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Dear Peter - Dick asked me to respond to your letter for him, since I type much more quickly. I don't believe I saw the letter you sent him some time ago, but I'm sorry to hear about the dystonia that resulted from your DBS. In answer to your questions about Mirapex: Yes, he titrated gradually to the his current dosage. He now takes one 1 mg tablet 3 or 4 times a day (depending on how he feels). He started with .25 mg tablets on the same schedule, if we remember correctly. Then after a week he went to .5, and after two weeks, to .75 mg. He had such a good response at that level that he remained at that dose for several months, as his doctor had suggested he could. Eventually he went on up to the current 1 mg tablet. I believe the suggested titration schedule was printed in the "Patient Information" sheet that was included with the medication. Actually, we had to ask the pharmacist for it, but it's available for the asking. I don't know if the same would be true in Australia or not. It might be helpful to you to know that Dick felt a response to the Mirapex within a few hours. No one had suggested that he reduce his Sinemet, so his body reacted as if he was terribly overmedicated. When that dose wore off, we made the decision to reduce the Sinemet. The Patient Info sheet said test subjects had reduced their Sinemet by an average of 1/3, so we felt reducing was the right thing to do. Eventually Dick reduced his Sinemet dosage by 1/2. Dick will have been on Mirapex 2 years in July. When he started the Mirapex he cut down to 1/2 of a 1 mg tablet of Sinemet 3 times a day. He still takes it 3 times a day much of the time, but occasionally adds a 4th 1/2 tablet - usually if he's going to play golf or work in the yard. Dick had also tried Parlodel and Permax, but neither worked for him. We can't remember now what the problem was - I think he may have had some mild side effects and no perceptible benefits. The side effects we've noted that we think come from the Mirapex are increased freezing and balance problems. However, the benefits are so significant that those alone would not be enough reason for him to discontinue it. Again, we're certainly sorry to hear about the dystonia from your DBS. Dick's pallidal stimulations reduced his severe dystonia quite a bit, but he still had some until he started the Mirapex. He hasn't had any dystonia since. I don't know whether it will work as well for you, since his dystonia was already reduced by the surgery before he added Mirapex. We certainly hope so, though. Dick is having more rigidity as the disease progresses, but it doesn't seem to be the same thing as dystonia. I've probably told you more than you ever wanted to know about this, but I've tried to include whatever information I thought might be helpful. We wish you the best of luck with the Sifrol (I agree with you about the name - Mirapex sounds much better), and hope it becomes available soon. We'd be happy to answer any additional questions that come up. We'd like to hear from you when you find out how well the Sifrol works for you. Good luck! Margie Swindler cg for Dick, 54/17