, severe lung disease (including Bronchial asthma); epilepsy and seizures (in anamnesis), gastrointestinal erosive-ulcerative lesions (risk of upper gastrointestinal bleeding), diabetes and decompensated endocrine diseases, severe hepatic and/or renal failure, open-angle glaucoma, pregnancy, lactation.

Side effects

From the nervous system:. Dyskinesia, including choreoathetosis, focal dystonia, on-off syndrome with prolonged use, dizziness, ataxia, seizures, anorexia, sedation, somnolence, nightmares, nervous tension, increased excitability, anxiety, insomnia, psychotic reactions, hallucinations, depression, paranoid states, hypomania, increased libido, euphoria, dementia.

Gastrointestinal tract:Nausea, vomiting, constipation, epigastric pain, dysphagia, ulcerogenic effects in predisposed patients.

Cardiovascular system: Orthostatic hypotension, collapse, cardiac arrhythmias, tachycardia.

Hematopoietic system disorders:moderate leukopenia, thrombocytopenia, hemolytic anemia.

Laboratory parameters:changes in levels of glutamathoxalate transaminase, glutamate pyruvatoxalase, alkaline phosphatase, lactate dehydrogenase, urea nitrogen, bilirubin, protein-bound iodine, positive direct Coombs reaction.

Others: blepharospasm, mydriasis, diplopia, slight increase in body weight with long-term use.

The side effects usually depend on the dose taken and also on the individual sensitivity of the patient. Side effects can be resolved by temporarily reducing the dose without a break in treatment. If the side effects do not regress, treatment is discontinued gradually.

Overdose

Symptoms:firstly an increase and then a decrease in blood pressure, sinus tachycardia, confusion, agitation, insomnia, anxiety. Orthostatic hypotension may also develop. Symptoms of anorexia and insomnia may persist for several days.

Treatment:Gastric lavage, administration of activated charcoal. If necessary, symptomatic treatment in a hospital setting. There is no specific antidote.

Pregnancy use

It is contraindicated during pregnancy and lactation.