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10-28-2012, 12:39 PM | #1 | ||
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Magnate
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this is well explained in an article described a little farther down.
and it ain't easy with oral l-dopa and i don't see anyone posting here with advanced pd reporting great results taking only an extended released agonist or the neupro patch, anecdotally have heard the patch is better for some people. so knowing that fluctuating l-dopa causes biochemical/transcription changes which might have a negative affect for hours/days, i'd say it is worth trying to achieve a consistant l-dopa level. that seems more art than science but duodopa shows that "quality" is more important than "quantity" with l-dopa. think about it, you pump the carbidopa/levodopa into your intestine, not your blood, you on average improve your "on" time and reduce dyskensia. the only difference between duodopa and oral meds is oral has to pass thru the stomach and duodopa doesn't and consistant dosing. i don't have dyskinesia but i certainly wear off and am way beyond the "honeymoon" stage and am still playing around with doseages of immediate release and controlled release. so if one has to take 50mg/hr for quality of life, possibly dissolving in ginger ale to speed delivery, then maybe you might have to do that. the 100mgIR/200mgCR combo makes sense since the CR is less than 70% bioavailable and therefore you could be getting 120mg of l-dopa and it takes longer to get into your bloodstream. i've read CR lasts longer if taken with food, i believe it's in the insert. IMPAX LABS will be getting their l-dopa tablet approved which is supposed to be as good as STALVO, hopefully better because it is a combo of immediate and controlled release l-dopa. ------------------- http://www.touchbriefings.com/pdf/2264/Mouradian.pdf here's interesting discussion of duodopa infusion which is given to patients where oral l-dopa just isn't working well, either too much off time and/or dyskinesia. -------- i found the following observations very interesting: Abruptly switching back to intermittent therapy does not revert the patients to their baseline severity of motor fluctuations. Rather, a relatively smooth motor response is enjoyed for at least several more days until the beneficial effect of continuous therapy eventually dissipates. The latter observation suggests that continuous therapy had produced plastic changes in the basal ganglia, which lasted well beyond the removal of the physiologic stimulation and re-introduction of intermittent therapy. The advantages of continuous dopaminergic therapy in PD can be gained in both early and advanced disease where fluctuations can be ameliorated both by stabilising circulating drug levels and by normalising some of the central pharmacodynamic alterations attending chronic, non-physiologic, intermittent stimulation 2. Clinical experience has shown that L-dopa given to non-parkinsonian patients produces no dyskinesias in the absence of nigral neuronal degeneration. 3. With advancing PD, as the number of dopamineproducing nigral neurons decrease from about 50% at the onset of symptoms down to about 20% or less, striatal dopaminoceptive medium spiny neurons become increasingly exposed to the fluctuations in plasma and brain levels of L-dopa and, hence, dopamine. The presence of a normal complement of nigral dopaminergic neurons in non-parkinsonian individuals shields the striatum from oscillating L-dopa levels. 4. With advancing disease, as more and more neurons disappear and the capacity to store dopamine and release it tonically is diminished, standard intermittent oral therapy with anti-parkinsonian agents with a relatively short half-life, such as Ldopa, result in oscillations in striatal intrasynaptic dopamine levels that mirror the oscillations in plasma. A neurotransmitter system that is designed to function normally tonically is replaced with an artificially pulsatile system. This non-physiologic situation is believed to underlie the altered pharmacodynamics of the L-dopa response. Biochemical and molecular aberrations have been documented in experimental models as a result of intermittent stimulation of the nigrostriatal dopaminergic system. 5. drug delivery such as with intravenous infusion of Ldopa. Abruptly switching back to intermittent therapy does not revert the patients to their baseline severity of motor fluctuations. Rather, a relatively smooth motor response is enjoyed for at least several more days until the beneficial effect of continuous therapy eventually dissipates. The latter observation suggests that continuous therapy had produced plastic changes in the basal ganglia, which lasted well beyond the removal of the physiologic stimulation and re-introduction of intermittent therapy. The advantages of continuous dopaminergic therapy in PD can be gained in both early and advanced disease where fluctuations can be ameliorated both by stabilising circulating drug levels and by normalising some of the central pharmacodynamic alterations attending chronic, non-physiologic, intermittent stimulation |
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"Thanks for this!" says: |
10-28-2012, 01:09 PM | #2 | |||
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In Remembrance
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For me, at least, using a short schedule (2 hours) approximates a continuous delivery rate. It is relatively easy to keep track and you just need to remember whether your first dose fell on an even number or odd. If I do mess up, it is fairly easy to merge back into a similar interval since I am never more than one hour off. I think this approach over the last few years has helped me get free of freezng problems and to minimize dykenesias.
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Born in 1953, 1st symptoms and misdiagnosed as essential tremor in 1992. Dx with PD in 2000. Currently (2011) taking 200/50 Sinemet CR 8 times a day + 10/100 Sinemet 3 times a day. Functional 90% of waking day but fragile. Failure at exercise but still trying. Constantly experimenting. Beta blocker and ACE inhibitor at present. Currently (01/2013) taking ldopa/carbadopa 200/50 CR six times a day + 10/100 form 3 times daily. Functional 90% of day. Update 04/2013: L/C 200/50 8x; Beta Blocker; ACE Inhib; Ginger; Turmeric; Creatine; Magnesium; Potassium. Doing well. |
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"Thanks for this!" says: | Conductor71 (10-30-2012), soccertese (10-28-2012) |
10-28-2012, 02:36 PM | #3 | ||
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Senior Member
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I think I've posted before that we too are on a two-hour med schedule and although every neuro we've told has been amazed that we can maintain this schedule, they have also said that it is much better as (1) you aren't dumping too much into your system at a time, thus the "peak and valley" you see with larger doses does not happen to as large a degree and (2) you are maintaining a fairly steady level of dopamine in the system. The problem, of course, is at night, when we try not to take any meds and that is getting increasingly harder.
This article is interesting to me for another reason: drug holidays. I have read several places that getting off of sinemet resets you to baseline (if you survive, there is that pesky mortality risk), so that even if you were taking 1000mg before, after a short drug holiday, you may start back to 2-300mg and have just as much response as you did years earlier when you first started taking the drug. This is fascinating to me, that in such a short period, the neurons can be "desensitized", I think they call it. There was also an article I read recently that talked about the theory that most PWP are taking way more drugs than really needed, and how much better they did if they gradually titrated down. Specifically, ldopa. I'll try to find it again but think it was on a parkinson's recovery site. Thanks for sharing the fruits of your research efforts |
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"Thanks for this!" says: |
10-28-2012, 04:14 PM | #4 | ||
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Magnate
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Quote:
http://www.touchbriefings.com/pdf/3009/Mouradian.pdf i think one has to be very careful when mentioning a drug holiday. |
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"Thanks for this!" says: | Atma Namaste (10-29-2012), pegleg (11-02-2012) |
10-28-2012, 07:11 PM | #5 | ||
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Member
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I am supposed to take 1.5 Carbi/Lev 25-100 every two hours. I find that if I take 1/2 every hour it works considerably better. The problem is trying to remember to take it every hour.
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"Thanks for this!" says: | Atma Namaste (10-29-2012) |
10-29-2012, 01:32 PM | #6 | |||
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Junior Member
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Quote:
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10-29-2012, 02:11 PM | #7 | |||
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Junior Member
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Quote:
Broken-cell-wall-chlorella, according to a DO I saw recently, is evidently good for cleaning up debris in the brain from Dopamine metabolization, but it is thought to chelate out the drug, decreasing availability. So it seems best to confine it to protien time. Just when the whole scenario seems to stabilize enough to attempt to pin it down with an analysis for possible comparison, it is liable to change. |
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"Thanks for this!" says: | moondaughter (10-30-2012) |
10-29-2012, 02:26 PM | #8 | |||
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Junior Member
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Quote:
Broken-cell-wall-chlorella, according to a DO I saw recently, is evidently good for cleaning up debris in the brain from Dopamine metabolization, but it is thought to chelate out the drug, decreasing availability. So it seems best to confine it to protien time. Just when the whole scenario seems to stabilize enough to attempt to pin it down with an analysis for possible comparison, it is liable to change. |
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10-29-2012, 05:32 PM | #9 | |||
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In Remembrance
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Generally speaking, yes. A typical day for me begins at 5:00 AM with a C/L 100/25 plus a C/L 200/50 and, if the bladder has been active in the night, a B-complex and a magnesium-potassium combo. Then at 7:00 AM I am uswually "on" and take another pair of the two forms of C/L along with whatever I am experimenting on. Repeat the pair at 9 AM, 11 AM, 1 PM, 3 PM (plus beta blocker and ACE inhibitor), 5 PM, and 7 PM. May have another at 9 PM but often not.
I know that that sounds like a lot, but I have little trouble with dyskinesia or similar woes and my freezing is seldom a factor. I was taking a heck of a lot of requip before this and jerking like a puppet plus daily freezing. This regimen, especially with the acetyl-l-carnitine, is a piece of cake and doesn't scare my wife so badly. I see danger in the multi-pharmacy approach and seem to be steadily improving.
__________________
Born in 1953, 1st symptoms and misdiagnosed as essential tremor in 1992. Dx with PD in 2000. Currently (2011) taking 200/50 Sinemet CR 8 times a day + 10/100 Sinemet 3 times a day. Functional 90% of waking day but fragile. Failure at exercise but still trying. Constantly experimenting. Beta blocker and ACE inhibitor at present. Currently (01/2013) taking ldopa/carbadopa 200/50 CR six times a day + 10/100 form 3 times daily. Functional 90% of day. Update 04/2013: L/C 200/50 8x; Beta Blocker; ACE Inhib; Ginger; Turmeric; Creatine; Magnesium; Potassium. Doing well. |
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10-30-2012, 09:08 AM | #10 | ||
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Senior Member
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[QUOTE=reverett123 (plus beta blocker and ACE inhibitor)
I have great difficulty maintaining a steady-state of almost anything; I can go one hour, or four hours, without drugs; absorption rates seem to vary endlessly, and different levels of emotional uproar or celebration or a hurricane or a good song seem to change the production of l-dopa in my own burnt -out brain, thereby messing up my perfect dosage. I have 2 default positions: very high and very low. Also, i get up sometimes at midnight; by 9 a.m. my pills for the day are already gone. Doc says take 3 a day at meals; mine are all gone when the sun comes up, so i improvise but not too well. yesterday i went to bed at 4:00 and got up at 10:00. That's p.m. I had breakfast at 11:00 p.m. i try to also sleep a second time in the day -- it's not 24 hour days; i do two 12 hour days, sometimes 4 six-hour days; hard to keep an even keel. but the reason i am here now is again i saw the R123 statement about ACE inhibitor;. what is it and where i can i get some? Can I smoke it? I want some because R123 has already done the Phase 3 clinical tests... on himself, as usual. And he says that his ACE inhibitor works. I let Rick test all my drugs before i take any. So does Merck, I hear. If it doesn't kill him, the FDA knows it must be okay. He has survived inhibiting his ACE and i didn't even know we have ACE's to inhibit. Rick, where's the legal source for ACE apps.? |
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