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noah

switching sinemet from 3times per day to q 2 hrs

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noah    66

 I take sinemet 3 times per day in addition to azilect and amatadine and have a little case of the wiggles(cant remember its formal name)

MY doc suggested trying 1/2 pill q 2 hrs.  Should I expect any symptoms as I try this out?  Any tips on how to make the transition?

I was considering asking him to give me ER formula instead of every 2 hrs.  IN your opinion which is better?Thank you

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Dr. Okun    411

I have not been impressed over the years that ER and CR (extended release) actually extends the life of the meds as PD progresses. I think you may be describing dyskinesia.  I always suggest lower dose and given more frequently.  I talk about the importance of timing and intervals in one of the chapters in the 10 secrets book.  It is critical to the success.  Keep working for the best dose and interval and also consider sometimes deep brain stimulation or dopamine pumps can be helpful when doses are required frequently.

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Dr. Okun    411

The protein issue does not affect everyone, so I first try to determine whether it is an issue.  I usually tell patients to try to eat 35-40 minutes after a dose of sinemet when there are 2 hour intervals.  It is art of medicine and everyone needs a little different plan.  Hope that helps.

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Dr. Okun    411

If you mean Stalevo, remember this drug is usually associated with more dyskinesia (STRIDE-PD study).

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MusicMan    771

I have not been impressed over the years that ER and CR (extended release) actually extends the life of the meds as PD progresses. I think you may be describing dyskinesia.  I always suggest lower dose and given more frequently.  I talk about the importance of timing and intervals in one of the chapters in the 10 secrets book.  It is critical to the success.  Keep working for the best dose and interval and also consider sometimes deep brain stimulation or dopamine pumps can be helpful when doses are required frequently.

I think I may have to start Sinemet fairly soon and would be interested in lower doses, more frequently. How would you typically begin a patient on this protocol, when their symptoms are fairly mild? Specifically, in general terms, how little and how often?

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chrissy55    1

 My neurologist is changing my meds from sinemet 25-250 X 6 daily and entacapone 200mg X 6 daily to Stalevo 200 every 4 hours. I am a little scared because the sinemet entacapone is working ok , Dr. wants Stalevo. I usually get sick when I have to change meds. I am looking for a little reassurance. Thank you

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Dr. Okun    411

I personally usually do not change things much if working well.  I also watch out for dyskinesia with Comtan or Stalevo.  Having said that many times a new regimen can be brilliant so the follow-up is the key.

 

To start sinemet we typically use mild doses, 1/2 tab every 4 or 5 hours and slowly titrate up over many weeks until symptoms are controlled.  There is no formula as it must be titrated to the symptom(s).

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