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On Sat 04 Sep, Marg Meikle wrote: > Because of the recent study about Requip being a better bet for Young > Onsets (holds off the dyskenesia longer), my neurologist took me off > Sinemet. He put me on Mirapex though, as he said that chemically it is the > same aas Requip and he knows the dosing better. Any thoughts on this? > Sounds like they both are dicey for driving, but I think the Health Canada > warning bulletin was about Mirapex. > > Thanks. Marg Meikle 43 / 2.5 mos. diagnosed, mother of a 20 month old > boy. > > > Hello Marge, I feel a long note coming on because I feel very strongly about this subject, but first, let me amswer your direct question : I think your neuro is probably right when he says that Mirapex and Requip are both about as effective for the job - That is, to substitute for levodopa in the early years with PD. Having said that, I would urge you to have nothing to do with either of them. The idea of using agonists rather than levodopa in the early treatment of PD is plain stupid!! You have put your finger on the real problem yourself: Side-Effects. The family of drugs generally called 'Dopamine Agonists' are riddled with potentially dangerous side-effects, beside which, levodopa is a model of good behavoir. In fact, the only problem with levodopa is that you can take too much, which causes dyskinesia. Side-effects caused by agonists are many and varied. It appears that every one has his own set of side-effects which are unique to that person. You only find out by using them, and it may take months or more for the side- effect to show. I am talking serious stuff here: the recent problem of falling asleep while driving (Still unresolved) is typical of the sort of thing which can occur. Now let's talk about Levodopa. To show what can be done with levodopa, I have had PD for 21 years (from diagnosis) ; I started taking Sinemet/ Madopar in my second year; I continue to take about 800 mg per day of levodopa and am very comfortable with it. Of course, for the last 6 years I have had to supplement the diet with a gradually increasing amount of Permax (Pergolide). I am now exceeding the original limits for Permax, and may just be beginning to see what may be a side-effect, but at least my exposure is only 15 Pergolide-years. (6 years, ramping fron zero to 5 mg) The exposure if you start with an agonist on diagnosis, would be in the region of 60 to 100 Pergolide-years. Next, what is the reasoning which enables neuros to say with authority that it is advantageous to delay the introduction of levodopa? Let's start with a simple question: "What is Dyskinesia ? Answer: We don't know. We DON'T KNOW ?? How do you know then that it will be to your advantage to delay the introduction of levodopa? Well, dyskinesias get worse as time goes on, yes, and er, the amount of levodopa taken increases as time goes by. NO IT DOESN'T -Oh yes, thats right Well erm 'Motor Fluctuations' (They always say that when under pressure - The relevance to the subject is anybodies guess. And that is literally the extent of the reasoning that I have been able to glean. The hope is that if you delay the introduction of Sinemet by say, 2 years then at the other end of your life, when we know that it gets more and more difficult to control the Parkinsons symptoms, you will buy more time before that unhappy event. And that is all it is - a hope. I have a simple amd logical explanation which is naturally linked to the number of Substantia Nigra cells remaining. Since nobody has yet managed to alter the rate of deterioration of the Substantia Nigra in any way, just how do they think they are going to exercise this wonderful feat, and at a range of XX years (Fill in however many years you are planning to live.) I do know of one, inevitable result which will come from the adoption of this philosophy - Smith-Kline-Beecham will sell a LOT more Requip.. Now we are talking Big Business! Does anyone out there see things my way?? Regards, -- Brian Collins <[log in to unmask]>