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CR vs IR and eating

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I am wondering about making the change from Sinemet IR only during the day to a combination of CR and IR. I currently take CR only in the evening and I seem to get a better response than from the IR, particularly after meals. It sounds like on this forum that many people take CR through out the day, possibly in combination with IR with good results. When I've brought this up to my doctor in the past, she made it sound like it was too hard to predict/control the effects of CR with continuous use through the day. As I have considerable off time with some dyskinesia with the current regimen of IR only during the day, I'd like to try something different. We've also discussed Rytary but it seems that might be even trickier to switch to. I'd appreciate your thoughts on this.

 

Also, on a related issue, I'm wondering how it works when people take a low dose of Sinemet every two hours as far as food intake. If it's best to wait a period of time before and after dosing to eat, how does this frequent dosing work with meals? Thanks!

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I believe the IR and ER use at the same time should be used on a case by case situation. I will usually use my own experiences as an example when it is applicable. The IR is usually added to the ER regime when (1) someone is in need of a faster acting medication to get quick relief of their symptoms and (2) when people are finding that the ER dose is not lasting until the next dose so an IR may be used to hold off symptoms until the next ER dose is taken.

In my own experience and medication regime I take 2 Sinemet IR 25/100 soon as I wake up in the morning to "jump start" my day. About 30 to 45 minutes later I take a Sinemet ER 50/200. Around 3:00pm, I take a Sinemet IR 25/100 followed with a Sinemet Er 50/200 around 4:00pm. In the evening, about 8:00pm, I take a Sinemet IR 25/100 followed by Sinemet ER 50/200. The reason my times are not exact is because it all depends on how I am feeling and if i am feeling like I am going to be "off." I also carry a few Sinemet IR 25/100 with me in case there is a situation where I may need a dose in case I am going "off."

As for the issue of people who take Sinemet every 2 hours or so and how do the eat. If someone is in this position, they may eat about 30 minutes after taking the medication. Sinemet is best absorbed and most effective when taken on an empty stomach, food may decrease some of the absorption, but not all of it. Now if the person eats protein between doses, they my have to increase the dose after eating due to the interaction of protein and Sinemet.

I hope this helps and please keep me posted.

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I seem to remember you mentioning taking Rytary in the past.  In your experience, how does the Rytary compare to the regimen you just mentioned with the combination of Sinemet IR and ER in terms of effectiveness and side effects?  It seems I've heard more favorable comments about using ER and many comments about difficulty getting the Rytary dose right.  I'd appreciate your perspective on this.  Many thanks!

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I did switch from a CR and IR Sinemet regime to a Rytary regime when Rytary first came out. The initial dose of Rytary (which came off of a conversion chart  provided by Impax Pharmaceuticals which produced Rytary) seemed to too high of a dose and caused severe dystonia. When switching to a lower dose it did not seem I could get the timing of the Rytary and my symptoms in sync. I wanted to give Rytary a fair shot so I tried it for 3 months. I always give new medications 3 months to work unless I have a severe reaction. During that 3 months I kept a journal and for the life of me I could not  maintain a level of relief as I did with the Sinemet ER and IR regime. So I opted to go back on the Sinemet regime where I did receive great coverage.

There are many patients that have switched to the Rytary and have had excellent results. In the Parkinson's world, and the world in general, there is not a "one drug fit's all" situation. That is why there are so many medications for Parkinson's patients.

I hope this helps and please keep me posted.

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