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I have some personal experience with this issue. What this paper is referring to is the rapid change from one agonist to another. When the new agonists first came out on the market the package insert I believe said that to change from one to another you were supposed to phase down one and start the other over a period of weeks. That led to bad times for those that needed the agonist badly as was my case. Dr. Goetz felt that he could substitute an equivalent dose of one drug for another without ill effects. In my case I was taking 30 mg of parlodel and in one day he stopped the parlodel "cold turkey" and started I believe 3 mg per day of pramipexole. Old timers may remember my hospitalization about 2 years ago to change drugs. I was hospitalized because the drug was new and Dr. Goetz wanted to make the transition under hospital conditions. I presume he then did this formal study and published it to document in the literature that what he did was safe and save others who could not go without an agonist during the transition between drugs. It worked well as far as the transition was concerned for me while other people were coming into the hospital deteriorating when their doctors followed the FDA guidelines.. Camilla Flintermann wrote: > Judith Richards just sent this article--it refers to speed of titration in > ADVANCED PWPs---FYI. > ******* > > Rapid titration of dopamine agonists safe in advanced > Parkinson's disease > > WESTPORT, Apr 29, 1999 (Reuters Health) - Introducing a new > dopamine agonist at its full converted dose improves the efficacy > and safety of the drug for patients with advanced Parkinson's > disease, according to study results published in the April 12th issue > of Neurology. > > Dr. Christopher G. Goetz and colleagues from Rush University, > Chicago, Illinois, examined two titration regimens for switching > patients with advanced Parkinson's disease from bromocriptine or > pergolide to pramipexole. > > The slow titration regimen was administered in accordance with > the package insert for pramipexole, "...with weekly increases in > dosage to reach their equivalent dosage." Patients assigned to the > rapid titration approach received the full converted dose the day > after stopping the former agonist, and the dose was adjusted > weekly thereafter as needed. > > Every week a blinded observer assessed Unified Parkinson's > Disease Rating Scale (UPDRS) scores and asked the patients > about any adverse effects. "The mean time to reach a UPDRS > score that was superior to baseline without increased adverse > effects was significantly shorter in the rapid-titration group (mean > 2.1 weeks versus 5.3 weeks)," the investigators report. > > Dr. Goetz's group found increased parkinsonian features > exclusively among patients in the slow-titration group, leading the > clinicians to conclude that "...rapid conversion is safer than a slow > titration in patients with advanced disease." > > By the end of the 8-week study, UPDRS scores had improved > significantly in both titration groups, and the average final doses of > pramipexole in the two groups were similar. > > The researchers recommend that clinicians use "...a 1:1 conversion > for pergolide to pramipexole and 10:1 for bromocriptine to > pramipexole." > > Neurology 1999;52:1227-1229. > > -- > Judith Richards, London, Ontario, Canada > <[log in to unmask]> > ^^^ > \ / > \ | / Today’s Research > \\ | // ...Tomorrow’s Cure > \ | / > \|/ > ``````` > > Camilla Flintermann, CG for Peter 80/70/55 > Oxford, Ohio > http://www.newcountry.nu/pd/members/camilla/one.htm > <[log in to unmask]> > > "Ask me about the CARE list for > Caregivers of Parkinsonians ! " > -- ****************************************************************************************** Charles T. Meyer, M.D. Middleton (Madison), Wisconsin [log in to unmask] ******************************************************************************************