I've been lurking on this list for the past 6 weeks or so, ever since I
started researching PD on behalf of Bill, my father-in-law. He's an
83-year old MD, diagnosed about a decade ago. But recently, he fell
backwards while walking at home, and hit his head on the hard surface of
the floor. He badly hurt his hip, and thought it may be broken, although
X-rays have been negative. He was hospitalized, and while his hip seemed
to recover somewhat, his PD got a lot worse.

I appreciate this list tremendously. I've learned a lot, and enjoyed
watching the interactions (especially how some folks get all worked up
about personalities, instead of simply reaching for the "delete" key.)

In any case, I printed out many of the postings and brought them to the
hospital, where I read them to Bill. Unfortunately, he still is very
much a product of his scientific training, and tends to discount
anecdotal information, preferring to trust only medical and scientific
journals.

For example, there have been numerous postings about taking Sinemet on
an empty stomach. Bill received his doses just before his  "delicious"
hospital dinner was served. I checked the PDR (Physician's Desk
Reference) and found no reference to *when* the med should be taken,
although it cautioned that in some cases, high protein meals could
interfere with the drug. I searched MedLine, and found only one study
(from the Academic Hospital, Leiden, The Netherlands, September 1993)
relating to Sinemet CR (Bill takes the standard variety, not CR version)
which stated:

[I've included the entire abstract at the end of this message--
formatting may be messy.]

<quote> If the patient on levodopa is in a clinically satisfactory
condition, then non-fasted condition could be preferred because of the
smooth plasma level profile demonstrated. However, if the initial
levodopa concentrations are not in the critical range to be effective
for the patient, the advice should be to take the drug in a fasted
condition. <endquote>

So now what? Does anyone on this list have anything more recent? I think
it's obviously very important to time the meals so the drugs can work at
their most effective rate, but I'd like to have more authenticated,
non-anecdotal information.

Thanks for everything so far, and the future.
--Bob

Title
     The influence of a standard meal on Sinemet CR absorption in
patients with Parkinson's disease.
Author
     Roos RA; Tijssen MA; van der Velde EA; Breimer DD
Address
     Department of Neurology, Academic Hospital, Leiden, The
Netherlands.
Source
     Clin Neurol Neurosurg, 1993 Sep, 95:3, 215-9
Abstract
     We studied the influence of dietary protein intake on the plasma
level profile of levodopa, carbidopa, and 3-O-methyldopa and clinical
efficacy in 12 patients with idiopathic Parkinson's disease after intake
of one levodopa-carbidopa 200/50 controlled release tablet (Sinemet CR;
LC-CR). The tablet was given 1 h before the protein rich meal on one day
(fasted) and together with the meal on an other day (non-fasted). Higher
levodopa and carbidopa concentrations were reached when the LC-CR was
taken 1 h before the meal, but the plasma level profile for levodopa was
flatter in the non-fasted state. The area under the curve for levodopa
was slightly higher in the fasted condition. For the clinical variables
walking and tapping slightly better clinical results (P = 0.08) were
found in the fasted condition with the higher levodopa levels. If the
patient on levodopa is in a clinically satisfactory condition, then
non-fasted condition could be preferred because of the smooth plasma
level profile demonstrated. However, if the initial levodopa
concentrations are not in the critical range to be effective for the
patient, the advice should be to take the drug in a fasted condition.
Language of Publication
     LA=ENG
Unique Identifier
     94062234
###