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Gradual transition to Rytary/expired samples

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I'm wondering about a gradual transition to Rytary from IR Sinemet, maybe one dose at a time versus a complete switch in one day. It seems that different doctors have different opinions on this matter.   I have a difficult time adjusting to new medications and would feel more comfortable taking a very gradual transition approach rather than switching all at once according to the conversion chart (which seems to be best guess and would need some adjustment anyway).

also, I was given some Rytary samples which expired in July. Are these still good or have they likely lost effectiveness? If I'm going to finally try this medication I'd like to at least make sure the trial is with samples that are still effective.  Thank you very much!

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There are many ways in which the Rytary can be added to a medication regime. I have seen Rytary in the morning and Sinemet in the afternoon and night time for 1 week. Rytary morning and afternoon the next week. Then Rytary 3 times a day with no Rytary. Then you have to go through fine tuning the Rytary. I am not saying it is a bad medication,  because it isn't. It has been a savior to people in my family, my friends, and patients.  But, it was not for me. My true belief is that if a person is going to try Rytary,  then the should start it all in one day, by itself, and keep a journal (which I believe everybody with Parkinson's should do). This journal (which should contain medication,  strength,  time of day, time of when and what you eat,  the time you wake up and the time you go to bed) can show trends when off and on times occur and this will help you adjust your medication. 

I have also noticed that the exchange chart just works on total Sinemet used and not the Sinemet CR, but you should just add the dosage.

What I have heard from patients and Dr's alike is that the exchange rate seems to give a Rytary dose that appears a little high, thus giving the patients dyskensia,  headache, vomiting, and if long term it can cause obsessive disorders. This could possibly be not taking into consideration of the CR, but many Dr's are looking at the conversation table and dosing it down one notch. Also, c/l is carbidopa/ levodopa. So if the chart states (Situation A) you should start at 3 capsules of Rytary (each cap if 48.75/195) three times a day, some Dr's are choosing (Situation B)  4 capsules of Rytary (each capsule is 36.25/145)  three times a day. The total levodopa  difference between situation A and Situation B is 15mg of levodopa DAILY. But we all know how much a a different 15mg can make.

I hope this help and please keep me posted.

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