Ivan, you asked:
>What would you do if you feel like your medications are
>
>1) too numerous and yet,
>2) you want to try pramipexole.
>
>My main battle is against frozen motion, toe curls, and staying warm
>enough, all possible with deficient dopamine levels in my blood and
>tissues.
>.
>I use combined Sinemet 25/100 and Sinemet CR (1300 mg L-dopa/24 hrs),
>selegeline (eldepryl) 10mg/before 3PM, and NADH (20.0 mg/24 hrs).
>
According to our neuro, a movement disorder specialist as well as a
pharmacologist, they don't like to combine two dopamine agonists, such as
Mirapex and Permax, but I don't see anything in the list of meds you're on
that would contraindicate adding Mirapex (Pramipexole). Guess I should add
that I'm just assuming NADH isn't a dopamine agonist.
Dick has been on Mirapex for exactly one week now, starting at 0.125 mg. By
the second day on the drug, he was able to cut his Sinemet CR dosage in half.
We weren't expecting much from the drug, and were warned it could make his
dystonia and dyskinesia worse. He did have a short episode of worse
symptoms, but after he cut his CR back, there were no repeats of the
symptoms.
It's too early to say with any certainty that the drug is what's making the
difference, but so far (knock wood), he seems to have more energy, he has
regained his ability to smile normally, he hasn't had a single episode of
"spaciness," which had become an almost daily phenomenon, and hasn't had any
depression as far as I can tell. I also haven't seen any freezing or
bradykinesia, although we haven't seen any improvements in balance, as others
have reported. To me, he's more like the person he was more than five years
ago.
I want to be cautious about singing the praises of Mirapex too highly, both
out of an unwillingness to mislead anyone, and perhaps out of a fear that it
*can't* really be as good as it seems to us right now.
We understand that as a dopamine agonist, the Mirapex helps the brain make
better use of whatever dopamine is available, in whatever form. It may be
that Dick responds especially well to this drug because he has such severe
dystonia, and now some dyskinesia, at very low levels of Sinemet. It seems
to me that somehow, with Mirapex, he's getting dopamine comparable to the
levels he had several years ago by taking half the amount of Sinemet he was
on. He now takes just half of a CR three times a day.
I should add that the picture of how much of the improvement is Mirapex is
clouded a bit by the fact that he started taking 100 mgs of vitamins B6 and
B12 a week before starting the Mirapex. However, if facial "masking" and
depression are characteristics of PD and caused by lack of dopamine, I think
the improvement has to be due to the Mirapex and not the vitamins. Not so
sure about the renewed energy.
Anyway, Ivan, I think it couldn't hurt to try Mirapex. Look at it in terms
of being able to cut back on your Sinemet, not as actually adding another
drug. If your neuro agrees, ask him if he has a free "starter pack" with the
smaller start-up doses in it.
Please let us know what you decide to do. Margie cg for Dick, 52/15
[log in to unmask]
