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Brian, I started Sinement three weeks ago. 1/2 of 25/100 once a day for the first week up to two a day in the second week and upped to three day in the third week, and from there on a full 25/100 three times a day at meals. I asked if they should be taken at meals or on empty stomach and they said "it didn't make a difference." I have been diagnosed for about two years and tried Mirapex for about six weeks unsuccessfully. I don't notice much change yet but the tremors seem more pronounced and frequent. I know you have dealt with Sinement at length. Maybe you can fill me in with some expectations. Thank you. Any comments would be appreciated by anyone experienced with Sinement. [log in to unmask] ----- Original Message ----- From: Brian Collins <[log in to unmask]> To: <[log in to unmask]> Sent: Tuesday, September 14, 1999 2:54 PM Subject: Re: BARB and CAROLE AND Requip > On Tue 14 Sep, Clare Wilson wrote: > > In a message dated 9/14/99 7:40:06 AM Mountain Daylight Time, > > [log in to unmask] writes: > > > > << ReQuip, which caused severe joint and > > muscle pain, and a general worsening of arthritis >> > > > > Barb and Carole: this is interesting. Because I am coming down off > > Requip to check out the possibility that it is exacerbating my 'restlessness' > > or akathesia, whatever. I'm going up on sinemet CR 25/l00 at the same > > time. During the past l8 months, my neck and shoulder stiffness/pain > > has become more of a problem. It sounds likely after your reports, that > > Requip has been responsible for my own complaints, including lower > > back and hip pain. Brian is probably right...."don't have anything to do > > with the agonists!" I'm halfway to being completely off Requip. Wish it > > didn't take so long to titrate. > > > > Clare > > > > > > > Hello Clare; I just want to clarify your quote for others who may read this > correspondence and draw the wrong conclusion: I disagree strongly with > people who are urging newly-disgnosed PWPs, or those who may only be 1 or 2 > years since diagnosis, to start taking dopamine agonists in place of Sinemet > /Madopar. I slso disagree strongly with those who seem determined to stuff > as much as possible of any new drug down the throat of the poor PWP. Where > is the long-term plan? (We all know that PD is progressive: so the treatment > should also be progressive). > > I do strongly agree with the use of dopamine agonists in the later stages, > howewver, where the levodopa which we need to make up the deficiency in our > brain begins to be threatened by dyskinesias. It is at this point that I > advocate the introduction of a dopamine agonist -not much - just enough > to allow you to operate smoothly. In this way, I have kept going for the > last 6 years, and my dosage of Permax has gone from 0 to 5 mg. > > Here is the breakdown of my dosage; Diagnosed Age 39 > Started Levodopa Age 40 > Started Permax Age 54 > Current age Age 59 > > > I think that any PWP, at an early stage in the illness, should be presented > with a forecast by his neurologist, perhaps not as aggressive as my timings, > but sufficient to enable the PWP to d a little forward planning in his life. > Regards, > > -- > Brian Collins <[log in to unmask]>