I've been lurking on this list for the past 6 weeks or so, ever since I started researching PD on behalf of Bill, my father-in-law. He's an 83-year old MD, diagnosed about a decade ago. But recently, he fell backwards while walking at home, and hit his head on the hard surface of the floor. He badly hurt his hip, and thought it may be broken, although X-rays have been negative. He was hospitalized, and while his hip seemed to recover somewhat, his PD got a lot worse. I appreciate this list tremendously. I've learned a lot, and enjoyed watching the interactions (especially how some folks get all worked up about personalities, instead of simply reaching for the "delete" key.) In any case, I printed out many of the postings and brought them to the hospital, where I read them to Bill. Unfortunately, he still is very much a product of his scientific training, and tends to discount anecdotal information, preferring to trust only medical and scientific journals. For example, there have been numerous postings about taking Sinemet on an empty stomach. Bill received his doses just before his "delicious" hospital dinner was served. I checked the PDR (Physician's Desk Reference) and found no reference to *when* the med should be taken, although it cautioned that in some cases, high protein meals could interfere with the drug. I searched MedLine, and found only one study (from the Academic Hospital, Leiden, The Netherlands, September 1993) relating to Sinemet CR (Bill takes the standard variety, not CR version) which stated: [I've included the entire abstract at the end of this message-- formatting may be messy.] <quote> If the patient on levodopa is in a clinically satisfactory condition, then non-fasted condition could be preferred because of the smooth plasma level profile demonstrated. However, if the initial levodopa concentrations are not in the critical range to be effective for the patient, the advice should be to take the drug in a fasted condition. <endquote> So now what? Does anyone on this list have anything more recent? I think it's obviously very important to time the meals so the drugs can work at their most effective rate, but I'd like to have more authenticated, non-anecdotal information. Thanks for everything so far, and the future. --Bob Title The influence of a standard meal on Sinemet CR absorption in patients with Parkinson's disease. Author Roos RA; Tijssen MA; van der Velde EA; Breimer DD Address Department of Neurology, Academic Hospital, Leiden, The Netherlands. Source Clin Neurol Neurosurg, 1993 Sep, 95:3, 215-9 Abstract We studied the influence of dietary protein intake on the plasma level profile of levodopa, carbidopa, and 3-O-methyldopa and clinical efficacy in 12 patients with idiopathic Parkinson's disease after intake of one levodopa-carbidopa 200/50 controlled release tablet (Sinemet CR; LC-CR). The tablet was given 1 h before the protein rich meal on one day (fasted) and together with the meal on an other day (non-fasted). Higher levodopa and carbidopa concentrations were reached when the LC-CR was taken 1 h before the meal, but the plasma level profile for levodopa was flatter in the non-fasted state. The area under the curve for levodopa was slightly higher in the fasted condition. For the clinical variables walking and tapping slightly better clinical results (P = 0.08) were found in the fasted condition with the higher levodopa levels. If the patient on levodopa is in a clinically satisfactory condition, then non-fasted condition could be preferred because of the smooth plasma level profile demonstrated. However, if the initial levodopa concentrations are not in the critical range to be effective for the patient, the advice should be to take the drug in a fasted condition. Language of Publication LA=ENG Unique Identifier 94062234 ###