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>This is why I favor early treatment with levodopa: 1) easier titration 2) >longer stability 3) longer monotherapy (which, by the way, reduces the >cost!!!!) > >Eventually, most patients will be on two drugs, one of which will be >levodopa. Why not use levodopa first if it provides easier and quicker >titration, longer period of clinical stability, simpler monotherapy, and >lower cost? Hard to beat!!! > >Jorge A Romero, MD in regard to cost, the use of CR medication is not efficient and does have relatively highly variable spikes in blood concentration data in the case of Sinemet. (I have found no data for the other versions of CR.) The cost is higher - especially during the monopoly period. also, too many are started on too high a dose: 50/200 carbidopa/levodopa; when half a 25/100 is more than most patients need. What is your opinion regarding the effect of overdosing (because the sales representatives of the drug companies are recommending the 50/200)? my belief is that peripheral nervous system and the enteric nervous system disruption by the overdosing is likely to be harmful; though this be only in the aspect of stomach discomfort during high spikes or addiction worsening - especially when some consume 2 at a time of the 50/200CR. -- Ron Vetter 1936, '84 PD dz mailto:[log in to unmask] http://www.ridgecrest.ca.us/~rfvetter