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Thanks for your comments Brian.........
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From: Brian Collins[SMTP:[log in to unmask]]
Sent: Sunday, December 28, 1997 3:43 PM
To: Multiple recipients of list PARKINSN
Subject: Re: MIRAPEX/SYNEMMET dosage
On Thu 25 Dec, Mario A. Gonzalez wrote:
> I have been on Mirapex .50 3 X day fot the last 4 months, I was also taking Synemmet 2
> 5/100 3 X day, plus Eldepryl 2 X AM.
> Last time I went to the Neuro, he said to start by cutting the PM Synemmet for one wee
> k, then cut the additional Afternoon one. So now I only take Synemmet in the AM.
> M question is: should I increase the Mirapex to .75MG 3 X day? Is the objective to giv
> e up Synemmet completely and just take the MIRAPEX?
> I am a little bit confused as to what I should or should not be taking. Are the Agonis
> ts better for you than Carbidopa/Levodopa.
>
> Can someone comment please?
>
> Mario A. Gonzalez [log in to unmask]
>
>
>
>
Hello Mario, I find it difficult to follow the logic of your neuro. The
effective time of a single dose of Sinemet is in the range 2 hours to 5
hours (the longer time is applicable to recently diagnosed PWPs). So even
when you were on 3 per day, you were effectively having to put up with
gaps between your doses. Did you ever notice that? It may be that the
Eldepryl prolonged that time a little. I find it difficult to be too firm
in my suggestions without knowing how long you have had PD. I am guessing
that you are in the range 3 to 5 years - could you correct me if I am
wrong?
The great thing about the early years of PD is that the brain still has
a fair supply of dopamine-producing cells, and is able to rescue you from
most of the weird and wonderful tablet dosages prescribed by some so-called
experts. You don't seem to hear so much of them when (like me), you have
had PD for 19 years. The best that I can do for you, is to offer you some
guidelines to remember:
1) It is possible to manage in the early years without Sinemet; some
neuros still think delaying Sinemet use in the early years is a good thing.
I happen to think they are loopy, and challenge them to present a logical
explanation. Even the most dedicated anti-sinemet nut is forced to
acknowledge that ultimately, none of the Dopamine agonists can, by themselves,
cope with the symptoms of PD over the long term as effectively as Sinemet.
The Dopamine and the agonists are best used in the way that their name
suggests- to supplement and add to the effect of the Sinemet.
2) During the early years, the brain needs relatively little extra Dopamine,
but paradoxicaly it is in those early years that the system is able to cope
with large excesses of Dopamine. (I can supply the explanation for this if you
are interested)The question is; just because the brain CAN cope, should it
be made to do so?
Regards,
--
Brian Collins <[log in to unmask]>
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