Originally Posted by johnt (Post 1252499)

alreadybutnotyet,

Welcome to the forum.

How long is it since you were diagnosed? And, how long is it since you've been having problems with your drug regimen?

In the ideal world you should discuss drug regimen issues with your doctor. But, in case he/she is unavailable to give timely advice, I raise the following points. But, please note that I am not a doctor.

200mg levodopa every 4 hours is not the same as 100mg every 2 hours. If you run the app, you will see in the output graph that the smaller, more frequent dose gives two lower peaks and its combined effect lasts longer.

As the disease progresses the gap between the "on"/"off" threshold and the dyskinesia threshold becomes smaller. Therefore, it becomes harder to go above the first threshold, while staying below the second threshold.

It would help if you kept a diary showing the times of your "on"/"off" transitions and your dyskinesia transition. It may be possible to relate those results back to your doses and also your diet.

You may be at a stage where you have to choose between being "off" and being dyskinetic.

How bad are your "offs"? For me, 12 years post diagnosis, they are not severe: my typing is much slower, but I can still walk well.

How bad is your dyskinesia? For me, I have none.

You imply in your post that you have compliance issues. Would these be worse if you had irregular doses both in size and time?

Do you have any other symptoms, such as dystonia, hypotension, falls. For me, I'm beginning to pick up troublesome leg cramps.

The process to follow is then one of two dimensional titration (both dose size and dose timing).

I would start by changing a single dose of just one of the IR tablets.

John

Originally Posted by soccertese (Post 1252489)

no, it doesn't negate the ER function, if it did the tablet wouldn't be scored, the package insert states it can be halved but not quartered. if you chew a ER then it approximates 200mg of LDOPA and 50mg of carbidopa. the C/L is mixed up in a matrix of starches, cellulose, maybe wax, so the matrix is maintained when split.

with ER, because it stays in your stomach longer, more of the l-dopa is broken down so it is estimated to be 60-80% bioavailable when compared to regular l-dopa.. i use the 60% number when calculating the total l-dopa i take/day, so a whole CR=120mg regular l-dopa.

btw, i prefer the mylan brand which i guess isn't available due to hurricane damage in puerto rico.

Originally Posted by johnt (Post 1186235)

I've written a very small app that calculates the LEDs of your drugs and totals them to get your levodopa equivalent daily dose (LEDD). It runs directly from the web page, so there's nothing to install. It can be found on my web-site at:


John

Originally Posted by jeffreyn (Post 1252617)

alreadybutnotyet said: "... when the timer goes off, I just reach over and instinctually turn it off and go back to whatever I was working on."

I do this sometimes as well, but in my case (at the present time) the consequences seem to be less severe. You could of course press the snooze button instead of the cancel button.

alreadybutnotyet said: "Shortly thereafter I realize what I've done and now I don't remember if I took my pill or not ..."

A multi-compartment pill container should solve this problem.

Originally Posted by alreadybutnotyet (Post 1252687)

So you're saying that half of a 50/200 ER is about 60% of a regular (non-cut) 50/200 ER? Is that the half-life of the pill? What parameter is reduced? Is it the length of time the drug is effective? Sorry for the confusion. My amantadine (1/2 tablet twice a day) makes my short-term memory problems worse.[/QUOTEt

taking the 2 halves of a 50/200CR has the same affect as taking the whole pill. if you chewed that pill the affect would approximate (2) 25/100. i see you are already taking a CR at night so you could play around with adding CR, subtracting 25/100 during the day.
i'm not a doctor so do this at your own risk or talk to your doctor, best to test on the weekends. i think a lot of md's don't recommend CR during the day for advanced pd'ers since it can be unpredictable and build up later in the day. like i mentioned before, i'll take 100-150mg of 25/100IR(immediate release) in the morning to get a jump start, an hr later 50mg of IR +50/200CR. This might last me 3hrs, i'll follow with 100mg and repeat the pattern just once or twice, i don't want to take more than 3 50/200's during the day.

just got an RX for 25/250 C/L. This gives me more options, split to get 125mg and 62.5mg when i split the 125. it has only 1 score but splits pretty ok into qtrs, pill is blue, the mylan brand. i've tried the 25/250 an hr after eating some protein (no will power) and it kicked in in an hour. fwiw, it's cost to a pharmacy is not much more than 25/100 and even though there is less carbidopa, if your're taking 1000mg combined IR and CR like i am probably doesn't matter. so even if you paid for the rx out of pocket it would be a cheap reserve.