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About Marketfocus

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  1. Marketfocus

    Rytary honeymoon then drop off

    Is there a recommended minimum interval with Rytary? And at some point does a fairly short interval suggest a return to Sinemet IR? Thank you.
  2. Marketfocus

    Rytary honeymoon then drop off

    I started Rytary a couple of months ago and seemed to have a really positive response initially-for the first few weeks, with more on time than I was having with Sinemet IR. However this benefit has diminished considerably as time has gone on. I'm wondering if this means the dose just isn't high enough or if this might mean I don't really respond to this medication? Do others have this experience where it's great at first and then drops off significantly? Thank you!
  3. Marketfocus

    Rytary experience

    Mark, Could you please provide a link to your description of your experience with Rytary? I realize everyone is different, but after a couple of months of trying Rytary where it seemed to have a pretty beneficial effect at first, it's now woefully inadequate - sometimes not kicking in at all, wearing off very quickly, being extra sensitive to food intake, etc. Don't know if I'm still just undermedicated and need to keep tweaking the dose, but I'm curious if others have had that experience. Thanks.
  4. Marketfocus

    Rytary transition

    I am finally trying Rytary and have been hoping to make the transition one dose at a time, beginning with the morning dose. My MDS has agreed to try this although has never done it this way/is uncertain how to implement this, having always used the published conversion charts. I have been taking 850 mg Sinemet IR, 25/100 1.5 tabs at 7 am, then 2 tabs each at 10:40, 2 pm, 5:20 pm and 1 tab at 8 pm. Based on this dose, the published dose for Rytary (for a switch all in one day) would be 3 caps 36.25/145 mg 3 times per day (1305 mg levodopa). Therefore, in order to try the morning dose only, I initially started with this level - 3 caps Rytary (435 levodopa) followed by my regular Sinemet doses the rest of the day (after waiting 4 hours to resume Sinemet). By the fourth day, I experienced significant dyskinesia lasting 6 hours, skipped my 2nd dose of Sinemet and resumed it once dyskinesia subsided. For the remainder of the week, I have decreased the morning dose of Rytary to 290 mg (2 caps), and after four hours have continued with regular Sinemet dosing and schedule for the rest of the day. I've experienced some but not significant dyskinesia with this approach. In general, I've had better on time for the entire day than I was having with regular Sinemet IR. As I'm still experiencing some dyskinesia, I'm wondering if I should further decrease the Rytary dose in the morning (perhaps to 240 or even 190)? Or is the dyskinesia possibly caused by the Sinemet taken later in the day? I'm uncertain how or if I should adjust remaining Sinemet doses for the rest of the day after having taken the first dose of Rytary in the morning. After reviewing this first week's experience with my MDS, her suggestion is to just go with the typical approach of switching to Rytary all in one day and adjusting from there. Given my sensitivity to medications, which was my reason for wanting to try the one dose at a time transition in the first place, I'd like to continue to give this a try and not give up after only a week. I am all for "starting low and going slow" with all medications and feel I will have a better chance of success if this can be managed gradually. I appreciate any advice or suggestions you might have on how to make the this transition to Rytary one dose at a time. Thank you very much!
  5. Marketfocus

    Rytary transition

    I am finally trying Rytary after I've had up to six hours of off time with Sinemet IR. But given my sensitivity to medications, I'm trying a transition one dose at a time, beginning with the morning dose. My doctor has agreed, but points out this isn't the typical approach and isn't sure how to best implement this. An article by Robert Hauser suggests that patients "sensitive to small changes in levodopa" initially find the right Rytary dosage for the first morning dose while remaining on the current levodopa schedule the rest of the day. Once the correct morning dose is identified, a second Rytary dose can be added and so on until the full day is covered. My Sinemet IR dose/schedule has been as follows: 25/100 - 1.5 tablets, 2 tablets, 2 tablets, 2 tablets, 1 tablet - starting at 7 am; 3.25 hours apart - for a total daily dose 850 mg levodopa Based on this dose, the recommended dose for Rytary (for a switch all in one day) would be 3 caps 36.25/145 mg 3 times a day (1305 mg) I've now tried the morning dose of Rytary for four days with the following experience and questions: Day 1: In order to start slower, tried Rytary 2 caps 36.25/145 (290 levodopa) for first dose. Did not kick in at all. Resumed regular schedule of Sinemet IR after 3.25 hours and felt pretty good the rest of the day (better than normal except for morning dose failure) Day 2: Rytary 3 cap 36.25/145 (435 levodopa) for first dose. Kicked in after about 30 minutes. On four hours (didn't really go off) but resumed IR at regular schedule for rest of day. Day 3: Same as day 2 except noticed more dyskinesia. Day 4: (today) Same dose Rytary for am dose (435 levodopa) at 7 am - by 12.30 still on but significantly more dyskinesia. Haven't taken next dose of IR yet 5.5 hours later (will wait until I go off and skip second dose IR) So I'm thinking the dose of 3 caps 36.35/145 (435) is too high and wondering how much I should back off - maybe 390 (145+245) or 340 (95+245) if I can hopefully get samples of these amounts? Or should I try the 290 again? Also, I'm not sure how to determine when/how much of my regular IR dosing/schedule to resume. It was obvious the first day when the Rytary didn't kick in at all and I was off. I just took my regular IR on schedule and it was fine. And I assume I shouldn't take another dose of IR when I'm already dyskinetic. Finally, when I hopefully reach a level of Rytary in the morning that (a) kicks in and (b) doesn't make me dyskinetic, how much of my remaining doses/schedule of IR would I take? It seems as if I just skipped my initial IR morning dose and then picked up with the second dose, I'd be getting too much C/L. Or should I slightly reduce the amount of Sinemet in later doses? I suppose these are some of the complications for why a switch all in one day is recommended, but I can tell already that the recommended dose of 3 36.35/145 TID would likely have been too high for me. The fact I'm getting more on time is encouraging to me whereas I've had frequent dose failures with the regular Sinemet IR. Anyway, thank you so much for your help and any advice you might have!
  6. Marketfocus

    Sinemet and morning Blood Glucose increase

    This discussion about how administered insulin affects Sinemet and vice versa makes me wonder how Sinemet might affect hypoglycemia in someone who is not Diabetic. I have reactive hypoglycemia where my insulin spikes/blood sugar drops rapidly after consuming too much sugar or carbs, etc.. I try to control it by following a low glycemic diet. But I have always felt that my PD symptoms were worse when I felt hypoglycemic and sometimes even immediately after taking my Sinemet (which I try to always do on an empty stomach) and I may be slightly hypoglycemic. I'm always trying to balance the food intake, Sinemet timing and hypoglycemia. I'm wondering if there might be a way to refine how I'm taking my meds (maybe smaller amounts more often?) or the liquid version mixed with vitamin c you've described before? Seems best to somehow keep the hypoglycemia at bay. Any thoughts you might have on this would be appreciated! Also do you have a link to the article mentioned above? Thanks so much for all Your time and the help you give all of us! It's really invaluable!
  7. I have the opportunity to apply to participate in a clinical trial for the Neuroderm subcutaneous carbidopa levodopa pump. I'm wondering what the results are so far as to the efficacy of this delivery system and what phase the clinical trials are now in. I've had a consistent problem with poor absorption of C/L right from the beginning of treatment and now have unpredictable on/off times. I've been diagnosed with SIBO and now have to take a PPI so I'm wondering if avoiding the gut with this type of option might be a good alternative. Rytary is my next step otherwise but I'm wondering if I have issues with absorption if that would be a problem with Rytary as well. Thank you for any update you might have on the C/L subcutaneous pump.
  8. Marketfocus

    Proton pump inhibitors

    Do proton pump inhibitors interfere with the absorption of Sinemet? I've been under the impression that drinking something acidic, eg with vitamin c, could help increase absorption so it seems that acid suppressing medications might have the opposite effect. Thank you.
  9. Marketfocus

    Sinemet absorption with applesauce

    If more acidity helps with breakdown of Sinemet, what is the effect of taking proton pump inhibitors (PPIs)? Does this further diminish the absorption of Sinemet? What about other treatments for GERD (eg Pepcid, ranitidine , etc?). Thank you.
  10. Marketfocus

    Sinemet absorption with applesauce

    I would appreciate the recipe for putting Sinemet into a drink formula. I'm also wondering if chewing an immediate release Sinemet (maybe one of my two pills per dose) could help with absorption . Thank you.
  11. Marketfocus

    Barium swallowing study

    I've recently developed laryngitis and difficulty swallowing liquids (causing occasional coughing/aspiration) and my ENT has recommended a barium swallowing study . His exam found a vocal chord nodule - he thought due to acid reflux - and incomplete closure of my vocal chords due to this nodule. He has prescribed nexium to address the acid reflux . I noticed in previous posts you mentioned a dye is used in the swallowing studies. Is this the same as barium? I'm concerned about side effects of contrast agents, including constipation for barium as well as these agents aggravating my frequent migraines. Is barium advisable with PWP and/or are there other methods used to assess swallowing in Parkinson's patients? Thank you.
  12. I've recently developed difficulty swallowing liquids and am taking my medications including Sinemet with applesauce . I previously drank a lot of water and often took my Sinemet with sparkling water to enhance absorption . I'm wondering how this might now be affecting the absorption of Sinemet. I'm concerned about my fluid intake in general and will be seeing a speech pathologist soon to hopefully get some help. But it seems as if sinemet's effectiveness has decreased further since I started taking it with applesauce. I'm taking it still as whole pills, not crushed. How much does water affect the absorption of Sinemet? Would crushing the pills or any other strategies likely help? Thank you!
  13. I'm wondering about a gradual transition to Rytary from IR Sinemet, maybe one dose at a time versus a complete switch in one day. It seems that different doctors have different opinions on this matter. I have a difficult time adjusting to new medications and would feel more comfortable taking a very gradual transition approach rather than switching all at once according to the conversion chart (which seems to be best guess and would need some adjustment anyway). also, I was given some Rytary samples which expired in July. Are these still good or have they likely lost effectiveness? If I'm going to finally try this medication I'd like to at least make sure the trial is with samples that are still effective. Thank you very much!
  14. Marketfocus

    Rytary transition

    I'm interested in trying Rytary because I'm really not getting a good response from regular immediate release Sinemet. I'm wondering if there is a standard protocol for making the transition - my current MDS is recommending making the switch all at once (in one day) from Sinemet to the best guess daily dose of Rytary. Yet a previous Doctor thought it would be okay to change one dose at a time - I've also spoken with other PwP who successfully made a very gradual transition to Rytary. I have a very difficult time adjusting to new medications and would feel much more comfortable with a very slow and gradual transition process. Is this appropriate for a switch to Rytary, and if so, what might a general transition approach look like? Finally I have been given Rytary samples which expired a few months ago, in July. Are they still okay to use? (Seems like it would be better to use unexpired samples, particularly starting out, but maybe there is more latitude in the date when they lose effectiveness . . .?) Than you very much!
  15. Marketfocus


    I'm wondering if Meclizine can be taken safely by PwP? A former neurologist suggested it might be helpful with the dizziness/vertigo I experience with migraines. Does it interact with Sinemet or is it otherwise contraindicated for persons with Parkinson's ? I have also read meclizine could potentially be neuroprotective. Is there any evidence to support that ? Thank you