Should an early-stage PD patient try to keep dopamine agonist (e.g. RequipXL) use to the minimum (put up with as much symptom as reasonably tolerable) so as to extend useful life of this med before starting levodopa? Have read and been told by neurologists a clear YES (“...the use of any dopamine agonist will eventually cause a decrease in the sensitivity of the same dopamine receptors that it is intended to stimulate”) as well as a clear NO (“...it’s the progression of the disease that makes the drug less useful, not anything the drug itself does”). Can you help me find the answer, backed up by credible research? Would be grateful for the citings/articles. Thanks much!

hi rappleman,

I don't think anyone will be able to answer that for you accurately. Most neurologists recommend holding off on l-dopa and using the agonists. This makes sense and one can only wonder how those who waited would have done had they started sinemet from day 1. The opposite is true as well, those who started on sinemet can't go back so we can only compare similar pwp on sinemet from day 1 vs on agonists until they had to go on sinemet.

Finding similar pwp requires more attention to details in current day thinking as they search for subtypes of pd. So for example, i wouln't compare a tremor dominant pwp with a rigidity dominant one.

i can tell you my experience. i had a neuro who adamantly does not prescribe sinemet until he has tried everything else. This way I managed to last 6 years post diagnosis on agonists and anticholinergics and at least 3 years with symptoms before diagnosis [denial ] with no med before i went to a neurologist. So i feel very comfortable with the fact that i have had pd for at least 3 yrs [probably more] prior to dx.

So that means now i've been on sinemet for 11 years but also had pd symptoms for 11 years before I went on sinemet. i became dyskinetic almost right away. I have it somewhat under control with amantadine.
The problem with sinemet doesn't stop at dyskinesia and this reason even more than dyskinesia makes me obligated to speak out about it. Sinemet stops working after awhile and life becomes a big medicine juggle. Then you add more med.

My speech is ok in the mornings, but as soon as the sinemet builds up everyday my speech goes very faint, becomes very slurred and it races. I can outtalk anyone when my speech is racing.

Sinemet changes your personality too. But it works, i 'll never forget the relief i got immediately from sinemet. Unfortunately it doesn't last without modifications. There are people here who have taken sinemet since day 1 and 15 or more years later they are still doing fairly well.

as with everything it seems concerning pd - no one knows for sure,
but hope this helped some. the only thing they seem to know for sure is that exercise is imperative.

paula

hi rappleman,
It depends on just how the the agonists work for you. Some including myself tried and could not take the agonist. For me they made me sleepy. All I could do was sleep for about 6 months each Requip and Mirapex before I got off of them and started l-dopa. I have been on the l-dopa for almost 12 years now and still working well for me.
PD is a designer disease. I don't know of any two patients taking exactly the same dosage and combination of medications. I would suggest trying the agonist first. If they work for you great but do not be afraid to go to the l-dopa if the agonist do not work.

GregD

i'd try the agonist and see how well it works. nothing to lose.
everyone is different.
i couldn't tolerate requip, tried to get used to mirapex for 1 year but it also made me too drowsy.

have not tried the agonist extended release versions and am using sinemet, just satisfied enough to not want to give the new agonists a try plus with no insurance, generic sinemet much cheaper. but 1 pill/day is appealing.

i went without meds for 6 years after diagnosis and tolerated a lower quality of life.

what about azilect? also clinical trial for agonist patch? any chance of trying one of those?


vigorous exercise imho is possibly neuroprotective, might slow progression.