On Sat 28 Feb, Honie12440 wrote:
> Two or three weeks ago someone raised the question of requip wearing off.
>
> There is no question in my mind that the requip in by body is wearing off.
>
> I started Requip with very little difficultity about three months ago. In a
> period of about 15 days I titrated up to 5mg. taken 3X a day for a total of
> 15mg a day of requip. At the 15mg/day I was able to reduce my sinenet intake
> to a 25/100 tablet to every four hours or more. That was an improvement from
> the previous dossage of 25/100 tablet every 2 hours and 45 minutes.
>
> For the last 24 hours I have been off most of the time. Gradually the Requip
> has been loosing its effectiveness. At 15mg per day I now require a sinemet
> tablet every 3 hours or less. My doctor advised me to increase the Requip to
> 20mg per day to see how that effects me and to try and take sinemet every 4
> hours again.
>
> I will keep the list advised of the outcome of this wearing off effect on me.
>
> Dale Severance
> [log in to unmask]
>
>
Hello Dale, I don't question the symptoms which you describe in your post,
but I think you have drawn the wrong conclusion: The fact that you are
working with quite small changes in dosage of Requip, and are using quite a
sensitive method of assessing the result - the variation in effective time of
a sinemet 25/100 - means that you have suddenly started working with a
magnifying glass, where before you were just using normal eyesight. Have
you noticed the way that nobody talks about 'titrating up' on Sinemet ? We
all agree that it is the most powerful of the drugs which we use; I suppose
it must be a case of familiarity breeding contempt, so we add a tablet here
or there, and think nothing of it.
The difficult bit is trying to estimate the exchange rate of levodopa and
whatever agonist you may be using. When I was introduced to Permax, some 4
years ago, I did a few experiments and derived an exchange rate as follows:
1 mg of Permax per day = 17 mg per hour of levodopa.
(Note the different units) Note also that there is no guarantee that
this relationship remains linear at all values nor that the exchange
rate is constant for anone else but me.
putting this into a more workable form, it meant that I could take 1mg
of Permax per day, and reduce my Levodopa intake from about 900 mg/day to 700
mg/day. I saw no point in doing it that way, so I didn't. Instead, I kept my
levodopa intake constant at about 900 to 1000 mg/day (the variance is due to
using some extra at meal times to counter the effect of food). Since then,
each time I have started to find my Off time increasing above about 1 hour
per day, I have added 500 micro grammes of Permax to my daily intake. The
result is that 4 years later, I am still taking the same dose of levodopa,
and I am up to 3.5 mg/day of Permax.
Now, I had to give you all that background to put your findings into
perspective. The 3.5 mg/day that I now take should be related to the advised
max dose of Permax which currently stands at 4mg/day: I don't have very much
further to go !
What is happening ? Old age is happening. Never forget that Parkinsons is a
degenerative disease, and what you are measuring is your personal rate of
decline. It can be something of a shock to confront your future in this way,
but I am sure in your case that you can take it. The symptoms which you called
wearing off are in fact the normally hidden degeneration of PD. You could
say that we are buying time when we use the tablets, and Permax has done an
excellent job by giving me 4 years of apparently no change in my condition
and at the same kept an adequate margin to avoid Dyskinesias.
And now, to counteract the rather doom-laden message above, I will give my
basically optimistic nature some space: Over the 19 years since I was diagnosed
I have several times found myself at the leading edge of the 'tablet
technology', wondering where I was going to go next, and each time, some new
form of medication has popped-up to extend my effective life. I am hopeful
that this will happen again.
Regards,
--
Brian Collins <[log in to unmask]>
