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On Wed 12 Feb, Debbie White wrote: > I'm new at this. My mother was diagnosed with PD last week, and I've > already received so many helpful replies to my inquiries. Thank you. I > still have more question and I have an idea I'd like to pose. > > First, the question. My mother was given 25/100 Sinemet 3x/day and has > taken it for about 5 days now. She sees slight improvement in her balance > and slight increase in use of her hand. Is this enough to expect? Does the > dosage depend solely on how the patient feels the PD is being managed at > that dose? If she can get by with things the way they are, should she > postpone taking a higher dose? Or is it best to feel as good as you can, > even if that means increasing the dose? Hello Debbie, As your mother is newly-diagnosed, I am sure that a dosage level of Sinemet can be found which will virtually restore normal functioning, for a few years at least. ( I should perhaps hedge a little to ask a) Your mother's age, and b) now that you know she has PD, is there evidence which with hind-sight you can say was probably Parkinson's ?) Assuming that she is a genuine new sufferer, I want to make you aware of the situation regarding Sinemet, and my suggestions on how to make the best use of the drug. Sinemet, and the other levodopa-based drugs, are unique in that they replace the very chemical which by its loss triggers the well-defined PD symptoms, and the only real problem is in getting it to the brain in the required quantities and at the right time to make up for the brains impaired flow. However in the early stages it is extremely easy to put together an effective dose, because the brain can step in and effectively 'trim off ' any excess that you may take in tablet form. It is here that two philosophies emerge: quite a lot of neurologists give new patients BIG doses ( like 200/50 Sinemet ) because they know that it will enable the patient to function well for up to 6 hours per tablet. I can so far find no hard evidence to prove that any harm is being done by this practice, but I am not comfortable with it. The alternative approach is to administer the Sinemet in smaller doses, but more frequently. So it is the big blockbuster single dose versus the 'little but often ' approach. Even though the inconvenience of regular tablet-taking can be a real drag, I think that you are maximising your mother's long term prospects by taking the little-but-often approach. In fact, your doctor seems to be on the same trail as I am, prescribing 3 times 100/25, but I think he has not gone far enough. The aim of the game is to find the Minimum effective dosage., and I would propose the following: 1/ Take the present Sinemet tablets, break them in half, and take them at evenly-spaced intervels through the day - say half a tablet every 3 hours. 2/ This will probably produce no significant change compared to your present set-up, but it provides a better starting -place. 3/ If the result is still unsatisfactory, start to shorten the interval between each half tablet, down to a minimum of 2 hours between tabs. 4/ If still not enough, keep to the 2 hour interval, and start raising the size of each dose. Each of us has a different type of requirement, but you may like to know that I have been following this sort of system for quite a long time. ( I have been taking Sinemet and its cousin Madopar for 17 years, and my present rate of consumption is 75 mg of levodopa every 2 hours ( That would be 3/4 of a Sinemet 100/25) Well, there you are: That is my idea of the safest way to achieve the best result from your tablets. If you decide to try it, please let me know how you get on. Regards, -- Brian Collins <[log in to unmask]>