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Sinemet 25/100 ER equivalent?

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What is the equivalent for Sinemet 25/100 IR with the ER? We have been trying to find that middle ground where the pain and decrease of movement is tolerable and at the same time there is minimal  dyskinesia. By accident i discovered that the ER of same dose worked pretty well. There was very good even on time. Still had to contend with dyskinesia but shorter duration. Some of my IR had been damaged so  until i could replace i used some ER i had..I have been on Sinemet 25/100 IR 6x a day or every 4 hours. Dyskinesia is quite severe. On the 25/100 i took similar but more often could go 5 hours and so sometimes only the 5 pills in a 24hour period. I have not seen anyone else on the ER. I also take Azilect and Ropinerole 8 mg ER daily - have now tried 4mg in am and 4 mg at night whick helps some,   i also have DBS. Just wondering if you have heard o fanyone on the 25/100 ER . What do you think is optimal timing for the Ropinerole? Thank you!

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First let's start with the Sinemet IR versus Sinemet ER question. My mantra with Parkinson's medication has always been "Start low and go slow." By this I mean to start with the lowest strength and increase slowly until the need response is met. I take both Sinemet IR and Sinemet ER myself.

My first recommendation is to keep a journal that contains the medication, dosage, time you took it, and when the dyskensia takes place. By this you will be able to see a trend of when the dyskensia or "off" periods happen and then you can correlate that to the doses of Sinemet you have taken prior to that.

At this poiAfter a discussion with your Doctor, you may want to talk about a medication regime change. As you said the Sinemet ER 25/100 did help you. I would start there. Te usual dosing is three time a day for the Sinemet CR 25/100. As you know, the more Sinemet you take the greater the possibility of dyskensia. If you are on he Sinemet ER 25/100 three time a day you may have to supplement with Sinemet IR in the strength od 25/100, usually take about 1 hour prior to taking the Sinemet CR. At this point, from your journal, you can see the trend and possibly chnge the dose of the Sinemet ER or the Sinmet IR. 

As we know, one size does not fit all. With this in mind you may have to change the dosage of the Sinemet CR (which only comes in 25/100 CR or 50/200 CR strengths) or the Sinemet IR (which comes in strengths of 10/100, 25/100, and 25/250). So there are many options to be able to tweak each dose every day. You may need to take a Sinemet IR 25/100 at 8:00am and a Sinemet CR 50/200 at 9:00am, Sinemet IR 10/100 at 2:00pm and Sinemet Cr 25/100 at 3:00pm, and Sinemet IR 25/100 at :00pm and Sinemet CR 50/200 at 9:00pm. Now if you find that you are having dyskensia between your morning and afternoon doses, you may have to decrease the morning Sinemet CR 50/200 down to Sinemet CR 25/100.

Trying to get the correct dose and regime of Sinemet can be very difficult to attain. That is why I highly recommend keeping a daily journal, with the information I stated above, to help you get as close to normal range to have the best quality of life.

Now to the Ropinirole. The exact timing is what is best for you because there are only suggestions as to when to take and they are not individualized per person. Once again, the medication journal will be helpful. Ropinirole is a nice medication because it comes in a variety of strengths, 0.25, 0.5, 1.o, 2.0, 3.0, 4.0, and 5.0mg in the IR dose and 2.0, 4.0, 6.0, 8.0, and 12mg in the ER dose. So your choices here are many. The nice ting about the many doses of the IR strength allows it to be either dosed all at once, (let's say 6 mg), spaced out to twice daily (3mg twice daily), and even spread out to three times a day (2mg three times daily). The ER version is usually once a day. The advantage of taking the IR dose is that you can specialize your your dose as to times when the need is the most. This will get you better control over your symptoms. This is also another medication where you may need to take 2 different strengths throughout the day to cover the needs of your symptoms (ie, taking 4mg IR in the morning and 2mg IR in the evening.

As you can see there is no definitive answer because the dosing of the medication can be specialized by you and your doctor to cover the times when you need it most to give you the best quality of life. It too me about 2 years to get the exact dose of Sinemet to control my symptoms to a bearable. The medication journal was truly the key. I brought the journal into my Doctor and we were able to see a pattern and adjust the medication appropiately to increase my quality of life. The regime I am on now is 2 Sinemet IR 25/100 at 8:00am (this gives me a jump start in the morning), Sinemet ER 50/200 at 10:00am, 1 Sinemet IR 25/00 at 3:00pm, 1 Sinemet CR 50/200 at 4;00pm, 1 Sinemet IR 25/100 at 9:00pm, and 1 Sinemet CR 50/200 at 10:00pm. I also carry with me Sinemet IR 25/100 as a rescue if I need it. I realized that taking an extra Sinemet IR 25/100 was to much as a rescue and it gave  m y dyskensia.

If you go to the main page of "Ask the Pharmacist" you will see a post near the top that reads "Medication Schedule." This is a fantastic tool to use as a medication journal to document the date, medication, strength, number of tablets taken at each dose, times of the day you take the medication, and a notes section to write down what happened throughout the day. You can either fill it in and save it to your computer or print them out and fill it in by hand (which I recommend). Then I usually recommend faxing or e-mailing it to your Doctor a few days before your appointment so both of you are on the same sheet of music when you have your appointment. This also saves time at your appointment because you do not have to go through everything that has happened since the last time you were there. It will all be on the Medication Schedule.

One thing to note is that you must have Microsoft Excel in order to download it.

I hope this helps and please keep me posted.

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