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Will A. Kuipers (Dallas, Texas)(75 /dx '91)<[log in to unmask]> wrote: <<<I have often wondered about this. There does not seem to be a constancy in the way doctors prescribe PD medicines. Each seems to be doing his own thing. When I was diagnosed 5 years ago I was put on 2 Eldepryl 5 mg. daily (in the morning and at noon) and 2 Sinemet CR (50-200) also daily (in the morning and in the evening). Why he started me off on CR I don't know. Other patients get other meds and dosages, I found. Are we the private research projects of our doctors? Anyway, maybe because of the CR I never experienced "on" or "off" conditions. Everything is the same throughout the day. As a matter of fact I am at my best in the early morning. This is probably an envious situation when compared with others with severe ups and downs, but it makes me sometimes wonder why I take these meds. The only thing I remember from the first year, that was an improvement, was a reduction of stiffness in the neck and back, which made driving a car easier. (Nowadays getting in and out of a car is more of a problem due to arthritis of the knees ). I have no problems walking, but my voice is affected. I wonder if there are more people with no clear on or off symptoms, either due to the meds or due to the fact that maybe their PD has not progressed very far. One way to find out is to temporarily quit taking the meds, but my dr. has cautioned against this. This may have been discussed in this list before. I joined only recently.>>> I wonder why there is inconsistent prescribing, also. The two Eldepryl was fairly much standard five years ago. The current status is mixed because the data is not clear-cut regarding this drug. With regard to initial prescribing, the Sinemet CR smaller pill 25/100 should be prescribed - or, the 50/200 taken as halves. The CR delivers to the bloodstream for a longer duration than standard Sinemet or generic. It also does not provide the "spike" soon after ingestion - which is an overload beyond what is needed. However, the regular medication decays in bloodstream concentration more rapidly which obviates the advantage of having to take CR drug less often. However, the cost difference for convenience is considerable. Also, the duration of sufficient levodopa in the blood is not near 12 hours. The taking of Eldepryl (which stays in the blood for much longer) in the morning only has been my choice - I did take one at noon also for a year or so. The taking of the second CR in the evening does not seem logical. It is probable that early in the disease progression, there is greater "storage" capability of the still-functioning neurons in the substantia nigra. But, it is probable that taking the second pill at 2 PM would provide levodopa until perhaps 7 PM. Unless one wishes to be better after supper than in the afternoon, it is better not to be most active when retiring for the night. In summary, my (documented in my homepage - "click here" sub-page) opinion is that you would be better medicated if you took the two 50/200 CR tablets as four halves at four hour intervals. This would keep nearly constant level of levodopa in your blood from 7 AM until about 16 hours later, 11 PM, if you consume the first half at about 6 AM. I would welcome more blood plasma levodopa data and pharmacokinetics information. The effects of food intake on the absorption also needs data gathering. Reporting and use of what is known more widely would help. Hope this helps, Will. Early on (12 years ago), I too was given too much at the start - and on a poor schedule: three pills taken just before breakfast, lunch, and dinner. The taking with meals reduced the amount absorbed, but the med was gone before the next did anything. If I had taken six halves of those 25/100 regular Sinemet tablets, I would have been better medicated instead of being given larger doses but staying with three per day. I got up to three 25/250 pills rather quickly - probably before 5 years postdiagnosis in 1984. I now take 3 generic 25/250 pills as 6 halves, 1 eldepryl in morning, and 6 halves of 0.25 mg. Permax with the 6 halves of carbi/levodopa and a 7th half just before retiring. ron 1936, dz PD 1984 Ridgecrest, California Ronald F. Vetter <[log in to unmask]> http://www.ridgecrest.ca.us/~rfvetter/rcpdsg.html/ (Parkinson group) http://www.ridgecrest.ca.us/~rfvetter/