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Help! I have some questions about Mirapex which I hope some of you can answer. >From what I read in your messages here, and on the Care List, there does not seem to be much consistancy among doctors who are prescribing Mirapex for PWPs. I sometimes have the uncomfortable feeling that post-approval trials are underway and we're the guinea pigs. My husband's neurologist succumbed to our second request, and last week wrote a prescription that started Neal on a super-conservative 0.125 mg. once a day for a week, then 2/day for week two, and finally 3/day in the third week. This latter dose finally brings his total daily intake to 0.375 mg. This intake of 0.375 mg/day (provided by three equally spaced 0.125 tablets) is recommended by Pharmacia&Upjohn as the way to BEGIN titrating Mirapex. What bothers us is the dearth of instructions about when to take the Mirapex and what to do about integrating it with all the other meds taken. Neal's neuro said not to change his other meds yet(Sinemet, Permax, Eldepryl.)He wants to know if he should take it with his Sinemet and Permax, or to insert it between doses. The neurologist said he was being bombarded lately with information from pharmaceutical sales people about Mirapex and now seemed more comfortable about prescribing it. Our pharmacist was able to provide me with an original bottle of Mirapex, including the detailed information insert that was included in the box. This answers some questions, but brings up others. What follows is based on the information provided by Pharmacia&Upjohn's package insert: About Mirapex and Other Drugs: The studies leading to approval included concomitant use of sinemet, and/or Amantadine, Eldepryl or anticholinergics. There is no mention of other dopamine agonists like Permax. Should Permax be decreased, left as is, or discontinued? It was found the average reduction of levodopa was 27% for older patients. (Young patients tested were not taking levodopa.) Were PWPs in the studies also taking other agonists? It is recommended that doses be taken three times/day. But when? With Sinemet (and Permax?) or separately? About Dose Size and Side Effects: Mirapex is rapidly and almost completely absorbed, reaching a peak concentration in about 2 hours. It can be taken with meals, but this will delay its absorbtion by about an hour. Its terminal half-life is about 8 hours in young patients, but increases to about 12 hours for those over 65. The drug is 90% eliminated via the kidneys. Aging affects kidney function and it is harder for older patients to get rid of drug end products. Anyone with a medical problem involving the kidneys needs to be careful with medications that put an extra burden on them. Because Mirapex does not have an end product metabolite, it is excreted unchanged. From this, can I assume it is still circulating as active drug, thus adding to the serum concentration if renal function is impaired?. A maximum total daily dose of 4.5mg. is recommended for maintenance after a 7-week period of weekly upward titration. One study of young patients found that a maximum dose of 1.5 provided benefits that were not significantly different from a 4.5 mg maximum. Body size and muscle mass are also factors in determining maintenance doses. Patients that weigh much less than average may have problems with the full recommended doses. Any of these factors could contribute to the unwelcome side effects some have experienced. I look forward to your comments and advice. Martha Rohrer ([log in to unmask])