How often do you have to change your meds?
Posted 23 April 2013 - 07:01 AM
How often do you have to change (commonly increase) your meds? I started taking levodopa three months ago, and i'm a little alarmed by my constant and rather steady need to increase my levodopa dosage. I've had to increase my levodopa dosage three times in the last three months (from 150mg to 200mg, to 250mg and then 300mg a day). Now i have to increase again, after only 10 days of improvement on 300mg of levodopa a day. If i didn't respond at all, i would understand it...It's like i develop some kind of tolerance to the drug...or just progressing faster...
Anyone else with a similar experience?
Posted 23 April 2013 - 09:30 AM
1. .25 mirapex 3x daily
2. .5 mirapex 3x daily
3. 1 mg mirapex 3x daily
4. 1mg mirapex 3x daily and 1.5 sinemet 25/100 3x daily
5. 1mg mirapex 3x daily and 1.5 sinemet 25/100 3x daily and 1 sinemet cr 2x daily
Everything starts out good, but by the next MDS visit 6 months later I need to adjust the medicines. I will also add I have increased the amount of walking/jogging that I do because it really seems to control my symptoms.
Posted 23 April 2013 - 08:28 PM
Posted 23 April 2013 - 10:47 PM
Edited by Kristakj78, 23 April 2013 - 10:50 PM.
Posted 26 April 2013 - 05:17 PM
The development of "tolerance" to the PD drugs with time is an issue of huge importance. The following data support this concept.
"...progressive shortening of the response to levodopa during long-term therapy is partially caused by development of tolerance to levodopa and not just by loss of dopamine storage sites"
"There is a tendency to continue to escalate doses of anti-Parkinsonian agents to lengthen “on” time, but the clinician should be aware that this is a strategy with diminishing returns.
The most striking example of this phenomenon in the author's clinic was a 50-year-old man who had been maintained on carbidopa/levodopa 25/250 every three hours and who, to cope with wearing-off at the end of each dose cycle, progressively increased his carbidopa/levodopa to 25/250 every 45 minutes around the clock and still had wearing-off. This case and some studies suggest that tolerance develops with continuous therapy (44–48). For this reason, it is worthwhile to try to limit the total drug intake and to provide some drug-free periods, generally overnight."
"Drug-free periods"...Makes you think, doesn't it? What if we don't progress that rapidly as it seems? What if our brain actually needs LESS levodopa? What if some of us develop this kind of tolerance faster? How can we "resensitize" our brains?
i wish we knew. I wish our neurologists knew better...
Edited by christie, 26 April 2013 - 05:18 PM.
Posted 27 April 2013 - 05:36 AM
I started my med oddessy with the agonists. I started with extended release Requip, then moved to regular Requip, then over the course of two years was taking 18mg of Requip a day. Yikes! Plus sinemet. I'm amazed I'm still here in one piece!
I slowly slowly slowly transitioned off all of that Requip (thank goodness) and am now taking more sinemet. In an effort to extend the on periods, I started comtan a year ago and, until I switched to the generic, it reliably gave me four hour on periods (the generic seems to give me no more than three hours). I am also now using the Neupro patch at the lowest dose they make which helps even out the off periods somewhat as well.
I think without the comtan and neupro patch I would be consuming handfuls of sinemet a day. You may want to ask your MDS about comtan, Christie. It doesn't work for everyone, but so far it has worked (more or less) for me.
Posted 27 April 2013 - 05:48 AM
Posted 27 April 2013 - 05:46 PM
I agree with you 100% that there is no real solution to this problem...Limiting the cumulative doses of levodopa in order to avoid long-term side effects is neither practical nor always feasible, especially in the presence of bothersome symptoms.
Still, the fact remains that PD "treatment" leads gradually-and with mathematical certainty- to reduced symptomatic control and increased side effects....Suggesting that the whole concept of simple dopamine replacement in PD is wrong. The best we have, yes, but still wrong.
Posted 28 April 2013 - 05:16 AM
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