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On Mon 08 Dec, John and Betty Oxley wrote: > 12-07-97 > I have not received any response from either this list or the Care list > regarding several questions we recently submitted, and we do need advice. > The question is actually two part. First, my husband, my PWP, made his > first visit to see a neurologist this past Thursday. He is taking John off > of Senemet and putting him on Requip. I understood the instructions to be > decrease the Senemet to 1 25/100 tab Senemet 2X a day for 2 weeks. > Decrease Senemet again to 1/2 25/100 tab 2X a day for two weeks. Then > begin Requip as directed on the introductory package: 1 0.25 mg tab 3X day > for one week and so on. I have seen here on this list that people are > taking the two medications at the same time decreasing one and increasing > the other. Is that the correct way? Is that what all of you have done? > Have we misunderstood the neurologist and had I better check with him > again? Second, have any of you experienced psychological problems when you > started decreasing the Senemet? Somewhat severe psychological problems? > Is this to be expected and endured or should I be contacting our doctor > again? If anyone receives this and can help, please answer. Many thanks, > Betty > [log in to unmask] > > > Hello Betty, You are quite right to repeat your request for comments - The e-mails come flooding in so thick and fast these days that it is easy to miss a genuine cry for help in the flood of trivia. My observations on your questions are: 1. You do not say how long your husband has had PD, but going by the small quantities of Sinemet (- yes, the quantities you mention are small in comparison with the amount taken in later years), it is not very long. The good news about that is that there are a number of choices open to you for treatment, all of which stand a good chance of success. 2. The manufacturer's advertising copy, issued when Requip was released on to the market (in April 97 , so it has not been in use very long) stated that Requip has been found to give good control of symptoms when used by itself in the early stages of PD. That does not greatly impress me :- in the early stages of PD, you can probably make a difference just by shaking a stick at it! What I am really saying is that though I would not myself have chosen your neruro's plan, I see no harm in what he has advised. Hidden in the background to this strategy is an arrgument which is as yet unresolved among neurologists, about whether you should delay taking Sinemet for as long as possible in the early years. Your man obviously favours delay; I subscribe to the opposite view. 3. One thing that I would urge you to keep in mind is that it is clear when you read this list, that some people take quite happily to say, Requip while others can suffer quite extreme adverse reactions- sometimes physical, sometimes psychological. If you get even a hint of this, try one of the other Dopamine Agonists instead. There are 3 or 4 available, and they all do their intended function satisfactorily, but no-one can predict whether you will have an advese reaction to a particular agonist. For my part, I have for about 3 or 4 years taken a mixture of Sinemet and Permax (another agonist), and they go well together. Neither of them could do the whole job on their own. but together I am coping quite well. (I'm coming up 19 years since I was diagnosed) 4. Last point - concerning your neuro's plan for managing the change-over: The strategy of reducing the Sinemet before introducing the Requip could be considered to be rather thoughtless or uncaring of your husband's comfort. He will have to endure whatever his under-dosed condition produces for that period. It is possible to define better strategies ( i.e. scaling the Sinemet down and at the same time scaling the Requip up, but I must mention that the technique proposed by yoyr neuro has probably been defined by him to yield more useful informotion on exchange rates etc, than the combined approach It depends on the level of discomfort which you are prepared to put up with for the next few days. I hope these notes are of some help. Regards, -- Brian Collins <[log in to unmask]>