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Marling McReynolds wrote: > I have noticed that although most of us seem to be trying to get > by on the least amount of meds, the doctors seems to prescribe > larger than needed doses for first time users, especially of > sinemet. Is this my imagination?? I was on 50/200 every 4 hours > in the beginning . . . . I ran across an article which deals with large initial doses in general among the web pages of a Canadian organization which provides physician education services. The article, "Dose Titration: Minimize to Maximize" is at http://www.interchg.ubc.ca/jauca/pages/letter10.html. It states that "There are numerous examples of recommended introductory doses [i.e., recommended in the monographs] which are larger than those eventually needed. These larger 'recipe' doses increase the chance of adverse effects as well as cost. . . ." The explanation given for excessive initial drug dosage recommendations is this. "The Federal Health Protection Branch requires that drug companies show [during clinical trials] that a drug has an 'effect', often compared to placebo, before it can be approved. The way to show that a drug has a significant effect in the smallest number of study patients is to use doses of the drug that will work in most study patients..... Once approved, the company must base dosing recommendations on the available study data." I don't know the specific applicability of this to sinemet or what "eventually" would mean for PD, but it's something to consider. I think in the clinical trials for sinemet CR the 50/200 strength was used. Here's what the Merck package insert says regarding the initial dosage of regular sinemet: "The optimum daily dosage of SINEMET must be determined by careful titration in each patient. . . . . Dosage is best initiated with one tablet of SINEMET 25-100 three times a day. . . . . Dosage may be increased by one tablet every day or every other day, as necessary, until a dosage of eight tablets of SINEMET 25-100 a day is reached." If you didn't know much about PD, how would you apply these instructions in the case of someone who had just been diagnosed? Phil Tompkins Hoboken NJ 60/9