On Thu 12 Feb, Phil Tompkins wrote:
> Arthur Hirsch wrote:
>
> > One might postulate that there is a continuum of sorts for doses.
> > The lowest dose might be half of a 25/100, taken at some appropriate
> > interval. Next lowest might be the whole 25/100, but taken at a
> > greater interval. Then perhaps a half of a 50/200 or two halves of a
> > 25/100 taken at the shorter interval. Then a 50/200 taken at the
> > longer interval. And finally a 50/200 broken in two and both halves
> > taken together.
>
> Were 25/100 and 50/200 chosen as dose sizes because they are are nice
> round numbers, not because of what people need?
>
> I'm trying half a 50/200 CR at shorter intervals as an alternative to
> a whole 50/200, which is a bit too much for me. Perhaps if I could
> get the halves timed right, I'd find my ideal level. But I'm
> running into trouble. I find the more frequent half pill doses to
> be more than twice as hard to manage. The effects change more
> rapidly, and it's less predictable what will happen. Sometimes a
> half dose doesn't seem to kick in at all. Effects of other
> variables, such as what I eat and when (and whether I've got the
> time and am able to attend to and keep track of the doses) have
> become much more important.
>
> I'm also taking small doses of regular sinemet, which kicks in
> quicker, as a starter, plus Permax, which I'm not sure is doing
> very much.
>
> I think I'll head back to the neuro to re-work the schedule.
>
> Phil Tompkins
> Hoboken NJ
> 60/9
>
>
>
Hello Phil, I am sure that I am not alone in saying that you are treading a
very well-worn path; one which I explored what seems like a long while ago.
Maybe some of my observations will be of use.
I find it most useful to think of the way that the brain 'sees' the Sinemet
as a rate of flow of levodopa into the brain. This is why the C R type of
tablet is so useful: it deliberately sets out to produce a certain flow
rate, which I found at the time corresponded to 50mg per hour. Thus the
effective duration of the CR tablet was 4 hours in my case. ( The release
rate will vary according to the individual; I suspect that the efficiency of
the digestive system may be the biggest factor.)
Now we come to the problem: there comes a time when a release rate of 50
mg/hour is too high, and you start getting overdose symptoms. ( Actually, 50
mg/hour always was too high, but your brain could absorb the excess dopamine
(see the current debate about my comments on MEG07 from Bernard Joly.) As
your Parkinson's progresses, the amount of overdose which your brain can
cope with will continue to decrease: The crunch point comes when the
downward- trending line of maximum rate that you can handle meets the upward
trending line of flow rate to control the PD symptoms. It looks like the
famous 'Rock and a hard place' with you in between, but this is where the
dopamine agonists come in. You are not there yet, so I will return to the
Sinemet CR subject for a moment.
Remember the point about flow rate: The sinemet achieves its CR
capability by dissolving at a controlled rate. If you break a CR in half,
you now have 2 smaller tablets, STILL set to release their contents by
dissolving slowly, but a bit confused because of the increase in surface
area caused by breaking it in two, which will tend to increase the release
rate - this is the opposite of what you need. The sad message is (and it
comes to most of us eventually- is that the Sinemet CR is no longer suitable
for you. I wish the Sinemet people would try to make a range of release
rates so that we could choose the best for our particular requirements.
Don't worry though, a return to the old Sinemet is not the end of the world.
i found that in my case, I could achieve close to my personal release rate,
which was at that time 37mg/hr, by taking 1.5 Madopar 62.5 tablets every 2
hours. A madopar 625 contains 50mg levodopa. I believe that there is an
equivalent Sinemet tablet.
There is one variable left: the 2 hours between tablets. It worked fine for
me, but your requirement may be different - its a case of trying to find the
best for you.
By now, I must have you completely confused! It took me months to work all
this out. A month ago, I would have offered the use of my computer program,
which does the hard part,, but following a hard disc crash, I am unable to
offer this option. I will try to answer any questions you may have.
Regards,
--
Brian Collins <[log in to unmask]>
