In message <[log in to unmask]> Parkinson's Disease - Information
Exchange Network writes:
> For Peter Flintermann:
>
> You ask the question about meals and liquid sinemet.  This is a problem for
> most people using LS.  The reason for the problem is the general short
> staying power of LS.  For most  people the use of LS is at most at hourly
> intervals.  Squeezing in a meal and allowing for the stomach to empty in this
> time frame is almost impossible.  It is known that the pylorus, which
> controls the emptying of the stomach, will open some 30 to 90 minutes after a
> meal.  That wide a margin is unacceptable for those on LS.
>
> The other problem is the possibility of bread and other food stuff might
> absorb the LS and move it through the digestive track without releasing it.
>  I feel this is what happens to me.  It may not be bread, but food in general
> somehow absorbing the LS or at least diluting it in such a way as to render
> the medication useless.
>
> Now LS can be taken at close as maybe 5 minutes before a meal.  It mush be
> taken on an empty stomach.  The LS will get through the pylorus and into the
> intestine where it will be properly absorbed.  This, however, is not the main
> issue.  The problem comes with the after meal dose.  This would be given on a
> full stomach and maybe just lost.
>
> This is what I do.  I learned this from a friend at a support meeting.  What
> was suggested was to add 1/2 of a 10/100 regular with the first food of lunch
> and a full 10/100 regular with the first food in the evening.  These pills
> should be chewed or crushed to speed the benefit.  Now I do not do this every
> day.  I only do this when (a) the meal  is high in protein and/or (b) it is
> important that I not have a down time after the meal.  Some times I will over
> medicate, sometimes under medicate but most of the time I will be on through
> the meal and the following 3 or 4 hours after the meal.  I must add two
> things (a) I continue to take normal medications through this time and (b) I
> am currently taking about 800 mg of levodopa daily.  People taking
> substantially less should adjust these kicker-patch meds downward.
>
> Finally, you mentioned the unmentionable in relation to liquid sinemet:
> Sinemet CR.  In my world of a narrow therapeutic region, the use of Sinemet
> CR is toxic to my system, my life and my well being.  I wish they had never
> manufactured it. The use of CR is assured of producing one of three
> conditions: 1-under medication, 2-therapeutic region, 3-over medication.  Now
> comes the killer -- it can keep one in one of these states for 2 - 4 hours.
>  That is where, for me, it damages my neurons.  My therapeutic window is very
> narrow.  The probability of (2) happening is almost 0.  That almost assures
> me 1 or 3 -- neither of which I will tolerate.  The result is if I think I am
> under mediated, I will sip LS and when it does hit me, I will be in gut
> wrenching dyskinesia.  I find Sinemet CR to be highly  toxic to my system.
>  The thought of mixing Liquid Sinemet and Sinemet CR brings pain to my
> system.  Now someone out there will say they are very successful doing just
> this.  I will almost bet they are always under medicated or their therapeutic
> window is wide and the use of LS is unwarranted.  I want you to know I am
> very shy when I talk about this, much like a mother seeing her young child
> playing with matches in a dynamite shed.
>
> Enough said on that.
>
>
> Regards,
> Alan Bonander
> Age 55, Diag 11 yrs, liquid meds, pallidotomy
> [log in to unmask]
> San Francisco area (San Ramon, CA)
For Alan Bonander
I was interested in your comment about SinemetCR. My wife's experience was
exactly the same. Regards - Bob Howard ([log in to unmask])