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Hello folks I went to a Parkinson's lecture the other night presented by Dr. Linda Sigmund (a Movement Disorder Specialist in Northern Virginia). She gave her annual talk after attending an Annual Neurologists PD Convention... Dr. Sigmund gave a general review of PD and meds...here are a couple of highlights from the notes I took during her lecture: ...a daily exercise program of stretching and strengthening is very important in PD to maintain balance, strength, joint range of motion, posture, decrease chances of falls, increase respirations, etc. (PD is a movement disorder that encourages a more sedentary lifestyle). ...40% of PWPD have depression also ...NEVER use Reglan, Compazine or Phenagin (antinausea meds) ...avoid Iron suppliments until more is known about effect on PD ...one needs a minimum of 75-100 mg of carbidopa to get Sinemet to the brain...if you are only on 25/100 CR twice a day (a total of 50 mg of carbidopa) the sinemet will not be utilized well so you need to add a carbidopa suppliment to get you up to 75-100mg a day. ...ways to improve Sinemets effectiveness...crush tab and dissolve in water, sit up when taking, move around after taking. ...Sinemet CR is good to take at bedtime for better sleep. ...Mirapex is a non-ergoline agonist; Parlodil is an ergoline agonist. ...Mirapex they now think, has a neuro-protective effect and can be given slowly up to 7mg/day ...Ropinerol can be given up to 24 mg. ...old agonists attach to D-1, D-2, and alpha receptors in brain ...Mirapex attaches to D-2, alpha 1, and maybe D-3 receptors ...Requip attaches to D-2 receptors only (this may partially explain why different agonists effect you differently) ...Neuro Convention consenses gave strong recommendation for use of Dopamine agonists for there L-Dopa sparing effects, reductions in Sinemet dosages for longer years of protection before unwanted side effects from Sinemet, they decrease on-off times, decrease dystonias and dyskinesias, and are thought to be neuroprotective...and now having 4 different ones to try gives a wider range for options/solutions. ...COMT inhibitor Tasmar...out for three weeks now...improves 'ON' time, decreases 'OFF' time, smooths out between Sinemet times, increases availability of Levodopa, has an overall increase of energy effect as reported by a significant number of patients taking it, is used in conjuction WITH the dopamine agonists and Sinemet (add a little Tasmar to the Mirapex and Sinemet for lower doses of both, to decrease the chance of side effects from any one of them), it's taken three times a day (8hrs apart), will decrease amount of Sinemet you need if you take over 600 mg a day, usually the only side effects are exterienced in the first 72 hours and are nausea, loose stools and bright yellow urine, if any dyskinesias occur then decrease the Sinemet more don't stop or decrease the Tasmar or agonist. ...important adjunct to meds are daily exercise, education, good nutrition, membership in a support group, care of your caregivers, OT,PT, Speech Tx when needed. ...she recommends Vit E 800 units, Vit C 500 units daily ...one example of what a movement disorder neurologist would do that a general neuro might not know to do is: she said she might perscribe a Regular Sinemet in the morning with Tasmar, followed in one hour by a Sinemet CR and the med transition will smooth out and compliment each other. By adding a little agonist to the mix, the patient will reduce their need for higher Sinemet doses. She said smaller amounts of more meds works best with those with PD under 70...for those over 70, less different meds is better because to an older persons less tolerance for variety. I hope some of this will be helpful to somebody. Gail Vass email [log in to unmask]