What has the neuro done to find that dose of Sinemet that is enough for your wife to cross the "on" threshold, yet not too much to cause complications?

Knowing how your wife's symptoms vary during the day, especially in relation to her doses of Sinemet, would be useful.

If the neuro is against using Rytary, but accepts that your wife needs more than 1100mg levodopa per day to function, would he consider increasing the frequency of the Sinemet dose, decreasing the size of the dose, while giving a slightly higher total than now. If this helps, the values could gradually be increased (in both dimensions) until the optimum is found.

As a general point, I think the key factor for PwP is the graph of levodopa, or equivalent, during the day, rather than just the size of the dose. For instance, 1mg rasagiline gives about a 100mg levodopa equivalent dose {LED), but it is effective for the whole 24 hours, so it gives about 4mg LED/hr. The Stalevo I take is effective for me for about 3 hours, so a 75mg pill, which has a LED of 100mg, gives about 33mg LED/hour. Not surprisingly, therefore, the Stalevo has a far more powerful effect on me. Even a hour is too long; continuous monitoring and dosing would be useful.

John