Jim asked
How should I time food intake when I'm taking carbidopa; levodopa extended-release?
At a glance
- Food, especially high protein food, can delay absorption of carbidopa; levodopa drugs.
- Immediate-release carbidopa; levodopa drugs are more affected by food than the controlled-release versions.
- If nausea is a problem, a small, low-protein, snack can help with symptoms.
Answer
There are some 'food' interactions with Sinemet CR (carbidopa; levodopa controlled-release) that are good to be aware of.
Here are a few of the more important ones:
- High protein diets will delay the absorption of the drug.
- Acidic environments will delay the absorption of the drug.
- Iron salts (even those contained in multivitamins) reduce the rate and extent of absorption of the drug.
The prescribing information for the drug particularly warns against a change to a high protein diet:
The patient should be informed that a change in diet to foods that are high in protein may delay the absorption of levodopa and may reduce the amount taken up in the circulation
So basically, food, in general, will likely reduce absorption of the drug (since the simple act of eating increases stomach acid).
Now, it is important to note that one of the main side effects of carbidopa; levodopa is nausea...which food can actually help to alleviate.
Therefore, if you are finding nausea to be a problem, it is recommended to take it with a small non-protein snack, such as fruit or a cracker.
I also want to point out that the immediate-release tablets (Sinemet) are more affected by food than the controlled release ones (Sinemet CR).
The immediate-release tablets are generally recommended to be taken as follows:
- Take with 6 to 8 ounces of water at least 30 minutes before eating or 1 hour after meals for maximum absorption.
- It can be taken with a small, non-protein snack to help combat nausea.
The controlled-release tablets are less affected by food intake, but again, you should generally avoid high protein meals with it.
I'll end with saying that any drug that contains levodopa is notoriously hard to titrate and dose in a way where there aren't fluctuations in your symptoms (sometimes known as 'on-off' periods). For best effects, try to take your medication as consistently as possible (i.e. the same way every day in regard to timing and food).
If you have questions about taking carbidopa; levodopa with other meds, let us know and we can help you out!
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