From the Guidelines
Role of Sinemet in Treating Restless Legs Syndrome (RLS)
Sinemet, a combination of levodopa and carbidopa, is not a first-line treatment for Restless Legs Syndrome (RLS) due to the potential for augmentation, a condition where symptoms worsen over time 1. However, it may be considered for patients with severe RLS who have not responded to other treatments. The recommended dose is typically 25/100 mg, taken 30-60 minutes before bedtime, and can be titrated up to 50/200 mg if necessary.
- Key Considerations: Treatment should be initiated with caution and under close supervision due to the potential for augmentation and other adverse effects 1.
- Monitoring: Patients should be monitored regularly for signs of augmentation, and the medication should be discontinued if symptoms worsen or if significant side effects occur 1.
- Alternative Treatments: Other treatments, such as ferrous sulfate, dipyridamole, and extended-release oxycodone, may be considered as first-line options for RLS 1.
- Special Populations: In adults with RLS and end-stage renal disease (ESRD), gabapentin and IV iron sucrose may be considered as alternative treatments 1.
From the Research
Role of Sinemet (Carbidopa/Levodopa) in Treating Restless Legs Syndrome (RLS)
- Sinemet (Carbidopa/Levodopa) is a dopaminergic agent used in the treatment of RLS, as it has been shown to be effective in reducing symptoms of the disorder 2, 3, 4, 5.
- However, the use of Sinemet (Carbidopa/Levodopa) can be associated with a significant problem of augmentation, which is a paradoxical worsening of symptoms, particularly in the afternoon and evening prior to taking the next nightly dose 2.
- Augmentation occurs in a significant proportion of patients treated with Sinemet (Carbidopa/Levodopa), with studies suggesting that it affects up to 82% of patients with RLS 2.
- The risk of augmentation can be minimized by keeping the dose of Sinemet (Carbidopa/Levodopa) low, and it may be necessary to change medication in some cases 2, 6, 4.
- Alternative treatments, such as dopamine agonists, may be preferred for patients with daily or refractory symptoms of RLS, due to the risk of augmentation associated with Sinemet (Carbidopa/Levodopa) 6, 4, 5.
- Sinemet (Carbidopa/Levodopa) may still be considered as a first-line treatment for patients with intermittent symptoms of RLS, particularly in cases where other treatments are not effective or tolerated 5.