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carb/levo dose & schedule

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Hi Mark,

I am currently taking carb/levo ER 25-100, 4 times per day at 7a, 11:30a, 3:30p, 7:30p. It helps, however the last hour before I take the next dose, I have a wearing off period. I've heard that rytary would help with the off time or you've mentioned a combination of regular C/L combined with C/L ER. Which do you think would be a good place to start and could you explain the regular and ER combination method as I didn't quite understand the timing of that. Thanks for all your tireless help.

Any help suggestions from others who have the same situation would be appreciated.

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I will usually recommend using the combination of the c/l Regular Release along with c/l Extended Release. I know that Rytary has worked for many people, but it appears that the dosing regime and strength does not always effective as far as strength, timing, and the amount of capsules one must take daily.

The dosing scheduling that I usually recommend (based on taking the Extended Release c/l 3 times a day) is to take 1 or 2 tablets of the Regular strength c/l first thing in the morning  (let's us 8:00am as a starting time) to "jump start" your day. At about 9:00am is when you want to take the Extended Release c/l. This is then followed by 1 Regular Release at 2:00pm, an Extended Release at 3:00pm, A regular Release at 8:00pm, and lastly an Extended Release at 9:00pm.

What I would recommend is to keep a journal with the times that you take each medication, the number of tablets you take each time, and any side effects (ie. off times) that you may experience at the time of day you experience them. Instead of a journal, if you go to the main page of my forum (Ask the Pharmacist) you will see towards the top a header that reads "Medication Schedule." You will need Microsoft Excel in order to download this and have it work. This Medication Schedule has a place to write the date, medication, strength, times a day, number of tablets taken at each time, and also a section where you can add any side effects you may experience. The reason I created this is because it is a great tool to help you fine tune your medication regime. It is also a great tool for your Physician. Once you compile them, you can then fax or e-mail them to your Physician a few days before your appointment so they can look them over before your appointment. I recommend this because I know that much of the time spent on an office visit is telling the Physician what has happened since your last appointment. This way they already have it and the process can go much more smoothly.

I hope this helps and please keep me posted.

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