[log in to unmask] wrote:

 > Charley,
 >
 > I read with great interest your timing of sinemet doses.   Would you
please
 > share with me what dosage you are on?
 > I am trying to relate sinemet to meals and snacks.
 >
 > Thanks Dean

Dean,

Here is where I am at after about 8 years of trial and error adjustments
to my meds (under supervision of my family physician and my
neurologist). My experience is that the meds. complement each other, so
I did not separate the Sinemet CR from the rest.

The bottom line for me is although the effects of PD and its meds have
steadily progressed to the point that I took disability retirement (this
time last year), I now have predictable "on" hours several times/day and
tremor is almost never a problem.  If there is such a thing as an
"average day" for a PWP, I would say that my "on" times exceed my "off"
times (Bradykinesia primarily) by about 25 per cent.  Also, I usually
get about 6 hours of good sleep/night.

I found that Sinemet CR alone was not adequate for me to deal with
Bradykinesia.  Adding Ropinirole helped me a lot. (I have also tried
Parlodel and Tasmar.) However, probably because my blood pressure has
always tended to be on the low side of normal, I have to be careful with
it.  An experiment with increasing the amount of Ropinirole lowered my
blood pressure level too much.  Because of this, I always take Sinemet
CR at least a hour before any Ropinirole.  (see more about Ropinirole at
the end)

I take-
Amantadine 100 mg x 2/day
Selegiline 5 mg x 1/day
Sinemet CR 200-50 x 4/day
Ropinirole 1 mg x 3/day

also SAM-e 400 mg x 2/day and standard multiple vitamins plus extra E.

about 0600  Selegiline & Sinemet CR w/medium cup of orange juice
0615  SAM-e with a sip of orange juice
0700  Amantadine w/breakfast of fruit and cereal with reduced fat,
lactose free milk or fruit and 2 waffles

0800  Ropinirole w/my concoction of 1/2 coffee and 1/2 lactose free milk

I usually am moving pretty good between about 0830 and 1100.  This is
the best time for me to do T'ai Chi exercise and walk or garden.  If I
feel like it, I'll take a mid morning break with either coffee or black
tea and something sweet to eat.

When I start to slow down around 1100, I take another Sinemet CR and a
Ginseng tea break or water if I am not at home.  I usually get another
good hour from about 1130 to 1230.  I take another Amantadine
w/vegetable juice, usually while making a low protein lunch.  After
lunch about 1300, I take Ropinirole, usually w/green tea at home or a
coke if I am out and about.

Early afternoons are usually pretty good for me, if I can do things at
my own slower pace. But I am definitely much slower then than my wife,
former work associates, and my ten year old son!  I take another SAM-e
w/water or juice about 1400.

About the most difficult time for me (Bradykinesia again) is late
afternoon.  Since both of my doctors have advised me to moderate the use
of Sinemet as much as possible, I use this time just to sit and listen
to or watch the news on radio or tv.  My son is still at school and my
wife is a teacher at school then anyway, so it is a manageable
inconvenience.

I take another Sinemet CR about 1630 w/juice or a soda when it is hot
and Ginseng tea when it is cool.

Evenings are pretty good for me, unless I get into a crowded situation
or something that requires multi-tasking.  I take my last Ropinirole
with dinner around 1800.

I start getting very slow around 2130.  So I take my last Sinemet CR
around then w/Chamomile flower tea.  I wait until about 2300 to go to
bed. (Because I have found out that every time I take Sinemet CR within
about 30 minutes, no matter the time of day or amount or type of liquids
I have drank, I need to relieve my bladder.)

Note about Ropinirole.  It definitely helps me move.  But it also causes
me to have "sleep attacks" within 30 minutes, if I am not moving around.
   This caused me major problems when I had outside employment, because I
did not have the freedom to just get up and move around.  I would fall
asleep at my work site.  Also, it is not safe for me to operate a motor
vehicle while using Ropinirole.  It is connected to a near accident,
when I dosed off about 30 minutes after taking it (in the morning and
after a good night sleep).  In another incident, I blanked out in the
early evening about 30 minutes after taking it, causing an accident
(fortunately no one was injured).  I have since voluntarily given up
operating motor vehicles while taking Ropinirole.

Charley
50/PD diagnosed 1993

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