thank you so much for your advice, you answered my question, primarily that
both permax and mirapex are agonists, but I wasn't sure of the comparative
strenghts of the two drugs, and that going off permax completely while not
replacing equal doses of the mirapex.  It only makes sense that I would have
difficulty.

As always ,I try to inject humor and optimism into my life.  Last night  I
heard a silly but appropriate line by homer Simpson " Cold Turkey, it's not
as delicious as it sounds"

I have increased the mirapex .125 and so far today have taken 1 sinemet
25/100 and 3 mirapex , as well as an eldepryl,  any thoughts on stopping the
amantadine? I am not sure what effect that is having...

thank you so much for your aid
Lisa
----- Original Message -----
From: "Jorge Romero MD" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, April 08, 2002 4:08 AM
Subject: Re: HELP


> Lisa:
>
> The symptoms you describe would suggest that the dosage of Mirapex may be
> relatively low to meet your needs.  Abrupt changes from one agonist to
> another can be made if the doses are close to equivalent, otherwise,
> tapering the old and ramping up the new are necessary.  Bob's statements
> about changing more than one thing at the time are also true.
>
> During transitions, it is not rare for people to feel temporarily worse,
as
> the dosage of the new medication is adjusted to optimal level by your
> neurologist.
>
> A rough way of calculating equivalent doses for the agonists (pergolide
and
> Mirapex) is to think of the "target" or "common," or "usual" daily
> maintenance doses:  for pergolide, it is 3 mg daily (1 mg three times
> daily), while for pramipexole it is also happens to be 3 mg daily (1 mg
> three times daily). [NOTE: many people are maintained at different doses -
> these are just guidelines for this calculation.]
>
> Generally speaking, an abrupt switch from pergolide to pramipexole is
> easiest for the PWP if the switch is at close to the same or equivalent
> dosage.  In your case, pergolide 0.25 mg five times daily (equals 1.25 mg
> per day) could switch over to pramipexole 1.25 mg per day.  Your switch
was
> to pramipexole 0.375 mg daily (0.125 mg three times daily), is the rough
> equivalent of a 70% reduction in dose.  That is why you may be feeling a
> loss of effect.  Your neurologist may have done this on purpose - I have
no
> way of knowing, since you do not indicate why the switch was made, and I
> cannot second guess his clinical judgment since he has seen you and I
> haven't.
>
> This may all be temporary, while your neurologist finds the best dose of
the
> Mirapex for you.  That may be why you are not feeling well - either you
> don't have enough dopamine agonist, or you are feeling the relative
> withdrawal.
>
> As a fall-back position, if your symptoms are so intolerable that you
cannot
> wait for your neurologist to be available on the island, you can always
> resume your old treatment, and discuss additional changes with your
> neurologist.  Ultimately, he might instruct you to increase the dose of
> Mirapex, but you should do that only with his/her supervision.
>
>
> Jorge Romero, MD
>
>
>
>
>
> ----- Original Message -----
> From: "Bob Martone" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Sunday, April 07, 2002 9:35 PM
> Subject: Re: HELP
>
>
> > Lisa,
> >
> > I have been helping my wife Nancy for years with all of her
> > meds. An abrupt change of agonists
> > didn't seem to create major problems. The abrupt withdrawal
> > of amantadine almost always caused
> > her symptoms to worsen. If you can, restore the amantadine
> > to your pre mirapex level and see if that doesn't improve
> > things dramatically. Its really not a good idea to change
> > more than one med at a time anyway because it is very
> >  difficult to determine which one is causing the problem. Be
> > sure to let your doctor know exactly what
> > you are doing, before you do it, if possible.
> >
> > Bob Martone
> > [log in to unmask]
> > http://www.samlink.com/~bmartone
> >
> > -----Original Message-----
> > From: Parkinson's Information Exchange Network
> > [mailto:[log in to unmask]]On Behalf Of
> > Lisa Crumrine
> > Sent: Saturday, April 06, 2002 10:23 AM
> > To: [log in to unmask]
> > Subject: Fw: HELP
> >
> >
> > ----- Original Message -----
> > From: Lisa Crumrine
> > To: Parkinson's Information Exchange Network
> > Sent: Saturday, April 06, 2002 12:09 PM
> > Subject: HELP
> >
> >
> > I have abruptly changed meds, per my new neuro from
> > .25 permax 5 x day to .125 mirapex 3 x day
> > removed amantadine 4 x day and continued on sinemet
> > 25/100 5 x day
> >
> > feeling semi ok at the moment but having a real
> > hard time mostly.  shaking /tremors and having a
> > hard time moving my body at all, very stiff!
> > any suggestions?  new neuro is unreachable (it's
> > saturday) and I dont really have anyone else to
> > call, I am on an island in the Caribbean (VERY
> > SMALL ISLAND) and don't have any one else to call or ask.
> >
> > Lisa in St John
> >
>
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