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Because both therapeutic and adverse responses occur more rapidly with SINEMET than with levodopa alonepatients should be monitored closely during the dose adjustment periodSpecificallyinvoluntary movements will occur more rapidly with SINEMET than with levodopaThe occurrence of involuntary movements may require dosage reductionBlepharospasm may be a useful early sign of excess dosage in some patients.

Patients should be alerted to the possibility of sudden onset of sleep during daily activitiesin some cases without awareness or warning signswhen they are taking dopaminergic agentsincluding levodopaPatients should be advised to exercise caution while driving or operating machinery and that if they have experienced somnolence and/or sudden sleep onsetthey must refrain from these activitiesSee WARNINGSFalling Asleep During Activities of Daily Living and Somnolence

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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