On Sun 25 Jan, JG wrote:
> Dear Listmembers:
>
> What are the symptoms of a Sinemet overdose?  The reason I ask is
> because my husband, Bob, went off of Permax last August and tried to
> titrate up onto Mirapex, this did not help him at all; no sleep, very
> stiff, rls began, very nervous.  (I am now wondering if the Ambien he
> took at bedtime had some type of bad reaction to any agonists he
> tried).  So, next he tried Requip.  Same bad situation.  Tried to go
> back on Mirapex, not good.  Tried to go back onto Permax - this caused a
> terrible reaction within a few minutes of swallowing the med, severe
> persperation (drenched), very weak, very bad)  So, Dr. said to try a
> very, very low dose of permax, but same thing happened.  Finally, a
> couple of weeks ago we discussed with Neuro that NONE of the sleeping
> meds helped him, the only thing that gave him about 1 -2 hours of sleep
> was a 10/100 reg. sinemet and a 25/100 CR, which he would take about
> 4:00 AM.  We decided to put him on Paxil (obviously by this time he was
> EXTREMELY depressed and taking far too much Sinemet)  Bob got himself
> off of all the sleep meds and now we are trying to cut back his daily
> Sinemet intake from about 8 - 10  25/100 CR's per day (only one 10/100
> reg/day).
>
> >From observing him  it appears that if he is on too much Sinemet his
> symptoms are almost the same as if he is on too little Sinemet.  Could
> this be true?  Over these months he stopped taking the Eldepryl too
> thinking this would solve the insomnia.  Since 1/24/98 he is taking:
>     10/100 reg. sinemet
>     25/100 CR                 at 4:00 AM
>
>     25/100 CR, one  at:  8:00 AM, 12:00 PM,  4:00 PM
>
>     Paxil, 10 mg. (dr. wanted to start low) one at 8:00 PM
>
> He does not have much good time.  He is afraid to try the very low dose
> of Permax again (he was on it for 3 years prior to all of this).  Also,
> he had a Pallidotomy on 9/26/97, the results of which seemed great for
> about 3 weeks.
>
> He decided to try the Mirapex last Aug. because his on time was
> dwindling and he thought this new drug may extend it.  The Mirapex and
> Requip only made his life miserable.  The Paxil seems to be helping
> every so slightly, at least he does have an apetite (sometimes), during
> all of this he has lost 30 lbs.
>
> Any advice, thoughts, ideas, or prayers would be so very much
> appreciated.
>
> Love to all of you,
>
> Jackie, CG for Bob, 47 (age) 6yrs (diagnosed)
>
>
Hello Jackie, I think there are some things that you can do which should help
with Bob's problems. I was sorry to see that the Pallidotomy has not been very
effective - Or has it? I wonder if you are taking proper advantage of the
operation: The essence of the Palidotomy operation as far as I understand it is
that it effectively re-locates the upper boundary  which defines the maximum
tolerable dose of Sinemet. Now, your comments about not being sure of what
constitutes an overdose of Sinemet suggest to me that you have got the
improvement; you just haven't cashed it in yet. I regard 800 to 1000 mg per day
of levodopa as a reasonable intake for someone without a Pallidotomy: In Bob's
case the goal posts have been moved to a potentially much higher doseage of
Sinemet.

 I urge you to try and put aside the scare stories about too much Sinemet being
bad for you. Even if your neurologist is of that persuasion, it is not relevant
in Bob's case.
  I suggest that you settle on a dose of Sinemet: The current one which you
describe seems about right, although I could perhaps even out the roller-coaster
ride with a few revisions to the dosages. From that baseline, you can start to
add in whichever dopamine agonist Bob can tolerate, and as time goes by, raise
the agonist dosage to keep up with your body's changing requirments.

I hope this makes some sense to you. if you need more explanation, please let
me know.

Regards,
--
Brian Collins     <[log in to unmask]>
Hello Jackie, I think there are some things that you can do which should help
with Bob's problems. I was sorry to see that the Pallidotomy has not been very
effective - Or has it? I wonder if you are taking proper advantage of the
operation: The essence of the Palidotomy operation as far as I understand it is
that it effectively re-locates the upper boundary  which defines the maximum
tolerable dose of Sinemet. Now, your comments about not being sure of what
constitutes an overdose of Sinemet suggest to me that you have got the
improvement; you just haven't cashed it in yet. I regard 800 to 1000 mg per day
of levodopa as a reasonable intake for someone without a Pallidotomy: In Bob's
case the goal posts have been moved to a potentially much higher doseage of
Sinemet.

 I urge you to try and put aside the scare stories about too much Sinemet being
bad for you. Even if your neurologist is of that persuasion, it is not relevant
in Bob's case.
  I suggest that you settle on a dose of Sinemet: The current one which you
describe seems about right, although I could perhaps even out the roller-coaster
ride with a few revisions to the dosages. From that baseline, you can start to
add in whichever dopamine agonist Bob can tolerate, and as time goes by, raise
the agonist dosage to keep up with your body's changing requirments.

I hope this makes some sense to you. if you need more explanation, please let
me know.

Regards,
--
Brian Collins     <[log in to unmask]>