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Rytary transition

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I am finally trying Rytary after I've had up to six hours of off time with  Sinemet IR.  But given my sensitivity to medications, I'm trying a transition one dose at a time, beginning with the morning dose.  My doctor has agreed, but points out this isn't the typical approach and isn't sure how to best implement this.  An article by Robert Hauser suggests that patients "sensitive to small changes in levodopa" initially find the right Rytary dosage for the first morning dose while remaining on the current levodopa schedule the rest of the day.  Once the correct morning dose is identified, a second Rytary dose can be added and so on until the full day is covered.

My Sinemet IR dose/schedule has been as follows:  25/100  -  1.5 tablets, 2 tablets, 2 tablets, 2 tablets, 1 tablet - starting at 7 am; 3.25 hours apart - for a total daily dose 850 mg levodopa

Based on this dose, the recommended dose for Rytary (for a switch all in one day) would be  3 caps 36.25/145 mg  3 times a day (1305 mg)

I've now tried the morning dose of Rytary for four days with the following experience and questions:

Day 1:  In order to start slower, tried Rytary 2 caps 36.25/145 (290 levodopa) for first dose.  Did not kick in at all. Resumed regular schedule of Sinemet IR after 3.25 hours and felt pretty good the rest of the day (better than normal except for morning dose failure)

Day 2:  Rytary 3 cap  36.25/145 (435 levodopa) for first dose.  Kicked in after about 30 minutes.  On four hours (didn't really go off) but resumed IR at regular schedule for rest of day.

Day 3:  Same as day 2 except noticed more dyskinesia.

Day 4: (today)  Same dose Rytary for am dose (435 levodopa) at 7 am - by 12.30 still on but significantly more dyskinesia.  Haven't taken next dose of IR yet 5.5 hours later (will wait until I go off and skip second dose IR)

So I'm thinking the dose of 3 caps 36.35/145 (435) is too high and wondering how much I should back off  - maybe 390 (145+245) or 340 (95+245) if I can hopefully get samples of these amounts?  Or should I try the 290 again? 

Also, I'm not sure how to determine when/how much of my regular IR dosing/schedule to resume.  It was obvious the first day when the Rytary didn't kick in at all and I was off.  I just took my regular IR on schedule and it was fine.  And I assume I shouldn't take another dose of IR when I'm already dyskinetic.  Finally, when I hopefully reach a level of Rytary in the morning that (a) kicks in and (b) doesn't make me dyskinetic,  how much of my remaining doses/schedule of IR would I take?  It seems as if I just skipped my initial IR morning dose and then picked up with the second dose, I'd be getting too much C/L.  Or should I slightly reduce the amount of Sinemet in later doses?  I suppose these are some of the complications for why a switch all in one day is recommended, but I can tell already that the recommended dose of 3 36.35/145 TID would likely have been too high for me.   The fact I'm getting more on time is encouraging to me whereas I've had frequent dose failures with the regular Sinemet IR.

Anyway, thank you so much for your help and any advice you might have!

 

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First off, I like to say that if someone is going to switch from Sinemet to Rytary that they should do it 100%. Trying to take Rytary and still taking the Sinemet kind of defeats the purpose. 

Many times I see the conversion and it is correct to the chart that Rytary provides, but it seems, from my experience, that the Rytary dose seems to be too high. Many of the doctors I have spoken with have seen the same thing.

I would recommend trying to drop down to the 390 for now and see how that works. It is really trial and error at this point. If you feel an off period coming between Rytary doses, then you could take a regular Sinemet. Stepping down off of a medication is just like starting a new one, you must go down in small increments over time.

If you had better success on Sinemet and Sinemet CR dosing, I would think about going back to it. I know many patients have tried the Rytary and did not feel it had the timing like the Sinemet.

Going from 435 to 390 is not much of a dose change, especially if you are still taking Regular Sinemet. I think eventually you may have to decide which medication controlled your symptoms better, Rytary or Sinemet .

I hope this helps and please keep me posted

 

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