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I am not sure where the perception that Permax has more side effects than Requip or Mirapex comes from. To my knowledge there are no head to head studies. Permax is older, but just as safe and effective as Requip and Mirapex. They all have side effects. They all have subtle differences particularly in terms of individual tolerances. Thus, if you do not tolerate one of these drugs, it is always worth trying one or both of the other two. In my practice I use all three of them successfully. Jorge Romero ----- Original Message ----- From: "Brian Collins" <[log in to unmask]> To: <[log in to unmask]> Sent: Wednesday, February 09, 2000 7:12 PM Subject: Re: Mirapex, Requip, Comtran Advice neded -Reply > Hello Bob, I missed your initial mail, but Stephan's thorough reply prompted > a few thoughts which I pass on to you: > I have used Permax for 6 yrs and am currently on 6 mg perday. I have had > no side effects at all, I think it is because instead of stuffing a max dose > into me from the start. I started with half a gramme, and only added more as > I needed to. This works out at 1mg per year - I claim the world's longest > 'titration' procedure. - But it seems to work. > > On Wed 09 Feb, Stephan Schwartz wrote: > > >// Since an agonist is always recommended, you may want to try Permax > > a strong, > > steady agonist -with side effects- but it works at most receptors. > > > > > Brian: > I do believe that I remember the first time that someone started the story > about CR tablets not delivering the full dose, due to the longer time spent > in the small intestine. It sounds sensible, but all I can say is that when > I wrote my analysis program and tested all the available tablets, I found > that whatever the nominal effectiveness was (that gets built-in with all the > other losses), the CR delivery was at the same level as the other Sinemet > tablets. (I suspect that it depends very much on how much Carbidopa is > present; Testing one CR in isolation may well show a loss, but testing > as I did as part of a daily dose, the losses are reduced. > > Stephan > > As for your Sinemet dosage, it appears you are under-medicated.Sinemet CR > >only delivers 75% of the levodopa into the blood stream. You could easily > >increase to 4x day. > > Brian > On the question of adding another CR to your diet - be careful- If you > over-do the dose, and find yourself with two CRs stacked one on top of > the other, it can be very unsettling (to say the least) and being CR, > the effect takes hours to go away. > Actually, the number of tablets that you take is out of your hands. It > is a product of your digestive, system etc, which define how long your > particular tablets last in the brain. The most efficient way to arrange > tablet dosages is to take the next tablet so that as the previous tablet > fades away, the new one comes into effect. With Sinemet CR that means you > take the next dose while still feeling good from the last one, but it > works!! The objective is to maintain as constant a flow of levodopa into > the brain as possible - that way, the few remaining cells that we have > are relatively unstressed, and let's hope last longer. > > Stephan > > I just started the Comtan three weeks ago and I am working my way up to 4-per day > > . Generally, no side effects, but not much in the way of symptom relief. I do genera > > lly feel better, though. > > Good luck. > > Stephan 55/9 > > > > >>> Bob Chapman <[log in to unmask]> 02/09/00 01:01pm >>> > > I need some advice from anyone who may have had similar experience with > > the following: > > I was taking Mirapex (1.5 mg per day) titrated from .375 mg per day over > > 8-9 months. I developed swollen ankles and "sleep attacks" the next 2-3 > > months. I tried relafin for swollen ankle, didn't work. Dr. then put > > ankle in a cast for a month, that didn't work either. I read on the list > > where some were having similar problems be cause of Mirapex. I stopped > > Mirapex (slowly) and swollen ankles and sleep attacks were gone, 4-5 > > months ago. Neuro thinks I am now under medicated because of increased > > tremors, slower gait, minor balance problems and increased drooling. He > > says I have two options, add requip to meds or add straight Sinemet and > > increase Sinemet CR ( I now take 21/2 tabs per day, 50/200 Sinemet CR) > > That's my only sinemet med > > I am afraid Requip will have the same side effect of swollen ankles and > > "Sleep Attacks" as Mirapex did. > > What would you do? > > Bob Chapman 66/60/55 > > > > > > -- > Brian Collins <[log in to unmask]> (59/39/34) >