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Difference between Stalevo and Mirapex


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#1 miracleseeker

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Posted 11 July 2013 - 01:09 PM

Dr Okun,

My mom takes both medication at the same time daily. Do you know why Mirapex is the drug that stops the shaking? I tried decreasing that because of excessive sleepiness but all it did was make her leg shake more. I thought they both work the same way but looks like each drug helps differently?

#2 Dr. Okun

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Posted 11 July 2013 - 04:03 PM

Mirapex is a dopamine agonist and works by stimulating the dopamine receptor in the brain.

Sinemet is a component of Stalevo and is a simple dopamine replacement. Stalevo has a medicine called Comtan that also blocks the breakdown of dopemine and makes it more available. In general both can help PD symptoms and both can usually help tremor. A lot depends on doses and timing.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#3 miracleseeker

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Posted 11 July 2013 - 04:47 PM

Why can't my mom function with just 1 drug?

#4 Dr. Okun

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Posted 12 July 2013 - 05:20 AM

It is totally possible to function with one dopaminergic. We usually recommend the use of sinemet using 25/100 tablets for the PD and titrating with the doctor by half pills until you find the exact best dose and best time interval between dosages.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#5 miracleseeker

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Posted 12 July 2013 - 08:13 AM

No my mom is addicted to Mirapex and requires both drugs to be normal. It might be true that one drug will do but it's kicking Mirapex that's not possible. Gotta love the pharamceutical companies that make sure you keep buying their meds.

#6 Dr. Okun

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Posted 13 July 2013 - 07:17 AM

About 1 in 6 people on dopamine agonists with Parkinson's disease will have compulsive behaviors or addiction-like behaviors. This may be due in part to the drug, and in part due to the individual's brain. In any case we have had some success in difficult cases by weaning the drugs down over many months and using drugs like depakote or clozaril to help with the withdrawal/addiction-like syndrome. This can be a difficult process. In the literature it has been termed the dopamine agonist withdrawal syndrome (DAWS).

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#7 miracleseeker

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Posted 25 July 2013 - 02:21 PM

How exactly would these 2 drugs help with the withdrawals? They are both prescribed for mental illness?

#8 Dr. Okun

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Posted 25 July 2013 - 04:46 PM

Could you define "withdrawals?"

Stalevo is a dopamine replacement therapy for Parkinson's disease that also has a dopamine extender called entacapone. Mirapex or pramipexole is a dopamine agonist. The patients on this forum usually utilize these drugs to treat symptoms of Parkinson's disease. Sometimes when stopping dopamine agonists you can get a withdrawal syndrome-- in many cases these drugs are weaned slowly and replaced with dopamine (sinemet or stalevo). If withdrawal symptoms persist some people add a mood stabilizer like depakote, an antipsychotic like clozaril, or a drug like amantadine. Some of the withdrawal syndrome, also called DAWS, can be very difficult to treat even when employing all of the above and sometimes even also behavioral therapy. Withdrawal can be like drug withdrawal in general (shaking, depression, anxiety, etc.).

I am not sure that is what you were asking, and if not I am happy to answer if you send a more specific question.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#9 miracleseeker

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Posted 26 July 2013 - 03:13 PM

Sorry Dr. Okun but I was referring to the 2 drugs that can help people get off Mirapex. Depakote and clozaril

#10 Dr. Okun

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Posted 26 July 2013 - 03:20 PM

These are used on a case by case basis, but often one or the other is added to the regimen and then a slow titration over many many weeks is performed to get people off of the dopamine agonist drugs. Using clozaril, depakote, or other strategies for helping to avoid DAWS and to treat dopamine dysregulation syndrome in Parkinson's disease has not been done much yet in practice. I suspect we will see more publications soon on this strategy.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#11 miracleseeker

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Posted 26 July 2013 - 05:48 PM

My question was how do these drugs help with getting people off of Mirapex? What is so special about them that it is being used for that purpose?

#12 Dr. Okun

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Posted 27 July 2013 - 07:21 AM


Could you define "withdrawals?"

Stalevo is a dopamine replacement therapy for Parkinson's disease that also has a dopamine extender called entacapone. Mirapex or pramipexole is a dopamine agonist. The patients on this forum usually utilize these drugs to treat symptoms of Parkinson's disease. Sometimes when stopping dopamine agonists you can get a withdrawal syndrome-- in many cases these drugs are weaned slowly and replaced with dopamine (sinemet or stalevo). If withdrawal symptoms persist some people add a mood stabilizer like depakote, an antipsychotic like clozaril, or a drug like amantadine. Some of the withdrawal syndrome, also called DAWS, can be very difficult to treat even when employing all of the above and sometimes even also behavioral therapy. Withdrawal can be like drug withdrawal in general (shaking, depression, anxiety, etc.).

I am not sure that is what you were asking, and if not I am happy to answer if you send a more specific question.



From yesterday?


From yesterday...does this answer?

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#13 miracleseeker

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Posted 27 July 2013 - 05:53 PM

You said mood stablizers help with withdrawals from going off of Mirapex. How does that work and why would it help?

#14 Dr. Okun

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Posted 28 July 2013 - 08:00 AM

We are not sure how or why mood stabilizers help with withdrawal from Parkinson's disease dopamine agonists. They may directly treat the symptoms, or alternatively stabilize the brain in some way-- we just don't know. They are also used in addictions of non-Parkinson's drugs.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips





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