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Dear Mark,

I currently take 1/2 of a 1.5MG of Mirapex four times a day. I also take one  25/100 Sinamet three times a day. Could you please suggest a schedule? Should I be weaning off the Mirapex since I started the Sinemet or are they ok together? My stiffness has become a little worse and I feel my tremor is trying to come back. Should I request an increase in one of them? I don't know whether to mention it to my doctor, because my life style is not affected. Should I hold off on increasing meds as long as I can, or take whatever it takes to relieve the symptoms? I was diagnosed six years ago and am 67. By the way, I feel extremely lucky. I have no serious side effects from these meds.

Thank you for your time, Mark

Sheryl

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Sheryl,

The first thing you should do is call the doctor and see if he wants you to take both medications. It is not uncommon for a patient to take both medications. With this in mind I would not increase or decrease any of the medications until you speak with them.

As far as dosing of the medications, if you are in fact supposed to be taking them both, would be as follows. Since the Sinemet is an immediate reacting and the Mirapex is a longer acting medication, it is best to take the Sinemet at a time when the Mirapex maybe wearing off. Below is an example of a schedule you should try is you are experiencing the "off" effects.

8:00am Sinemet

9:00am Mirapex

2:00pm Sinemet

3:00pm Mirapex

8:00pm Sinemet

9:00pm Mirapex

Now this is the schedule for the "perfect" patient. It may have to adjusted for each patient, because as we know, no two patients are alike. I usually recommend that a journal be used to track "off" times, Dosing times of medications, food intake, excercise, and sleep times (including naps). You may start to see a trend when you track these over a period of time.  It must also be noted that Sinemet should be taken on an empty stomach (30 minutes prior to a meal or 90 minutes after a meal). If the meal contains protein or is extremely fatty, the Sinemet should be taken 1 hours prior to that meal or 2 hours after that meal.

I hope this helps and please keep me posted.

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Sheryl,

Please keep me posted. Instead of the times I laid out for you, you could substitute the starting time as the time she wakes up.

That would be the starting time for the Sinemet, then you would give the next Sinemet 6 hours from that time, and the last Sinemet 6 hours from the second dose of Sinemet. 

You would also follow the same timing with the Mirapex. 

Example:

1) wakes up at 6:00am.

Sinemet 6:00am, Mirapex 7:00am, Sinemet 12:00pm, Mirapex 1:00pm, Sinemet 6:00pm, Mirapex 7:00pm.

When people are early risers they may experience an off time prior to bed because the medication was started early. If this happens,  it is fine to take a Sinemet prior to bedtime if an off period should come about.

I hope this helps and please keep me posted. 

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