Brian Collins wrote:
>
> This is a subject which irritates me from time to time, because to me
> it indicates a lack of understanding on the part of some doctors of
> what they are doing:
>
> The most important drug which we take is undoubtedly levodopa: All the
> others are really accessories to the levodopa, so it merits a
> treatment om its own.
>
> Sinemet and Madopar come packaged in tablets or capsules, in units of
> 50, 100, and 250 mg (or 100 and 200mg Controlled release).
>
> Unfortunately, people do not come conveniently calibrated in similar
> values. Everyone happily acknowleges that PWPs are all different, and
> this certainly applies to the amount of levodopa required, so why do
> so many doctors insist on using 'one tablet here, one there, and if
> that doesn't work try doubling the dose.' The reason why they get away
> with it is that in the earlier stages of the disease the remaining
> dopamine-producing cells compensate for any over or underdose, but
> when you get to the sharp end, when there are effectively no remaining
> dopamine-producing cells left, the match must be exact. I have found,
> for example that my requirement is for 37 mg per hour, and the range
> that I can accept is no more than plus or minus 1/4 of a madopar
> dispersible (or +/- 12 mg). I achieve this by taking 1 and  1/2
> Madopar dispersibles every two hours. (This is because a madopar lasts
> for 2 hours.)
>
> It may sound too much trouble, but this philosophy has kept me going
> through 18 years of levodopa, (and I haven't finished yet.)
>
> The plain fact is that no-one is going to go to such trouble on your
> account. Everyone is different, and it is up to each of us who wants
> to extract the best from the drugs, to undertake a modest amount of
> experimentation (If you are lucky, you may find a doctor who is
> prepared to help)
>
> I know that many people prefer to leave it all to their doctor or
> specialist, but I have doubts whether anyone who is not directly
> experiencing the effects can define requirements such as these. Does
> anyone else work to close tolerances like this?
>
> Regards,
> --
> Brian Collins  <[log in to unmask]>