Synamet 100/10 mg 10 mg + 100 mg Tablet

Synamet 100/10 mg 10 mg + 100 mg tablet by Healthcare Pharmaceuticals Ltd. is a medicine that contains Carbidopa + Levodopa. In Bangladesh, it is mainly used to help control symptoms of Parkinson's disease such as slowness, stiffness, tremor and difficulty with movement.

Carbidopa + Levodopa works by supplying levodopa, which is converted to dopamine in the brain, while carbidopa helps more levodopa reach the brain and reduces some peripheral side effects such as nausea. A key caution is that it should not be stopped suddenly unless a doctor advises, because abrupt withdrawal can cause serious worsening or a neuroleptic malignant syndrome-like reaction.

• Treatment of Parkinson's disease.
• Treatment of parkinsonian symptoms such as bradykinesia, rigidity and tremor when a clinician considers levodopa therapy appropriate.
• Some formulations may also be used for parkinsonism following conditions such as encephalitis, carbon monoxide poisoning or manganese intoxication, as directed by a specialist.

The dose of Carbidopa + Levodopa must be individualized according to symptoms, previous levodopa exposure, age, tolerability and the specific tablet strength or controlled-release formulation. Doctors usually start with a low dose and adjust gradually to the lowest dose that gives useful symptom control. Controlled-release tablets should generally be swallowed whole and not crushed or chewed unless the product instructions say otherwise. Do not change the dose, dosing interval or formulation, and do not stop treatment suddenly, without medical advice.

• Common effects include nausea, vomiting, loss of appetite, dry mouth, dizziness, headache, sleepiness, insomnia, abnormal dreams and constipation.
• Movement-related effects may include dyskinesia, involuntary movements, muscle twitching or wearing-off/on-off fluctuations.
• Low blood pressure on standing, faintness, palpitations or irregular heartbeat may occur.
• Mental or behavioural effects can include confusion, agitation, hallucinations, depression, anxiety, vivid dreams and impulse-control problems such as gambling, binge eating or increased sexual urges.
• It may darken urine, sweat or saliva, which is usually harmless but can stain clothing.
• Serious but uncommon reactions include severe sleep attacks, psychosis, severe allergic reaction, gastrointestinal bleeding, significant heart rhythm problems and a neuroleptic malignant syndrome-like reaction if stopped abruptly.

Use Carbidopa + Levodopa carefully in people with heart disease or recent heart attack, irregular heartbeat, low blood pressure, glaucoma, peptic ulcer disease, severe lung disease, kidney or liver impairment, endocrine disease, history of seizures, psychosis or other significant mental health conditions. Patients and caregivers should watch for excessive daytime sleepiness, sudden sleep episodes, hallucinations, confusion, worsening involuntary movements and impulse-control behaviours. People with suspicious skin lesions or a history of melanoma should be assessed by a doctor. Use this medicine under the guidance of a registered doctor or pharmacist.

• Non-selective monoamine oxidase inhibitors (MAOIs) must not be used with Carbidopa + Levodopa; they should generally be stopped at least 14 days before starting, unless a doctor gives specialist advice.
• Antipsychotics and other dopamine-blocking medicines, including some anti-nausea medicines such as metoclopramide or prochlorperazine, may reduce the effect of levodopa or worsen Parkinson's symptoms.
• Antihypertensive medicines may increase the risk of low blood pressure and dizziness.
• Iron salts and multivitamins containing iron can reduce levodopa absorption; spacing doses may be advised by a healthcare professional.
• High-protein meals may reduce or delay levodopa absorption in some patients; dietary timing should be discussed with the prescriber if symptoms fluctuate.
• Other Parkinson's medicines such as dopamine agonists, amantadine, COMT inhibitors or MAO-B inhibitors can increase benefits but may also increase dyskinesia, hallucinations or low blood pressure, so dosing must be supervised.
• Isoniazid, phenytoin and some other medicines may reduce levodopa response in some patients.

• Known hypersensitivity to carbidopa, levodopa or any component of the product.
• Use together with non-selective MAOIs, or use within the usual 14-day washout period after stopping them.
• Narrow-angle glaucoma, unless a specialist specifically determines it is safe.
• Suspicious undiagnosed skin lesions or a history of melanoma are listed as reasons to avoid levodopa in some product information; medical assessment is required before use.

During pregnancy, Carbidopa + Levodopa should be used only when the expected benefit to the mother justifies the potential risk to the baby, and the decision should be made by a doctor. Levodopa is reported to pass into breast milk and may reduce milk production; breastfeeding mothers should discuss whether to avoid breastfeeding or use an alternative treatment with their doctor.

Store at room temperature, away from excess heat, moisture and direct light. Keep tablets in the original container, tightly closed, and out of the reach of children. Do not use after the expiry date, and return unused or damaged medicine to a pharmacy for safe disposal when possible.