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On Fri 15 May, Margaret Mates wrote: For those > of you already on an agonist regimen: 1. Do you think you started > the drug at the right time? 2. What were the deciding factors in > starting? 3. Any other thoughts or opinions on this issue? > Thank you for any and all opinions. Margaret > > > Hello Margaret, you are fortunate to be in a position to pick and choose an agonist; the situation in earlier years was noy so helpful. In my case I first tried Bromocryptine (Parlodel) and had to drop it because of a bad psychological reaction (I was becoming paranoid and was lucky to realise what was going on and stop taking the drug after about six months. In 2 weeks I was back to my normal self.) I managed to cope for a few years more on just Sinemet, and was able to cope better than most by developing my computer program, which kept me going quite well until 1994, when Pergolide (Permax) became available. I was 15 yrs from diagnosis (21 yrs from first symptoms), and was taking about 800 mg of levodopa, with only a small margin between low dose tremor, and high dose dyskinesia. At this time, the most significant characteristic which I remember about those days is that the changes from off to on and vice versa had a 'harsh' characteristic. Sometimes not only did I find the typical symptom of one muscle fighting with another muscle - it felt to me as if different parts of the same muscle were pulling against each other, giving a sensation of tearing or ripping. It was not very pleasant. Bearing in mind my previous experience with Parlodel, I was not prepared to start shovelling large quantities of this new and unknown drug, so I started with 500 micro grammes and sat back to see what happened. (I continued with the levodopa with no change). The result was just what I hoped for: It tipped me back over the fence to a place where I had some positive margin. I am convinced that this is the most efficient way to prolong our active life: Increase your intake until you have a small, positive margin, and then STOP. Any more tablets are I believe, counterproductive, and may contribute to a more rapid rate of decline. Since that time, I have gradually increased my dosage of Permax as my PD continued to decline, which brings me to the present day: I am taking 3.5 milligrams of Permax, and the same 800 mg dosage of levodopa. One point about this sort of calculated system - it allows you to make some predictions, based on previous years. In my case I will be pushiing the max recommended dosage of Permax in 2 years time. I am already looking aroound for what to do next - Any suggestions? I have (I think) answered your questions in this rather rambling account, but I will just summarise. 1/ Take the agonist when you feel that you cannot continue with just levodopa. 2/ Introduce the agonist at as small a dose as you can, but obviously start with enough to tip you back on the good side of the track. 3/ Then use the agonist to track and match the continuing decline which is our burden. Regards, -- Brian Collins <[log in to unmask]>