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medication goal

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Hi Dr. Okun,

I am slowly titrating .25 ropinirole to try to determine the ideal dose. Right now I am taking 6:00 am: 2@.25; noon; 2@.25; and 6:00 pm 1@.25. I intend to add the 2nd .25 tablet to the 6:00 pm dose in a few days. I know this is still a very low dose, but I want to be careful not to exceed what I need. On this regimen I have consistent results of a reduction in pain & stiffness in my right jaw, neck, and shoulder, as well as a great improvement in energy and mood. (I had intractable fatigue for about a year before starting this medication.) I have inconsistent results for hip, hand, and ankle pain and stiffness--mostly I don't get enough relief from these symptoms to pursue my exercise goals. When I do have a window of relief from these symptoms, I feel like a different person. I find that caffeine can sometimes boost the effectiveness of the meds, but again, that does not seem to be consistent enough to rely on. My question is : what should my target for medication effects be? Should I be able to achieve complete symptom relief consistently at this early stage of PD? Or is that an unrealistic goal? If unrealistic, what would be a more achievable goal?



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We usually titrate up as you have done and we keep going until all bothersome symptoms are alleviated or improved, however in many cases you will not reach 100% improvement.  It is important to get the upper limit from your doc (some will go to 4-5mg per dose) but also to monitor and have your spouse or family member monitor for side effects such as impulse control disorders and dizziness/GI symptoms (among others).

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Thanks so much for your reply, Dr. Okun. This is useful information.

I live alone, but I have alerted my friends to keep an eye on me(!)

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