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On Sat 31 Jul, Charles T. Meyer, M.D. wrote: > Brian, > > I agree completely that requip is not a breakthrough. It is a rather small > step but an important one. They have made a drug that act on only one receptor > site, like at least 2 others (one marketed in the US.). I don't think that > professionals really believe the advertising anyway. EVERY drug that comes on > the market is a MAJOR BREAKTHROUGH. > > It likely will postpone dyskinesias and that is clearly a positive. >=========================================================================== > Charlie > I don't want to seem to be saying anything in criticism of Requip. That is not my target. I will try to explain myself more clearly:- When the earliest of the effective Dopamine agonists (Permax or Pergolide) was cleared, around 1993 to 1995 (?) its claim to fame at that time was stated to be that it had an affinity for the D1 and D2 dopamine receptors. This means that the agonist can attach itself to the D1 and D2 receptors and fool them into thinking that it is Dopamine, but at the same time those agonists fail to trigger the events which cause dyskinesias. All the subsequent Dopamine agonists have made the same or similar claims, and the experience appears to support the claims. I can vouch for Permax from personal experience. So these tablets work by producing additional margin which can be taken up in a variety of ways. 1/ My method is to hold a constant rate of flow of levodopa, and, as my available naturally-produced Dopamine reduces, buying-back an adequate margin to enable me to carry on by increasing the dosage of Permax 2/ Another option is to take a big dose of agonist, and trade this in by reducing the dose of levodopa. I don't like that option because it exposes you to a greater range of dopamine agonist .hours , with an increased risk of agonist-induced side-effects (which often make levodopa-induced margin seem trivial. So we can hold the levodopa and waggle the doseage of agonist or we can hold the Agonist and waggle the levodopa. Either way, we are trading consumption of levodopa and agonist in favour of control of our PD symptoms. You may have recognised the test set up by SKB as being item 2 above, and that is the point: They have simply re-shuffled the cards with which they cleared the drug in the first place, and dealt them out again!! The so-called breakthrough occurred 5 or 10 years ago, the latest SKB work just confirms something which was not in contention. Regards, -- Brian Collins <[log in to unmask]>