Limited life effectiveness of Sinemet

Shamey 24 post s 17-Apr-2007 1:03 AM	Do I correctly understand that someone with PD should try and avoid going on medication such as Sinemet for as long as possible to keep this drug in storage for when your symptoms become worse? I thought I heard that with each drug, there is a finite amount of time the drug remains effective for you in your body. Is there a standard progression of medication that a typical person with PD migrates through?
suzan29 5 post s 17-Apr-2007 12:38 PM	Ive been on sinemet Cr since 1994 and its still working pretty good for me.For me its important to keep the dose as low as I can to mimimize the side effects and the effectiveness thru out the coming years until a total cure can be found
Greg63 17 post s 18-Apr-2007 9:05 AM	Suazan Have you found a certain dosing method works best (for example low dose frequently during the day VS higher doses less often, etc) Thanks Greg
michelle 12 post s 18-Apr-2007 7:10 PM	This is exactly what I was wondering. All of the young onset lit says "stay away from sinemet". But my neuro said that a new study just came out that said taking sinemet from early age is not a problem, you just have to control how evenly the medecine is dispersed throughout the day. So, sinemet CR is a good option or iv sinemet is good. I don't know which way to go. Has anyone else heard of this study? Thanks
Ms Parkman 20 post s 20-Apr-2007 11:26 PM	Michelle- Several months ago I read on this topic of not delaying the start of Sinemet in young/early onset. I cannot site the source(s) of this information right now, unfortunately. However, in November we attended a symposium on PD at Cedars-Sinai in LA and the Neurologist speaking again stated that the protocol of delaying Sinemet in early onset was "old school" thinking. This neurologist advocated using Sinemet in early onset because of possible neuroprotective qualities derived from its use. We are going to a conference this weekend and I intend to ask this very question. My husband does not want to risk taking agonists at this time. If he could benefit from the smallest does of Sinemet CR, then why wouldn't he want to? Here is a website of an opinion that seems to support early use of Sinemet. http://www.umm.edu/patiented/articles/what_general_guidelines_treating_stages_of_parkinsons_000051_6.htm
Greg63 20 post s 22-Apr-2007 5:05 AM	Greetings Ms Parkman I am anxious to hear about your conference and the response you get about early use of Sinemet!!. Thanks for keeping us all in the loop and sharing...maybe your infor should go on the "message board" as well Thanks again and best of health! Greg
MarkComes Pharmacy Forum 103 post s 9-May-2007 7:35 PM	Shamey, The correct medication path for PD is what works for you. Everyone is different and their course of therapy is different. The modern belief on the use of Sinemet has supported using it at allstages of PD. Even early onset. With the advent of the dopamine agonists there has been a decline in the use of Sinemet in early onset PD. But, it is still being used. The belief of it not being effected later if used too early has gone away. The main goal of many PD specialists is to increase the quality of life now while we can still enjoy life. That is also how I look at myself. Best of health, Mark
Ms Parkman 21 post s 16-May-2007 8:00 AM	Greg- So sorry I did not get back to you after attending the conference in April. Yes, I did ask the panel of MDSs why they seem to perpetuate the ideal of stepping up to Sinemet only after the symptoms become intolerable using all the other drugs available. The answer given to the attendees was what I perceived as double talk. The speaker did not say that delaying the inevitable use of Sinemet is set in stone for every PWP, but said that the patient's needs should be considered and that some early onset PWP's are getting Sinemet. Then she went on with the tried and true mantra of saying that dyskensias with Sinemet affect everyone eventually and that again, it should be denied to the early onset patient. Ofcourse I do not agree with this, but my husband listens to his MDS who recites this to him and he believes it. My husband will not consider going to another MDS for another opinion because it would be an inconvenience. He currently is halfway into the titration up to 3mg ReQuip. It is not very effective for him. I can only hope that since he won't be getting Sinemet anytime soon, the the patch will work better for him when it becomes available.
lizzy4451 1 post 18-May-2007 8:15 PM	Ms. Parkman, I wanted to comment about your statement that your hubby isn't noticing much improvement as he titrates to 3 mg Requip. I assume you mean a total of 3 mg/day. If not, please disregard the following. Three mg of Requip per day is quite low and may not offer much improvement in symptoms. I'll certainly qualify this by saying that everyone responds differently to medications. Having said that, the 'normal' range for Requip is 9-24 mg/day. I've been (only) on Requip for 6 years. I currently take 6 mg/day (2-2-2) ... a very low dosage ... especially after 6 years. I've been VERY fortunate. Point being ... don't be discouraged if your hubby doesn't notice an improvement with 3 mg/day. At some point you may want to talk to his neuro about increasing the Requip to give it a fair chance.
lizzy4451 2 post s 18-May-2007 8:25 PM	Mark, I don't understand the change in philosophy regarding Sinemet. I understand the desire to improve one's quality of life today, but there are other ways to do that. Why exhaust this tried-and-true alternative so early in our course of treatment? Why bring on the dyskinesia sooner than one would if we stayed on other meds as long as possible? We basically get one shot (of usage) with Sinemet. Sinemet often is most effective for a period of 5 years and often causes increasing dyskinesia after that time. (See Michael J. Fox.) Yes, everyone is different and responds differently. Yes, there are folks who have been on Sinemet for 20 years with no significant side effects or dyskinesia. But ... on the average, it's 5 years and then dyskinesia. Your thoughts? Last Edited on 18-May-2007 8:32 PM
lizzy4451 4 post s 26-May-2007 8:12 PM	Hey Mark, I have another related Q. (Have I exceeded my limit?!?) Is Sinemet the only med that causes dyskinesia? If not, do the non-Sinemet alternatives ever/often/usually cause dyskinesia? What about the dopamine agonists? What is the likelihood of dyskinesia (in measureable terms)? Thanks SO much for all you do for us! Thanks a bunch! lizzy4451
MarkComes Pharmacy Forum 128 post s 11-Jun-2007 3:31 PM	lizzy, The "new" oulook on sinemet is brought on by the new aggressive treatment belief of young onset PD. Much of the old belief on Sinemet was the medication being used on the elderly population, The traetment of lower doses being used with a combo of other newer PD medication has displaced the belief of using Sinemet as a last ditch medication. As far as the dyskinesia, many of the other medication may cause it, but not to the extent of higher doses and longer treatment times of Sinemet. Best of health, Mark

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