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Peter, First of all let me say that you would have to go pretty far before I felt that you were imposing on me. I have gotten so much from your posts and private e-mail that I feel some times I am imposing on you and I am certainly glad to return the favor. Having said that I did not have a phase in of requip. I went directly from 30 mg of bromocriptine to about 3 mg of mirapex and later to about 15-20 mg of requip. My MD in fact wrote about this method or at least presented it to the AAN meeting. I have found the reference: I clearly am over stimulated at this point. I have some Dyskinesia with 20 mg. of Ropinerole but NO that is ZERO, NONE, NULL --levodopa for several weeks. I am headed to Chicago tomorrow armed with the BRAIN article and will almost certainly be reducing my voltage and changing some other things. AT least now there are some vague guidelines published. Again thanks for all your help. Charlie Neurology 1999 Apr 12;52(6):1227-9 Switching dopamine agonists in advanced Parkinson's disease: is rapid titration preferable to slow? Goetz CG, Blasucci L, Stebbins GT Department of Neurological Sciences, Rush University/Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA. BACKGROUND: New dopamine agonists are available, but no study has examined safe and effective ways to switch from one agonist to another. OBJECTIVE: To compare rapid- versus slow-titration schedules for starting a new dopamine agonist in patients already on chronic agonist therapy for Parkinson's disease. METHODS: Sixteen patients on stable carbidopa/levodopa and a dopamine agonist (bromocriptine or pergolide) switched to pramipexole using a conversion calculation of 1:1 for pergolide dose and 10:1 for bromocriptine dose. Patients were randomized to two titration schedules-either slow titration, following the package insert and taking up to 8 weeks to reach their equivalent dosage (8 patients), or rapid titration, receiving the full converted dose the day after stopping the former agonist (8 patients) with subsequent weekly dose adjustments. Using a blinded observer, the primary outcome variable was the time required to a Unified Parkinson's Disease Rating Scale (UPDRS) motor score superior to baseline without increased adverse effects. RESULTS: Both groups showed equivalent and statistically significant improvement after switching to the new agonist. 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). Furthermore, with slow titration two patients experienced enhanced parkinsonian serious adverse effects requiring hospitalization (two falls with fractures). CONCLUSION: The switchover from one agonist to another can be safely and successfully accomplished with a rapid titration based on an equivalency dose calculation. PMID: 10214748, UI: 99229561 pdawkins wrote: > Dear Charles, > I noted you were on ropinerole which I understand will not be marketed > here.(Australia) I am at present titrating Mirapex which is just becoming > available here. It appears the latest edition of Brain has confirmed that > chronic stimulation of the subthalamic nucleus and levodopa produce > dystonia. Something I was pretty well was aware of through personal > experience and my visit to Professors Benabid and Pollack. I have not been > able to try and get rid of my Levodopa as none of the ergot agonists worked > for me. If its not an imposition could you tell me how long was your > titration period and if you were on ropinirole before your DBS. I am > currently working my way up by increasing my Mirapex by 0.25, 3 times a day > every five days and yesterday (Sunday) I actually had no levodopa on a dose > of 3/4 of a milligram of Mirapex three times a day. As I'm working and > driving today I had to take a very minimal dose of levodopa this morning The > results so far are stunning and certainly compliment the DBS surgery. At > last. > > Kind regards > Peter Dawkins -- ****************************************************************************************** Charles T. Meyer, M.D. Middleton (Madison), Wisconsin [log in to unmask] ******************************************************************************************