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soccertese2010

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  1. here's the information page on mayne 25/100 C/L there's a picture of the bottle label. MANUFACTURED BY ACTAVIS DISTRIBUTED BY MAYNE Dispense in a well-closed, light-resistant container as defined in the USP. Manufactured by: Actavis Elizabeth LLC Elizabeth, NJ 07207 USA Distributed by: Mayne Pharma Greenville, NC 27834 40-9267 Revised — January 2016
  2. i can't get teva so i'm going to have to find another generic that will hopefully work as well. teva owned Actavis so i assume MAYNE got the Actavis CARBIDOPA/LEVODOPA and gave it a new MAYNE NDC and is only selling that C/L and the TEVA generic was put on the shelf? If that's the case, they're sure going to have some angry pd'ers. i have tried the brand name sinemet and liked the teva generic better. http://www.tevapharm.com/news/teva_completes_acquisition_of_actavis_generics_08_16.aspx
  3. whoops, missed the 3x a day in your message, sorry. if i had to choose between two drugs, everything else being equal, i would pick the one that let me exercise the best. exercise may slow down progression and also benefits you in many other ways. sinemet will likely be superior to pramipexole since it binds to more dopamine receptors than do the agonists like pramipexole. sinemet is worth trying. mucana has l-dopa so your're already taking one of the chemicals in sinemet. i'd stop the mucana if you try the sinemet. a number of people posting on pd message boards praise mucana, the major drawback that i see is quality control.
  4. you might be better off with sinemet, if you're not happy with what your're currently taking stop the mucana and add sinemet, you could start with 25/100mg/day and if there are no problems then try 200mg/day and if that isn't enough then 300mg/day. i'm not a doctor and i assume you have to have a doctor write you a RX and you'll start the sinemet (carbidopa/levodopa is what you'll be taking or benserazide/levodopa) under their supervision. a great resource is THE NEW PARKINSON'S DISEASE TREATMENT BOOK by J.ERIC AHKSKOG who has treated pd'ers at the mayo clinic for 30 years, he's a firm believer in starting with sinemet. 1st edition is very useful too. europe uses different sizes than in the USA. There is a new longer lasting C/L called RYTARY but it's very expensive and intended for more advanced patients. not sure why you are taking only .75mg pramipexole, usually that is too small a dose to be effective, 2-3grams is usually when it becomes effective. 1mg of amantadine, did you mean 100mg? what symptoms are you trying to treat with it? sinemet is the brand name of carbidopa/levodopa and is made by MYLAN for merk. i've tried it, it didn't work any better for me than the TEVA generic which unfortunately is no longer made by TEVA, they sold the rights to a company called MAYNE which also acquired the ACTAVIS C/L from TEVA and is only making the ACTAVIS generic from what i understand. the merck product - sinemet - is much more expensive so get a generic and you might find one works better for you. i have no info on isradipine nor know anyone taking it who has pd and high blood pressure. here's an article on sinemet phobia What's Hot in PD? The End for Levodopa Phobia: New Study Shows Sinemet is a Safe Initial Therapy for Treatment of Parkinson’s DiseaseWhat's Hot in PD? - July 2014 http://www.parkinson.org/find-help/blogs/whats-hot/july-2014 The newest study published in this month’s Lancet included newly diagnosed patients randomized to receive a dopamine agonist, a monoamine oxidase inhibitor (MAOBI) or levodopa. The primary outcome was the mobility dimension on the Parkinson’s disease questionnaire (PDQ-39) quality-of-life scale which is a validated way to measure meaningful improvements. There were 1620 patients randomized and followed. The three year follow-up revealed the PDQ-39 mobility scores were better in levodopa as compared to the other two groups. Follow-up at 7 years revealed levodopa was the best therapy, but there was a small difference favoring initial therapy with the MAOBI when this drug was compared to a dopamine agonist. The treatment related side effects were less in levodopa. Over the past two decades the trendy phenomenon, referred to as levodopa phobia (intentionally avoiding prescriptions for levodopa) likely impeded the best clinical care for many Parkinson’s disease patients. An accompanying editorial to the recent Lancet article pointed out that levodopa phobia and also the favoring of agonist therapy was primarily driven by aggressive pharmaceutical marketing. The Lancet study revealed that all three therapies should be considered, but ultimately that the choice of drugs should be tailored to the individual patient. Patient-rated mobility in this study clearly favored initial levodopa therapy. What all this adds up to for patients and for Parkinson’s sufferers is that Sinemet and Madopar should be considered safe and effective as initial treatments for Parkinson’s disease. The doses and intervals should be frequently adjusted by an experienced neurologist/practitioner in order to maximize benefits, and to tailor to individual symptoms. Patients and families should keep in perspective that the “talk” about levodopa being toxic and accelerating disease progression (levodopa phobia) can prove a major distractor to good care practices. Precious minutes in the doctor-patient relationship should not be wasted on these claims, and prescribers should not avoid or under-dose this critical therapy, especially in patients with treatable symptoms. Critics of Sinemet and Madopar will need to bring forward much stronger human data if they wish to change clinical practice. In the mean time, we need to serve our patients by sharing with them the weight of the evidence which strongly supports that levodopa replacement therapy is not toxic, does not accelerate Parkinson’s disease, and can be used safely as initial therapy.
  5. gardner brought up an excellent point, that your SSDI benefit is based on a 5year employment window and can go down to zero whereas your SS benefit can never go down even if you stop work. if you think you can work longer at your current job or any other job and don't have to apply right away then you should determine if your benefit will go up significantly if you continue to work or GO DOWN. i found the local SS office very helpful at least where i live, it's worth visiting them for advice, believe it or not they are on your side.
  6. you are taking the activas brand. black or green tea has amino acids that might interfere with l-dopa, probably not enough to be significant but worth trying just drinking water with your sinemet. it is unusual that you do fine all day, no fatigue? and then you come home and you feel tired. one might speculate you aren't taking enough sinemet in the evening. just curious, how long have you been taking the activa ® and when were you taking teva, did you have the same problem? can you be more specific what you mean by tired? sleepy, brain fog, nauseaus? sinemet can cause low blood pressure, have you checked that? CR is different than RYTARY. RYTARY is a combination of IR and a new CR formulation and could be very expensive since it just came out and there are no generics. CR has been around for at least 10 years, there are generics that your insurance will pay for like IR.
  7. just curious benderet you mentioned a roche generic, I don't think that is available in the U.S. the make a pill for europe i think. can you post what's on both sides of the pills you are taking?
  8. it sounds like you know food/protein can reduce the affect of sinemet but i have to ask when do you eat dinner and on avg how much protein do you eat? do you drink anything with amino acids before 7pm, even tea? do you take any supplements around that time? energy drinks? i assume you've tried eating nothing 1hr before the dose that covers you at 7pm and no food/supps 2 hrs after? you might want to play around with 50/200CR at times, maybe in the evening. it has much less bioavailability than IR, 60-80% and might last 4 hrs and have an equivalent max of 120mg to 160mg compared to IR. THE problem about CR is predictability, it takes an avg 90-120min to kick in and sometimes not at all since it dissolves so slowly. neuros seem reluctant to prescribe it because of this unpredictability. i like the mylan brand. if food isn't a problem then you could time your dosages closer together. make sure your're well hydrated and drink 6oz-8oz of water with sinemet. adding tbsp of lemon juice might speed gastric emptying, the longer sinemet stays in your stomach, the more is converted to dopamine which can't pass the blood brain barrier.
  9. just to be sure, you think what happened to me is possible? my MDS is quite skeptical and i cannot find a similar first person account anywhere and i'm reluctant to try pramipexole again just to prove it happened. since that episode my pd symptoms have gotten worse, new chest pains that strangely enough only occur when i'm off. and after 14 years, the off comes on very suddenly, along with rigidity in my feet, left shoulder, right hand, abdomen and newly in my right shoulder. i was approved for DBS but postponed it because i was worried about having insurance in 2017 based on the election results, i couldn't be certain if i would have insurance to pay for anything that might go wrong for 3 years after the operation or if the batteries had to be replaced sooner than expected. i'll be 65 in 3 years. now i'm taking 150mg C/L every 2 hrs alternating/combining with50/200 3-4 times which can give me 3hrs per dose if lucky but this regime is obviously going to wear me out. i guess i'll try the other agonists if i can't get reapproved for DBS.
  10. my independent pharmacy can't get mayne c/l, out of stock at wholesaler and no date when they'll have some. he also said price is more than 2x that of teva. not sure what's going on here, hopefully there isn't a major cost increase cuz hard to believe 1 generic mfg could get paid 2x, 3x if there is competition. so stump, it would be interesting to see what your copay was. usually pharmacy dispenses cheapest generic so will be interesting to see if your copay was higher.
  11. hi dr. okun, after 2 days of taking PRAMIPEXOLE .125mg tid, i developed sudden sharp/jolting short lived pains in the a chest and left shoulder, ocassionally in the back if i moved those muscles. pain started out small and then got severe enough that i could scream. i stopped taking it and the pain went away. have you ever seen this? i see muscle pain under side affects but this came as quite a surprise to my MDS.
  12. LOL, nothing is free, they jack up the cost of RYTARY to paying customers.. just put me on ignore. i assume they'll be coming out with RYTARY 2, 3, there are a few other new CR's in trial, evergreen is doing one now. who'd thunk that 40years after sinemet's introduction we'd be wasting our time talking about C/L much less PD. imagine if TRUMP was diagnosed with pd or someone he cared about? we'd have a cure even if it cost trillions! Intec IN 11 004Phase III - A Study to Assess the Efficacy and Safety of the Gastric-retentive AP-CD/LD in Advanced Parkinson's Patients (Accordance) Description The purpose of this study is to determine whether the gastric retentive Accordion Pill™ Carbidopa/Levodopa (AP-CD/LD) is more effective than the commercially available immediate release Carbidopa/Levodopa in reducing motor fluctuations such as "off time" in advanced Parkinson's disease patients. Who may be eligible to participate? Subjects aged 35-85 years old, diagnosed with idiopathic Parkinson’s disease. Subjects must be taking at least 4 doses of levodopa containing medication per day with at least 2.5 hours "Off time" per day on average. Investigator: Daniel Burdick, MD For More Information: Marsha Merrick - 425.899.3115 MGMerrick@evergreenhealth.com
  13. 1 last thing, mylan 50/200 might be more expensive than the other 50/200 generics so chains will always dispense cheapest generic they can get, who'd thunk that, and that won't be mylan. i deal with an independent pharmacy and they will work with me on getting generics i want. I started with ACTAVIS 50/200 a few years ago, can't remember the specifics but it must have had some side affect or some reason that i was motivated to try another generic. everybody is different,maybe ACTAVIS works fine for you, but when i got it it was at least twice the size of mylan. my philosophy when trying a new drug and your're unsure of how good the generics are spend the money to buy the brand name so at least you'll know that is an option if you like it, then try to find a good generic, harder and harder to do as the bigger companies sell off their generics to get permission from FDA to buy more profitable drugs. generic 50/200CR mfg's aren't tested by FDA for CR properties, just peak blood levels compared to brand name, and they are tested on healthy people. so that leaves the door open for a CR variability. i'm pretty sure that what i just stated is true but i'll doublecheck. http://www.slideshare.net/ChrysopigiVardikou/parkinson-drug-sinemetlife-cycle-strategic-plan https://www.merck.com/product/usa/pi_circulars/s/sinemet_cr/sinemet_cr_pi.pdf Manufactured by: Mylan Pharmaceuticals, Inc. Morgantown, WV 26505, USA Copyright © 1996-2014 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. Revised: 07/2014 uspi-mk0295b-txr-1407r003
  14. STUMP, if you get 50/200cr get the mylan generic, they mfg the brand name sinemet, as far as i can tell they are the same. don't wait, get a 50/200 RX, if it works it will remove a major problem , if it doesn't then, well, failure is not an option . if your neuro says no then just tell her you just want a RX to take it at night instead of RYTARY to save money on rytary, i imagine a lot of people do that. just being a little silly here and i doubt your neuro will write you a RX but the old MAO-B inhibitor selegilene breaks down into a small amount of amphetamine which will give you a small boost of energy, normal dose is 5mg twice a day but you could take just 1 dose before you take the 100mg, might preserve enough brain dopamine to get by with your 100mg, but it might give you too much dopamine when you take 150mg. it was the first drug i used, back then it was used a lot in early pd and then TEVA came out with azilect in 2006 and TEVA spent a fortune on getting neuros to prescribe it. i like the 1-2hr energy boost it gave but stopped it after 1year, started mirapex. i was very lucky to find a neuro who was willing to discuss trying any drug/treatment and if i presented enough evidence would write me a RX.
  15. stump, not to be a broken record but i use a combo of immediate release and sustained release (CR) C/L to try to get the correct dosage, rytary isn't an option. IR/CR combos are not perfect and sometimes i have to change the dosage on the fly i'm not going ON as quickly as normal so i leave out the CR and only use the IR until i can get back to predicable ON's. after 15 years from diagnosis I'm having to take 150mg IR every 1.5 hrs, anything over that amount doesn't help but if i take a 50/200CR i get 3hrs of on time. if i can do ok with this god awful dosage regime i think you might have success adding CR to your 100mg in the afternoon. not sure why you only take 100mg, do you get dyskinesias, tremors, tell bad jokes"? anyway, my "laws" for taking CR are: 1. can't take it if C/L is not acting predictably, i.e., not lasting as long or ON is taking longer to kick in or no ON at all. If IR is being unpredictable CR will be worse, once IR becomes predictable i'll add CR back in/. 2. bioavailability of C/R is 60-80% if IR, so a 50/200 CR = 120mg to 160mg IR in terms of how much TOTAL gets into your system but the maximum blood level is usually less than 50% of IR but is much longer. i know i'm making this much too complicated but knowing the basics about each drug will let you intelligently play around with dosing.. it sounds like 150 would give you the boost you need in the afternoon but you get some unpleasant side affects, i imagine you have mentioned this in previous posts. a 50/200CR according to the following info will in in theory give you in 2 hrs peak blood levels that is only 35% of IR. but will give that to you for maybe 4hours. so 35% of 200mg is 70mg which might be enough. so lets say CR kicks in in 90minutes and reaches peak dose in 120min. so you have to calculate when your last IR starts drop off and take your CR a minimum of 90 minutes before that time. these are just rough numbers but it's enough to try some tests. at your stage of pd you just have to be close, not perfect in your timing. as far as when to take an IR after the CR, figure 4hrs of peak dosage then much slower decline than IR. I'm kind of tired, if you or anyone else wants me to provide more basics let me know. i can't afford rytary but it is expensive and will just more expensive as will all pd drugs, there likely won't be a generic in our lifetimes, the manufacturing process to create sustained release drugs is IMPAX's specialty, hard to duplicate. as with any brand name drug manufactured only at 1 plant which i think rytary is, what's your plan if production is interrupted by natural disaster, factory damaged or is shutdown by FDA who delayed approving RYTARY for a year until impax fixed manufacturing problems. you can get a bad lot, what's your backup plan if you run out for a week, can you just go back to regular C/L? I'd be in a world of hurt if i couldn't get CR, I would have to go back to taking IR every 1.5 hrs, untenable, i thank god can get at least 2 3hr ON times using a 50/200, 4hrs using 1.5 tablets, 2 tablets gives me dysk. . not trying to be a trouble maker but this is something neuros don't think about when they give you samples. they don't want to mess with CR, too much variability at times and most patients don't like having to change dosages on the fly if you take CR but you'll be in a better position if you take the time to understand how to intelligently add just 1 CR during the day and 1 at night. i had to study this since can't afford long lasting agonists, can't tolerate regular generic agonists, stalevo, or amantadine so that left IR/CR as my last choice, i delayed my DBS. s. n healthy elderly subjects (56-67 years old) the mean time-to-peak concentration of levodopa after a single dose of SINEMET CR 50-200 was about 2 hours as compared to 0.5 hours after standard SINEMET. The maximum concentration of levodopa after a single dose of SINEMET CR was about 35% of the standard SINEMET (1151 vs. 3256 ng/mL). The extent of availability of levodopa from SINEMET CR was about 70-75% relative to intravenous levodopa or standard SINEMET in the elderly. The absolute bioavailability of levodopa from SINEMET CR (relative to I.V.) in young subjects was shown to be only about 44%. The extent of availability and the peak concentrations of levodopa were comparable in the elderly after a single dose and at steady state after t.i.d. administration of SINEMET CR 50-200. In elderly subjects, the average trough levels of levodopa at steady state after the CR tablet were about 2 fold higher than after the standard SINEMET (163 vs. 74 ng/mL). In these studies, using similar total daily doses of levodopa, plasma levodopa concentrations with SINEMET CR fluctuated in a narrower range than with SINEMET. Because the bioavailability of levodopa from SINEMET CR relative to SINEMET is approximately 70-75%, the daily dosage of levodopa necessary to produce a given clinical response with the sustained-release formulation will usually be higher. The extent of availability and peak concentrations of levodopa after a single dose of SINEMET CR 50-200 increased by about 50% and 25%, respectively, when administered with food. http://medlibrary.org/lib/rx/meds/sinemet-cr/