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On Mon 21 Oct, Susanna Bicknell wrote: > Hello, > We think that his Parkinson is very progressive. His medication is: > > Madopar HBS 125 mg, six a day > Madopar COMB 100/25 mg, six a day > Permax 0,25 mg, 12 a day > > > I know that every person having Parkinson's is different, but could > anybody give me an idea, if the amount of medication is high, and if > you think that the way I described my fathers Parkinson's is > progressive? > > Greetings and thanks for any help. > > Susanna Bicknell ( [log in to unmask] ) Nijmegen, the Netherlands > > Hello Susanna, I can understand your worry over your father's problems, and your description of his condition does contain a lot of text-book Parkinson's symptoms. The most reliable indicator (and that is not guaranteed) , is whether he responds positively to levodopa. I get the impression from what you say, that although it takes a lot of levodopa to do it, he does respond. Don't worry too much about the quantity; a friend of mine takes 3000 mg per day. The outstanding factor which does strike me is that he is taking on a lot of Benserazide. You may not have seen the recent discussion on Carbidopa, which is the other chemical mixed with Levadopa in Sinemet tablets, but the facts are ,in summary: 1. The Carbidopa is required to protect the levodopa from attack on its journey from the stomach to the brain. 2. 70 to 100 mg per day is adequate for this job - more than this, and the excess Carbidopa interferes with the normal functions of the body, and may be contributing to the evening symptoms which you describe. Now Madopar contains the chemical Benserazide, which does the same job as Carbidopa, and I see no reason why an excess should not produce the same adverse effects. I am not sure what drugs are available to you in the Netherlands, but I would expect that you have access to Sinemet tablets. The point of that is that Sinemet make a tablet with only a 10/100 ratio of Carbidopa/ Levodopa. I do not recognise the HBS and COMB designations, but I assume that one type is the normal tablet, and the other is the Controlled Release type. Sinemet only do the controlled release type in the 50:200 ratio, so you do not want that although the controlled release characteristic is very useful. I am suggesting that you try an experiment ( With your doctor's approval of course) where for a few days you use only the Sinemet 10/100 tablets, just taking as many tablets as required to match the current levadopa intake. I suggest that the best regime may be to take 1.5 tablets every 2 hours. You may find that too much, in which case, keep the 2 hour interval, and reduce the size of the dose. Assuming that this means 12 tablets per day, you will go from 300 mg/day down to 120mg/day. Well worth a try. Another contributor to the 7:30pm problem may be food-related. Assuming that you have your main meal in the evening, almost all PD sufferers find that the food (Protein) upsets the action of the tablets. You can try taking even more tablets just before eating, but in the end, you have to expect to have trouble with food. ( I've tried giving up food, and I can confirm that there is no future in it !!) I hope that has given you something to think about, and wish you the best of luck. Regards, Brian Collins. -- Brian Collins <[log in to unmask]