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On Fri 22 Aug, Phil Gesotti wrote: > Brian, > > You wrote: > > > >>The action of Permax is very slow. According to ny neuro, and I agree > >with him, Permax taken over a period tends to form a 'raised platform' > >from which the levodopa then does its short time-period thing. Looking > >for the effect of a single dose of Permax in the hours following the dose > >is doomed to failure - it's effect is so sluggish. Over the past few > >years I have gradually raised the amount of Permax to offset my steady > >deterioration so that I am currently taking 2.5 mg of Permax. I have had > >no side effects, and the effect seems to be linear over the range 0 to > >2.5 mg. > > Brian, > > When you say the effects are linear with dosage are you talking about > side effects or effectiveness of treatment. If the time constant for > Sinemet is in hours, what is your guess for that of Permax? > > Phil G. 47/1+ > > > Hello again Phil, What I meant was that when I started taking Permax, I found that the best way to 'cash-in' the improvement that the permax gave me was to back off on my Sinemet dosage. That gave me a better margin of operation between the two limits of tremor and Dyskinesia, so the Permax was living up to its claim of not triggering the dyskinesias and at the same time replacing the Levodopa. The return which I got as I increased the Permax, and backed-off the levodopa was 1mg per day of Pergolide was equivalent to 17 mg per hour of levodopa. (Note: per day for Pergolide, and per hour for levodopa.) To maybe make it easier to understand, the exchange rate works out that If I had started taking Permax on top of levodopa, where before I had been just taking levodopa, I would have found that taking 4 x 250 ugm ( (i.e 1 gram) of Pergolide, then I could reduce my intake of levodopa from (say) 900 mg per day to 700 mg per day. When I am increasing my Permax dosage to counter the fact that I have gone further down the hill in the continuous PD decline, I just take more Pergolide, and leave the levodopa at the same level. This effectively maintains my margins at their previous levels, so that I give the impression of not having changed. This concept is not easy to grasp, So I hope you understand. Onyour last point, Re: the time constant for Permax, I have not tried to look for that . All I can tell you is that at my last Pergolide increase; an increase of 500 micro grammes , or 1/2 gramme it took a week of careful checking before I coould be sure that the Pergolide had again produced the desired effect, giving me another year of relative freedom. Regards -- Brian Collins <[log in to unmask]> 57/18 (diagnosed) OR 57/24 (first symptoms)