Parkinson’s disease management is often very challenging. Dopamine is one of the key neurotransmitters involved in the disease process so that is really where treatment is focused. There is a loss or depletion of dopamine in Parkinson’s and treatment involves replacement of the dopamine – Sinemet is the primary treatment in Parkinson’s disease. The struggle in managing dopamine replacement therapy is that there is often a fine line between under treatment and over treatment. Concentrations can vary greatly, so the more frequent dosing you can have the more likely you are to have a steady state concentration in the body. The flip side is that dosing frequently is a huge burden if you’d like to have a normal life! This is the reason why you may see Sinemet dosed so frequently. (I.e. 5 or 6+ times per day can occur) For patients that struggle with this balance and can’t be managed with a simple regimen, you may see a combination of Sinemet controlled release with immediate release. Combination therapy with Dopamine agonists and other adjunctive medications is also seen in patients that require more complex medication regimens to manage Parkinson’s symptoms.