 |
 |
hi fred At 01:50 1998/12/13 -0800, you wrote, in part: >... My father is 72 ... He had been on tasmar and sinemet. >It had helped him tremendously. My mother reports that he >was getting out on his own, going to the grocery store, >getting hair cuts etc. that's great it seems to me that his meds were 'optimized' and he was feeling pretty mobile and self-confident how long has he had pd? how long has he been on sinemet? >Due to the recent scare his neuro told him to stop with >the tasmar. He was on sinemet only for approximately >2-3 weeks and has just had a liver test that was OK. the scare caught everyone by surprise good news about the test >He is having difficulty getting out of bed and has taken >to sitting in his favorite chair most of the day now. He >will not go out much at all. does he say why? to me, it sounds like he's undermedicated and probably feeling uncomfortable and stiff i.e. not enough levodopa getting to his brain the tasmar would have helped 'stretch' the levodopa in the sinemet, so when the tasmar was stopped, it might have been more logical to titrate the sinemet up as needed while titrating the tasmar down >His neuro started him on mirapex (spelling?) yep - the generic name is pramipexole >along with sinemet Friday. that's good news, i think! in tests, adding mirapex to a sinemet regime has resulted in a 25-30% reduction in the need for sinemet but i'm a tad concerned that your father's neuro hasn't 'optimized' him on sinemet alone at least as a starting point before adding mirapex tasmar [tolcapopone] and mirapex [pramipexole] both help in reducing the need for sinemet/levodopa but in completely different ways tolcapone is a comt inhibitor, which acts in the body, to help more levodopa [in the sinemet] survive the journey to the brain while pramipexole is a dopamine agonist, which acts in the brain, and 'fools' the brain into thinking it's got more dopamine in it Now my questions: >1. What has been your experiences with mirapex? >2. What side effects does mirapex have? >3. Is there a web site ewhere I can get mirapex >info to share with my family? you should be able to get a full drug monograph either from the neuro or from the pharmacist there is a ton of info and discussion on mirapex in our pd list archives at: <http://james.parkinsons.org.uk/> all brain chemistry meds need to be treated seriously [this may seem obvious] and also need to be added/fine-tuned ver-r-r-r-r-y slowly [this may not seem so obvious] it would be wise to titrate the mirapex dose up very slowly over weeks rather than days therefore it seems to me that your father's sinemet level needs to be raised a tad in the meantime so that he feels more mobile in simple terms lack of mobility = pd symptom = lack of sinemet/levodopa/dopamine and dyskinetic movements = med symptom = too much sinemet/levodopa/dopamine and hallucinations = med symptom = way too much sinemet/levodopa/dopamine maybe more in-depth observation of his hour-to-hour med [sinemet] response is called for? >4. His neuro is in Toledo and never mentioned >having the liver test until the recent scare. this isn't surprising most neuros were surprised by the scare some people think there has been an over-reaction; tasmar has been pulled off the market in some countries but the liver damage can happen so fast that the testing may be too late it's part of the roller-coaster ride of learning about new pharmaceuticals; we still don't know everything about aspirin yet! >We are thinking about looking for a new DR. >Any suggestions of DR's in Toledo, Columbus, Cleveland? >What about movement disorders specialists. how about discussing all of the above with your father's neuro first? if he's open to discussion, stick with him if not, give him the boot we have to learn to be our own advocates if not us, who? please note i'm not a medico just a nosy parkie! your [and your father's] cyber-sibling janet janet paterson - 51 now /41 dx /37 onset - almonte/ontario/canada [log in to unmask]