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thank you, dr. romero. i was hoping one of the MDs on the list would share their view on this subject. but now that you have -- and got me even less clear on this drug's behavior... :) -- i wonder if you'd be so good and explain the following as well: 1. although selegiline is indeed indicated for extending the duration of levodopa's effect, i was under the impression that nevertheless it has currently been prescribed as a FIRST mode of therapy -- usually in conjunction with dopamine-agonist drugs (such as requip, etc). moreover, it's given BEFORE sinemet is started, the logic being that any postponement of levodopa start -- even if not being a strictly corrective treatment -- is worth the trouble. 2. since selegiline has those amphetamine-like properties, yet the dopamine agonists act more like depressants (by definition, they are re-uptake inhibitors), then isn't mixing these drugs dangerous? wouldn't such practice expose a patient to a reaction not unlike that of serotonin syndrome? 3. re. that "confounding strong placebo effect" -- if memory serves, a recent study showed that when it comes to any dopaminergic neurotrasmitter problems, the placebo effect is stronger, longer and more serious (because of the role dopamine plays in emotions etc...). shouldn't then ALL pd-related studies that are shorter than one year, or those not tracked with long follow-ups, be considered inconclusive? thanks again, ariela ---- Jorge A Romero MD <[log in to unmask]> wrote: Ariela: Beware of drug company promotions and salesmanship. It may still rain on the Rasagiline parade! It is not clear that the so-called "amphetamine like properties" in selegiline are a disadvantage. Indeed, selegiline has antidepressant and "energizing" qualities, probably in part due to those same qualities which the drug company for the other side has focused on. In addition, selegiline has antidepressant qualities (which rasagiline undoubtedly shares) due to its abiity to delay the metabolism of catecholamines, the same reason that it may be useful in Parkinson's Disease, by delaying the metabolism of dopamine - extending the duration of action of a single dose of levodopa to some extent. The problem with selegiline is that it did not meet the expectations of the DATATOP study in delaying the progression of PD. After much hoopla, and enormous profits to Somerset and Sandoz, it fell flat on its face when the longer term follow-up studies became available, showing no delay in progression of PD. Thus, the only remaining use for selegiline was to try to extend the duration of the effect of each dose of levodopa, which was, in fact, the indication for which the FDA approved it in the first place. I am not aware that Rasagiline claims any EXTRA effect from selegiline - and the only selling point to date is this "lack of amphetamine like qualities," which is nothing more than an empty claim to emphasize a difference which is not known to be important. > improvements were greater for rasagiline than for placebo at all > time points and for all doses, but were ***INSIGNIFICANT*** due to a > "confounding strong placebo effect," That means that the study was UNABLE to show that the drug was better than the placebo control. It is interesting that they are claiming that the rasagiline group was better at 18 weeks after washout, althought the difference was not significant. It seems they are positioning themselves to make a claim for delay in the progression of the disease. However, remember that selegiline made that claim on the basis of 6 months' data, and the five year data proved them wrong. It would be like selling you a minivan with three doors instead of four,and claiming that one door less makes it safer, when most manufacturers are promoting the four door models as more convenient. We all want newer and better drugs for PD. Drug companies will do everything they can to sell you their drugs. Buyer beware!!! Jorge Romero, MD __________________________________________________ FREE voicemail, email, and fax...all in one place. Sign Up Now! http://www.onebox.com ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn