On Wed 09 Jun, Callie M. Judd wrote:
> having some problem with dyskinesia so we hoped to reduce the Sinimet by
> taking
> Bromocriptine too - but so far no luck on any reduction-
> We've tried three times before to remove the final 1 mg. Cogentin
> since we
> feel it contributes to his difficulties with constipation and hallucinations
> - but the
> tremors have always been under good control. We are now in the process of
> trying to reduce the Cogentin gradually enough to discontinue it but we
> aren't sure
> if the Sinimet & Bromocriptine will keep the tremors away. We will be keeping
> track if his ongoing but mild hallucinations leave him as we reduce the
> Cogentin,
> (we don't know for sure that the hallucinations aren't caused by the Sinimet
> or the
> Bromo - but the Neuro says the Cogentin is not supposed to be doing him any
> good anymore) The reduction will take about 3-4 weeks - will let you know
> the
> results - if he has to stay on it, it will be a good bet that nothing else
> he's used
> does well against tremor. Any other Cogentin users out there having
> "withdrawel"
> difficulties - using it for tremor reduction?........
> Hope we can be of help....... Marie
> Carepartner Husband
>
> 69/l2
>
>
>
Marie, I think you have missed the main culprit: The cause of your husbands'
dyskinesia is the Sinemet CR. The vital parameter in takng Sinemet is the
rate of flow of levadopa. Here are some typical values:
Quantity l-dopa Duration Rate of flow
Ordinary Sinemet plus 100mg 2 hrs 50
Sinemet CR 200mg 4 hrs 50
Sinemet LS 50 2 hrs 25
You will see that the popular tabs give the same rate of flow. You need
a certain rate of flow to make up for the missing dopamine cells output.
I will quote my figures, but yours will probably be in the same general
area. My 'bottom line' rate of flow is 37.5mg per hr. Below that value,
I get 'Offs' - above it I get Dyskinesias. Keep in mind that you have
no control over the timescale: all you can do is vary the size of the
dose.
The next point is that you cannot influence the l-dopa-caused dyskinesias
by juggling Cogentin or anything else except l-dopa. You must get the
Sinemet right first, then worry about the rest.
Last, This is a big mouthfull in one go. To see it in more detail, may
I suggest that you read my booklets Living with Levabopa, and A Model
to describe the effect of levadopa.... on the following Web site:
http:/james.parkinsons.org.uk
Regards,
--
Brian Collins <[log in to unmask]>
