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To Joyce T.: I have been on liquid Sinemet since May of 1991. Fortunately I do not have to drink it, instead I pump it directly into the small intestine. The pump runs about 5 seconds out of every 30 seconds and pumps about 1/4 of a cc of liquid Sinemet. I make my liquid Sinemet stronger than regular formulas just due to experience. Along the way I have helped others understand some of the good points and some of the bad points of liquid Sinemet. LESSON 1. UNDERSTANDING DIPHASIC DYSKINESIA: This is a combination of peak dose dyskinesia and end of dose dyskinesia. The peak dose dyskinesia happens when medication reaches its peak. The end of dose dyskinesia is less understood. It seems to happen at depletion of dose. In some patients this dyskinesia is closer to dystonia or a cramping of the muscles in the feet and/or calves. It has been a long time since I have experienced this, so I am going by what I have read. Dystonia is now being associated with OFF time. If dystonia is the end of dose condition, it may actually be that the Sinemet does not last over the current period causing OFF time to exist between pills. This could account for the dystonia. The objectives of liquid Sinemet (LS) is to reduce the peak dose dyskinesia and never experience the end of dose issues. LS has two properties that differ somewhat from regular Sinemet. (1) Since it is already a liquid it gets through the pylorus quickly and is absorbed in the intestine quickly. This means it arrives in the brain quicker and with possibly more intensity than pill therapy. (2) Since it is absorbed quicker, it does not have a long staying power. It is for this reason that a period of 1 hour between doses is the norm rather than the exception. The longest suggested period I have seen used is 90 minutes between doses which is the half-life of levodopa. It should now become apparent that LS with its quick acting but low staying power needs to be taken at relatively frequent intervals. The advantage is that one can titrate the dosage at the mg level very accurately and by taking the LS frequently, a sort of custom control release medication can be simulated. Lesson 2 deals with how to start LS and what dosage to use. I will save that lesson for another day. The reason for waiting is that you are currently taking 10 x 25/100 + 50/200. This is a daily dose of 300/1200. It is thought that the efficiency of levodopa decreases as the carbidopa increases beyond 200 mg daily. One of the members of this group was taking 21 x 25/100 daily. He is now taking 2 x 25/100 and 9 x 10/100 and getting much better results. That is an extreme case, but it points out the problem caused by excess carbidopa. I would suggest you first try reducing the carbidopa intake. This may be by using 2 x 25/100 as the first pills and than using 10/100 for the remaining pills. I suggest you try this for about one week. I would guess your total daily levodopa needs will drop and maybe some of the dystonia/dyskinesia may go away also. That is only a wish, not a fact. I would like to know what happens. So keep us informed. In a few days I will write lesson 2 on how to get started on LS. Than I will write lesson 3 which deals with staying on LS with variations and how one may use LS to help normal pill therapy problems. Regards, Alan PS: I might add that we can expect to see a powder form of carbidopa / levodopa + ascorbic acid (Vitamin C) available on the market soon. It is undergoing patient testing now. I would expect the powder versions to come in 25/100 and 25/250 versions. I understand this is currently available in Europe and has been well accepted.