Ivan wrote in part:
<<<<Linda Corson asks: .. my basic nuts-n-bolts questions are:
1. What's the minimum daily carbidopa level for the levodopa to be
maximally effective?
2. What are the side-effects of too much carbidopa?
3. At what level do the side-effects typically start to appear?>>>>
and
<<<Would a 10/100 pill kick in at the same rate?
I am wondering how the c-dopa/l-dopa ratios (1/4 and 1/10) influence a
PWP's dosing schedule.>>>
and (in another message)
<<<< The 7 peak-dose side-effects (P) or end-of-dose side-effects (E)
are:
END of DOSE:
(E1) the end-of-dose sweats,
(E2) the rapid tremors (Marling's "internal whim-whams" / Ida's
"cold turkey"),
(E3) the freezing spells( sudden lack of movement),
(E4) the sudden feeling of cold (my "hypothermia"), and pain in
the shins, feet, toes and hands and fingers.
PEAK DOSE:
(P1) sweats
(P2) hallucinations (like BIll's)
(P3) abnormal movements (dyskinesias)
Would ANYONE be able to share ideas on the problems caused
specifically by either too high, or too low, circulating CARBIDOPA
levels, and the associated Sinemet and Madopar pill strengths?>>>>
The minimum carbidopa is reported to be 75 mg. per day to be fully effective.
The Sinemet CR information indicates that circa 71% of the levodopa and circa
58% of the carbidopa in the tablet reaches the blood plasma. The efficiency of
the regular Sinemet is circa 99% for both ingredients. The November 1989
Neurology 39 (suppl 2) article starting on page 25 shows variability that is
rather large for the concentration of carbidopa in blood plasma within
young-healthy and older-healthy and older-Parkinsonians - as well as within
these groupings.
The carbidopa counters the decarboxylation enzyme. The COMT enzyme is
countered by the new tolcapone or entacapone to provide much longer residence
time for levodopa to remain in the blood stream.
The statement that CR Sinemet may cause more dyskinesia than regular in the
package insert information - and, the statement in the regular Sinemet insert
that Sinemet may cause more dyskinesia than levodopa alone - may indicate that
carbidopa is responsible for some dyskinesia.
The digestion and movement into the small intestine are the determining
processes for response to medication time. the 10/100 is very similar to the
25/100; and the 25/250 will not take significantly longer to provide results.
Pre-dissolving, biting into several pieces, or using warm water will decrease
the time to achieve effect.
The "carbidopa overdose" is primarily anecdotal. A number of persons have
found that getting down to circa 75 mg. per day from 400 or greater intake
gave much improvement in general feeling improvement and alertness.
I believe that some data gathering in regard to this is needed.
The benserazide in Madopar may be less prone to cause such an effect.
No connection or correlation of carbidopa to the peak and end of dose effects
listed has been found or implied by anyone as far as I know.
sweating and hypothermia may be part of the blood volume circulating during
digestion differing from when the stomach is empty. The autonomic system
signals may be goofed-up and carry food that gets oxygenated to warm us when
we are already warm or cool us when we are already cool by not having enough
oxygen - but, this is purely conjectural. I suspect that we get more sensitive
to these changes over the course of the disease.
hope this is of some help.
--
Ron Vetter 1936, '84 PD dz paradise is feeling good, not a place to go
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http://www.ridgecrest.ca.us/~rfvetter
