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When SINEMET is to be given to patients who are being treated with levodopalevodopa must be discontinued at least twelve hours before therapy with SINEMET is startedIn order to reduce adverse reactionsit is necessary to individualize therapySee DOSAGE AND ADMINISTRATION section before initiating therapy.

Before initiating treatment with SINEMETadvise patients about the potential to develop drowsiness and ask specifically about factors that may increase the risk for somnolence with SINEMET such as the use of concomitant sedating medications and the presence of sleep disordersConsider discontinuing SINEMET in patients who report significant daytime sleepiness or episodes of falling asleep during activities that require active participatione.gconversationseatingetcIf treatment with SINEMET continuespatients should be advised not to drive and to avoid other potentially dangerous activities that might result in harm if the patients become somnolentThere is insufficient information to establish that dose reduction will eliminate episodes of falling asleep while engaged in activities of daily living.

Caution should be exercised when the following drugs are administered concomitantly with SINEMET.

The management of NMS should include1intensive symptomatic treatment and medical monitoring and 2treatment of any concomitant serious medical problems for which specific treatments are availableDopamine agonistssuch as bromocriptineand muscle relaxantssuch as dantroleneare often used in the treatment of NMShowevertheir effectiveness has not been demonstrated in controlled studies.

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