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On Thu 29 May, Lynne Motley wrote: > The idea of crushing the tablet reminds me of something I read this week > in an earlier APDA newsletter (Spring 1996). There's a column by Enrico > Fazzini, D.O., Ph.D (Asst Prof. Neurology, NY Univ.) that includes brief > answers to readers questions. One reader says, in part, that it takes up > to an hour for his Sinemet CR dose to start working. Fazzini replies for > this specific PWP that, in part, perhaps taking a regular 25/100 Sinemet > (not CR) simultaneously with the Sinemet CR would help. He always advises > discussing everything with one's neurologist and he advises the > neurologist be a PD specialist, not a general neuro. > > Has anyone's neurologist advised taking a regular Sinemet simultaneously > with the Sinemet CR as a sort of boost until the Sinemet CR kicks in? > > Lynne CG for Virginia 78/8 > > Hello Lynne, I have encountered quite a lot of people who follow the technique of using a 'booster' dose of about 100 mg of levodopa to get the morning started more smartly - it is often referred to as 'kick-starting the system. I want to warn you of a danger inherent in the process, and I would advise anyone using the technique to think carefully about the following notes. These notes are based on my own observations, using my analysis program, but I have analysed a few other people; enough to know that my experience is not so different to other PWPs, BUT ONLY those who are well down the road with PD. People with less than 7 or 8 years of PD are unlikely to have experienced these particular phenomena. 1. The analysis shows that my particular requirement for levodopa is 37 mg per hour, on top of my current dosage of 2.5 mg Permax per day. Below 30 mg per hour I am switched off, and above 45 mg per hour I suffer dyskinesias. ly complicating factor is the effect of meals, which most PWPs are aware can upset the delicate balancing act. However, it is not relevant to this subject, and I will ignore food from now on. 2. When I manage to hit the magic 37 mg per hour, the effect is almost as if I do not have PD; it really is that dramatic.. 3. There is though, another way to get through the day: One which at first sight seems quite good, (- but I have my doubts....) To follow this route, you have to take a booster shot of levodopa, typically first thing in the morning. 'Kick-starting' the system seems to be the idea, and of course it does just that. You can imagine that it takes more time to approach 37 mg/hr by rounding off as it gets to the target value, than it does if you go shooting through the 37mg/hr target, on your way to a condition corresponding to a much higher dosage. 4. The strange thing is that it seems that as I travel to these higher dosage areas ( for the sake of understanding what is going on only), I begin to experience milder dyskinesias. Not only that, it seems that I can maintain my position in this 'Twilight Zone' with quite small doses of levodopa; actually less levodopa than the 37 mg/hr needed to maintain my lower level. Note that this Zone is not free of dyskinesias, but they seem to be of an intensity which PWPs are capable of accepting. 5. The killer blow comes when you try to get out of the 'Twilight Zone'. You can do no more than shut off the flow of levodopa and wait :- and as the descent begins, so do the dyskinesias. They are very distressing in my case, and I assume that they are what is called 'End-of-dose Dyskinesias' 6 If this is so, then I have described a way to produce End-of-dose Dyskinesias, and a way to avoid them. What I don't have is an explanation of the phenomenon. Still, you can't have everything.... I would appreciate comments on these observations, especially those who have experienced the end-of-dose type of dyskinesias. Regards, -- Brian Collins <[log in to unmask]>