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"Jorge A Romero, MD" wrote: > > To Charles Murray and Benjamin Winter: > To the statement that "Research suggested starting with Sinemet was unwise > if an > agonist would work," I would only comment that > it is important to ask what kind of research. > If you are talking about MARKET research, then it is certainly unwise to > start with levodopa if you own stock in any one of the companies that make > the agonists. > Remember that the data used to promote the agonists is being pitted against > 30 years of good experience with levodopa. There is not a single drug used > to treat Parkinson's that has the safety and efficacy record that levodopa > has when used correctly. > Jorge Romero, MD Added comment in agreement with Jorge: I don't have time to look them all up, but I've seen a number of trial reports about starting PD treatment with an agonist to avoid levodopa (Sinemet). It seems that while the agonist may cause less dyskinesia at first, after a few years when levodopa becomes needed because the disease has progressed to where the agonist no longer suffices, the dyskinesia is no worse than if levodopa had been used from the start. Meanwhile the patient has been denied the vastly superior control of other motor symptoms provided by levodopa- based therapy. Many neuros try to dodge the question by prescribing a bit of levodopa-type medication and an agonist together, possibly on some theory that the reduction of levodopa will be beneficial, but I don't believe it. Cheers, Joe -- J. R. Bruman (818) 789-3694 3527 Cody Road Sherman Oaks, CA 91403-5013