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Sinemet CR "dose failure"

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Dear Dr. Okun,


I am a 40 year old WF dx with YOPD 18 months ago. I currently use the Neupro patch 8mg/24 hour and Sinemet CR 25-100 3x per day. Most of the time I am doing great on this regimen, BUT


Every few (4-6) weeks I'll have an "episode" where I start to feel badly very suddenly - dizzy, vomiting, leg and arm heavy, tremor worse, severe fatigue, generally awful. My MDS said it is a "dose failure" where my most recent Sinemet XL dose fails to cross the blood-brain barrier, so I have my "regular" PD symptoms plus withdrawal symptoms like N/V. It's not an everyday/common thing like a traditional "off" period, it's only every few weeks, but it is awful. So, he gave me some regular short-acting Sinemet to take as a "rescue" dose when it happens. Since that appt I have used the rescue dose 3-4 times, and most of the time it works pretty well and I feel much better within 30 min or so. But, I am in a line of work where that 30 min can be a life-or-death situation. So, he is recommending Apokin injections instead.


Does this situation happen often? Thoughts on the new plan? Thank you!

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In general I would suggest you and your doc think about another approach.


You could move your dosages to specific intervals at the same exact times each day and at closer intervals. Since you seem to turn on with your current dose you may try 5 hours dosing intervals or alternatively 4 hour dosing intervals. On time every time is a good strategy and often will avoid the need for rescue dosages. Hope that helps.

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