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Thank you, Dr Romero, for explaining Lisa's situation for benefit of all of us. You have addressed all issues in detail to many people on various questions with regard to PD. I do not expect that all doctors will agree 100% among themselves. Sometimes we want doctors to agree to what we think is right. We keep on changing doctors for better or worse. I almost wish that at one point we can try Mirapex as oppose to Permax, but than we would not be able to drive in Canada.(Actually we have no complaint about Permax). Is it possible though that one's body gets used to certain drug, say Permax, that the drug does not work at some point of time and the doctor may switch to another drug (Mirapex or other)? Emily for Julian ----- Original Message ----- From: "Jorge Romero MD" <[log in to unmask]> To: <[log in to unmask]> Sent: Monday, April 08, 2002 3:08 AM Subject: Re: HELP > Lisa: > > The symptoms you describe would suggest that the dosage of Mirapex may be > relatively low to meet your needs. Abrupt changes from one agonist to > another can be made if the doses are close to equivalent, otherwise, > tapering the old and ramping up the new are necessary. Bob's statements > about changing more than one thing at the time are also true. > > During transitions, it is not rare for people to feel temporarily worse, as > the dosage of the new medication is adjusted to optimal level by your > neurologist. > > A rough way of calculating equivalent doses for the agonists (pergolide and > Mirapex) is to think of the "target" or "common," or "usual" daily > maintenance doses: for pergolide, it is 3 mg daily (1 mg three times > daily), while for pramipexole it is also happens to be 3 mg daily (1 mg > three times daily). [NOTE: many people are maintained at different doses - > these are just guidelines for this calculation.] > > Generally speaking, an abrupt switch from pergolide to pramipexole is > easiest for the PWP if the switch is at close to the same or equivalent > dosage. In your case, pergolide 0.25 mg five times daily (equals 1.25 mg > per day) could switch over to pramipexole 1.25 mg per day. Your switch was > to pramipexole 0.375 mg daily (0.125 mg three times daily), is the rough > equivalent of a 70% reduction in dose. That is why you may be feeling a > loss of effect. Your neurologist may have done this on purpose - I have no > way of knowing, since you do not indicate why the switch was made, and I > cannot second guess his clinical judgment since he has seen you and I > haven't. > > This may all be temporary, while your neurologist finds the best dose of the > Mirapex for you. That may be why you are not feeling well - either you > don't have enough dopamine agonist, or you are feeling the relative > withdrawal. > > As a fall-back position, if your symptoms are so intolerable that you cannot > wait for your neurologist to be available on the island, you can always > resume your old treatment, and discuss additional changes with your > neurologist. Ultimately, he might instruct you to increase the dose of > Mirapex, but you should do that only with his/her supervision. > > > Jorge Romero, MD > > > > > > ----- Original Message ----- > From: "Bob Martone" <[log in to unmask]> > To: <[log in to unmask]> > Sent: Sunday, April 07, 2002 9:35 PM > Subject: Re: HELP > > > > Lisa, > > > > I have been helping my wife Nancy for years with all of her > > meds. An abrupt change of agonists > > didn't seem to create major problems. The abrupt withdrawal > > of amantadine almost always caused > > her symptoms to worsen. If you can, restore the amantadine > > to your pre mirapex level and see if that doesn't improve > > things dramatically. Its really not a good idea to change > > more than one med at a time anyway because it is very > > difficult to determine which one is causing the problem. Be > > sure to let your doctor know exactly what > > you are doing, before you do it, if possible. > > > > Bob Martone > > [log in to unmask] > > http://www.samlink.com/~bmartone > > > > -----Original Message----- > > From: Parkinson's Information Exchange Network > > [mailto:[log in to unmask]]On Behalf Of > > Lisa Crumrine > > Sent: Saturday, April 06, 2002 10:23 AM > > To: [log in to unmask] > > Subject: Fw: HELP > > > > > > ----- Original Message ----- > > From: Lisa Crumrine > > To: Parkinson's Information Exchange Network > > Sent: Saturday, April 06, 2002 12:09 PM > > Subject: HELP > > > > > > I have abruptly changed meds, per my new neuro from > > .25 permax 5 x day to .125 mirapex 3 x day > > removed amantadine 4 x day and continued on sinemet > > 25/100 5 x day > > > > feeling semi ok at the moment but having a real > > hard time mostly. shaking /tremors and having a > > hard time moving my body at all, very stiff! > > any suggestions? new neuro is unreachable (it's > > saturday) and I dont really have anyone else to > > call, I am on an island in the Caribbean (VERY > > SMALL ISLAND) and don't have any one else to call or ask. > > > > Lisa in St John > > > > ---------------------------------------------------------------------- > To sign-off Parkinsn send a message to: mailto:[log in to unmask] > In the body of the message put: signoff parkinsn ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn