 |
 |
Phil Tompkins wrote: > With Tasmar I seem to have even more trouble than before achieving > the proper level of levodopa. They don't package sinemet (straight or > CR) in pills of the optimum "denominations" for use all by itself, > not mention use in conjunction with several other drugs like a COMT > inhibitor, an MAOB inhibitor and a dopamine agonist. And these all > have different effective durations. So after starting the day with > dose 1 of everything, what and in what strength should you take > next, and when should you take it? And then what do you take after > that? Not that I'm trying to determine all this and act accordingly, > but one would have to, taking meals into account as well, in order to > maintain the optimum proportions. There are just too many variables > to juggle, especially as PD advances and that fateful "therapeutic > window" (the difference between a dose that is too small and one > that is too great) is closing. > So I now get dyskinesia without taking a lot of l-dopa, and, for some > reason, I don't know whether because of advancing PD or the drug > mix, for me the margin between too much and too little sinemet seems > even narrower. I haven't yet reached the stage where the "therapeutic window" has become too small, but I know many PWP who have. The problem is best explained in mathematical terms, which may be too arcane for most listmembers: The decline of available dopamine following a dose of levodopa or an equivalent agonist seems to be exponential; that is, proportional to the amount remaining at any given time. The more you begin with, the quicker it disappears at first. The steepness of the initial decline is why advanced PD needs more frequent dosage to keep within acceptable limits of too much or not enough. As a matter of casual interest, the makers of Tasmar and Sinemet have announced plans to cooperate, hopefully to develop guidelines for managing the two drugs, and perhaps even to combine them in a single pill. Cheers, Joe -- J. R. Bruman (818) 789-3694 3527 Cody Road Sherman Oaks, CA 91403-5013