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Of course. Nita Brian Collins wrote: > 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]>