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Dear Mark,

I have written to you before about Rytary which I have given up on.  I was dxed in 2004, age 52.  I was started on Sinemet I think very soon after.  I checked & as far back as I can find (2009) I have been taking Ropinirole ER 4mg, Amantidine 100 mg, Azilect 1 mg once daily plus 10 mg c/l 6 x daily.  I am having little on times & a lot of freezing & off times.  I asked my neuro about changing meds & he said I'm on the best ones but I was wondering if my body is immune to them & a change might help.  Any thoughts would be greatly appreciated.  Thank you, Brenda

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Brenda,

Sinemet is the true gold standard for Parkinson care. That does not necessarily mean we stop looking if it starts to fail us.

I don't like to make a lot changes, so I would suggest changing the Ropinirole to Sinemet CR. This way you have consistency with your primary meds. You may have to tapper off Ropinirole and slowly increase Sinemet CR.

Make sure all Sinemet is taken one hour before food or two hours after a meal for best absorption.

Also, an add on of Amantadine to take 1 capsule twice daily would probably help.

Lastly, there is the Apokyne Injection, which works like an epi-pen that you can hardly feel, that brings you out of "off" periods very quickly.

I hope this helps and please keep me posted.

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Dear Mark,

I received carbidopa/levodopa ER 50-200 today with instructions to take 1 tablet at bedtime.  I just called his office & asked for the script & he ordered it.  Is this the way you think I should take it?  I was really hoping to not have to take as many 10-100's during the day.  Good neurologists are few & far between in this area & I know of no movement disorder doctors so I am hoping you will advise me soon! 

Thank you very much!

Brenda

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Brenda,

If you are taking it for Parkinson's and want to take less of the Regular Sinemet during the day, the usual dose of the ER is usually three times a day. You could try taking it in the morning to see how long the effects last, then talk to the Doctor to let him know. Many times I see the ER used three times a day and the Regular Sinemet used if needed throughout the day.

Usually the only reason I have seen Sinemet ER used at bedtime is for Restless Leg Syndrome. Since this is not the case, I would definitely get in touch with the Doctor and express your concern.

I hope this helps and please keep me posted.

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