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My experiences with Mirapex have been less than ideal, as I know many others have experienced. Reducing the amount of sinemet I was using is the most positive result I have had to date, one that I value greatly. I now use only 2/3 of my pre-Mirapex sinemet dose, and I guess if that's all the benefit I ever got, I would continue. But I have really struggled with the return of some symptoms that had been well-controlled by sinemet i.e I have experienced a reduction in the volume of my voice, I have a constant aching in my hands and arms, and worst of all I am not able to walk nearly as well as before-Mirapex. I stumble easily ,and in general have no confidence to get from point A to B. I was at our local APDA office on Thursday, and in talking with Cynthia Holmes, our local director, she mentioned that Dr. Erwin Montgomery, who was our APDA medical director until a recent transfer, and who was the neuro in charge of the Pramipexole studies here at the U of A, had written an article about this which will be in our next newsletter. She dug it out, and there is so much real wisdom and experience in it regarding this drug, that I am hoping she and Dr. M will forgive me for leaking this pre-press. To summarize Dr. M's advice: he recommends maintaining the levadopa dose and adjusting the Mirapex upward until there is a benficial response. Once that is achieved, he says to reduce levadopa in weekly intervals until there is an increase in symptoms (this is where I am camped, and I think others too). He said the symptoms which may return are tremor, difficulty walking, decreased manual dexterity, increased difficulty with balance, or a decrease in voice volume. At this time he recommends adjusting the Mirapex upward until those symptoms resolve, and at that point further reduce levadopa if possible. Apparently he has had success in maximizing the Mirapex and cutting the levadopa to an absolute minimum with this seesaw procedure. Frankly, I had thought of reducing the Mirapex, as in my mind it was the culprit responsible for this mess, and now I have instead added one tab extra, and am going to hang in there to try to find a comfortable place in this. Dr. M's approach makes sense to me, and I know he followed many patients through 3 or 4 years of study protocol, so he ought to know. Hope this helps someone out... Kathie Tollifson [log in to unmask] 47/9