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Bode

Sinemet Use

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Dear Dr Okun, I am glad to find you here. 

I am writing from Nigeria. We only have the 25/250 Sinemet here. At the start of treatment about 7 years ago I was placed on Sinemet 1/2 tab 3x daily, Bromocryptine 1 tab 2x daily and Artane 1 tab 2x daily. At present, l use 1/2 tab every 3 hrs because of the frequency of off periods. I have stopped using the Bromocryptine.(on my doc advise)  I find my left foot shake uncontrollably a few times during the day. I have lost a lot of weight due to not being able to eat enough as I have to use the Sinemet 1 hr before food. Do you have any advice on how I can extend the On hours? Or any other general advice. DBS is not available in Nigeria and coming to you in the US is too costly for me, the last time I checked with you. Many thanks. 

Edited by Bode

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You may try a half of a tablet every 3 or 4 hours and that may help a lot (Sinemet 25/250).  Also be careful as the artane may worsen cognition and some people will not use this drug.  Mucuna pruriens can be added to the Sinemet as another option.

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The bromocriptine is not used much anymore because of risk of scarring of cardiac valves and lungs.  Most people switch to a non-ergot agonist (patch, pramipexole, ropinerole).

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Thank you so much. I am currently sourcing for the Mucuna Pruriens. I am scheduled to see my doctor in a week and I will ask for an alternative for the Artane. I hope the alternative will be available here 

Best Regards 

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Many of my patients use Sinemet, Madopar, Agonist or other medications and use them in combination to try to avoid Artane which can lead to cognitive and other side effects.  Hopefully you and your doc can work something out.

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Thank you very much. 

I was with my Doctor about a week ago and she said there are alternative medications for Artane but the issue in my country is with Availability and Affordability. She recommended Amantadine 100mg daily dose. Also to adjust the Sinemet (25/250) to half 3hrly. She observed that I displayed more anxiety than the  last visit and said this may be why I lost weight. I have now got the Mucuna Pruriens seeds but I don't have a processing procedure  to protect the L-Dopa during heating. I will continue to search. Any advice on Amantadine as I have read about some of the scary side effects? 

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Amantadine works best for dyskinesia in our hands.

Sometimes cutting the Sinemet in half when you use the 25/250 can leave you with not enough.  You may try 1/2 plus a quarter.  Also, be sure you are spacing the drugs appropriately. 

Tell me what symptoms you are trying to treat and the problems and times they occur with respect to med dosing and maybe we can give you and your doc some ideas?

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Thanks for the early response. 

The symptoms are as follows when I'm off  : Very slow movements, dragging of the left leg,  stiffness of the left arm (no swinging when walking ), uncontrollable shaking of the left leg when on or off periods is approaching, general body weakness, anxiety which delays the on period start up, ulcer-like stomach pain,. All these become more aggravated when stressed up. Also I come on at about 40 minutes after using the Sinemet. I do not feel any effects on the symptoms after using Artane. Because I feel very uncomfortable when off I tend to use the Sinemet about 15 minutes before the 3 hrs spacing. 

Many Thanks. 

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I feel I should give more details. The dose of the Artane is 5mg 2x daily. I notice that my thumbs shake slightly when I am not active though I manage to control them. My wife has complained that I am more active than my usual self when I am 'ON'. Anxiety has been there as a part of me for a long time but became more pronounced since I was diagnosed with PD and since  I lost my job. I control this by increased activity. I saw a psychiatrist for counseling. My doctor is reluctant to give me a medication for the anxiety and I agree with her. Many of the PD medications that I have seen in the other posts on this forum are not available in my country. I hope you have a better view of my case now. Many Thanks. 

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One suggestion you may try is asking your doc about dosing Sinemet every 2 hours.  There is also an artane tablet that is 2mg and if the benefits are the same at 2mg you will likely get less side effects.

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