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I don't believe there is a 100% correct answer to your question. Dr. Hubert Fernandez just posted this information (March 16 NPF Discussion Corner) in response to a similar question: The general reasoning why most specialist start with dopamine agonists (if they can) instead of sinemet is because there have been several double-blind head-to-head trials comparing sinemet vs. dopamine agonists in early PD. The conclusions are all very similar: 1. Levodopa is more efficiacious than any dopamine agonist 2. Dopamine agonists have more side effects: nausea, sleepiness, hallucinations, and lightheadedness. This is more prominent in the elderly. 3. But the onset of motor fluctuations, particularly dyskinesias was slower or delayed with dopamine agonists. This is more prominent in the young. Therefore, if our patient is older, or suffering from severe disease, we general start with levodopa right away. If our patient is young, or have milder symptoms, we generally start with dopamine agonists or other drugs. (You must register to join the Discussion Corner at NPF. It is the formoer "Ask the Doctor" column) Peggy ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn