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Phillip, You don't mention any "helper" drugs in your regimen, and they can help you cut down on your sinemet by making it more efficient. I'd suggest asking your neuro about permax and eldepryl, which seem to be most effective. I'm currently taking pramipexole, a dopamine agonist in the trial phase, which will be marketed soon. Tolcapone is another trial drug that looks very promising and should be on the market in about two years. I'm in the same position you are: life is a choice between starving in order to stay "on," or eating and going "off." My plan is to hang in there as best I can until tolcapone becomes available, then go for a pallidotomy if the medicine isn't enough. Hopefully, the Udall bill will pass and the cure found before then. good luck to you. pine`