First of all, John, I salute and thank you for taking your time in responding my question and concern.

I have been taking half a pill of Sinemet 25/250 mg at 8 am, second half at 11:30 am, third half at 3:30 pm and fourth half at 7 pm for the last 9 months. Since administration of Neupro, I started with Lexapro 10 mg - gradual increments to complete 1 tablet during breakfast. I apply the patch around 9:30 - 10:00 am.

I was considering to quit treatment since the 4 mg patch has a marginal benefit weighted against the rigidity is causing to my left leg late afternoon and early evening (I guess that is the time when supposedly the patch reaches "half life" concentration). The 6 mg patch is apparently more effective but make me limp in the same time period. But after reading your advice, maybe I should not be too radical and "fine-tune" the
peak-dose dyskinesia with neurologist and give it one more try.

During the first two weeks of incrementing gradually from 4 to 6 mg, the side effects were not that cumulative; but they indeed were past one week using the 8 mg patch. That might be the reason why when I dropped only one day from 8 to 6 mg I could still have in my system the cumulative concentration of the higher dose.

To answer your final question: side effects start between 3rd and last Sinemet half pills.

I am very appreciative, John, for your insight.

Lobo