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Hello. My dad was diagnosed with PD approximately 4 months ago, though we all believe he's had it for several years. He is up to 8 25/100 pills per day. He does have some improvement with speech and slowness. HIs biggest problem is balance and walking. His neurologist told him he is maxed out on the 25/100 pills per day, and the only reason a person would move to a higher dosage, such as 25/200, 50/500 etc. (just using those as examples, not sure of the exact ratio of carbidopa/levadopa), is to take fewer pills. True? I've read blog after blog after blog and personal stories of PD patients who take more than 8 pills of the 25/100 and the other combinations plus additional enhancers. Neurologist also told us that because he isn't having a good response to the 25/100, he probably has Parkinson's Plus. I saw improvement after his pills were increased one by one.


I am my Dad's caregiver and am trying to help him, so any advice would be greatly appreciated. This is all very new to all of us (and very scary to say the least!)

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First of all, thank you, from me and all the other PD patients out there. I truly believe sometimes it is easier to have PD than to be a caregiver of someone with PD. I really mean that & thank you.

The first piece of advice I can give you is that he is going to have good days and bad days, good hours and bad hours, & even good minutes and bad minutes.

There are a few things you need and need to remember when it comes to PD:

1) Keep a journal or calendar. On this you can put when you gave him the meds, what time ate and what did he eat, what times where good and what time were not so good. The good times are called "on" periods, while the bad times are called "off" periods. This is great info to give to the Dr. I usually recommend doing it on the computer, that way you can email it to him or print it off and fax it to the Dr a few days before the next appt. so you don't have to waste the first 20-30 minutes explaining what has gone on since the last appt. He already has it and should be ready to go the minute he steps into the room. The calendar will also help you adjust the timing of meds also.

2) With most, if not all, of the meds for PD, use the approach "start low and go slow." What this means is that the Dr will (or should) start off any med at a low dose and slowly increase it over time. If the dose is started too high...side effects. If the dose is raised too quickly....side effects. From what you have told me, it sounds exactly like what the Dr. Is doing.

3) PD is one of the unique diseases that tells you when to take your medicine. The key is to take the meds before your body says you have to. That is where the calendar comes in. You cab see that by changing medication "A" to an hour earlier really helped, now on the calendar you have the date you did it and what the results were.

4) the main goal is to increase his quality of life, nothing more, nothing less.

Ok, now to you're question. He take multiple sinemet tablets multiple times a day, and now the Dr wants to increase the strength of the tablets ao that he can take less tablets at one time and/or so he may also be able to take the sinemet fewer times per day. This is a usual progression of dosing sinemet. Why have time take 2 of the 10/100 when he can take 1 of the 25/250. The Dr if increasing the dose of each tablet with the hopes it will last longer. That is why there are so many strengths of sinemet. Because just the smallest dose increase can make a world of difference. Many times I have also seen Dr's mix and match long acting sinemet with short acting sinemet. What they usually do is start the day with 1-2 short (regular) acting sinemet. This helps jump start the day. Then the patient may take 1 long acting tablet 3 times a day, with some short acting about 1-2 hours before the next dose of long acting is needed. This helps limit the "off" period.

So, hopefully now you can see why the calendar is so very important. You can keep track of every dose and time change that you have made for him. It will also allow you to fine tune his meds so we can help him achieve the best quality of life we can at this moment of his life.

I hope this helped and please keep me posted.

All my best.

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