[soccertese]

https://www.michaeljfox.org/foundati...dopa-conundrum

i find this discussion on developing a better levodopa administration very interesting.
i couldn't tolerate agonists so there was no choice but to start C/L, which i did 4 years after diagnosis and taking mirapex for a year before starting C/L.

it's amazing after 30 years since C/L came on the market were're still debating starting agonists vs C/L. I see a lot of newly diagnosed pd'ers paying huge copays for azilect and then later adding an agonist and wonder would they be better off physically and financially on C/L? And then add to that how incredibly expensive any new formulation of C/L will be, i haven't seen the projected price of rytary from impax labs, it's a new extended release C/L waiting for FDA approval but wouldn't be surprised if $10/pill. imagine being prescribed that and azilect?

[GerryW]

The linked Journal of Parkinson's Disease http://www.journalofparkinsonsdiseas...mans_Blog.html
has some fascinating entries both pessimistic and optimistic. The Brain Stain entry about how amyloid diseases progress through a sort of crystallization was of particular interest to me as it explains a lot and is hopeful.

[soccertese]

it's on my list of pd sites that i check daily and is one of the most interesting, the section where they interview researchers and give bios has a lot of interesting perspective.

[lab rat]

Originally Posted by soccertese

https://www.michaeljfox.org/foundati...dopa-conundrum

i find this discussion on developing a better levodopa administration very interesting.
i couldn't tolerate agonists so there was no choice but to start C/L, which i did 4 years after diagnosis and taking mirapex for a year before starting C/L.

it's amazing after 30 years since C/L came on the market were're still debating starting agonists vs C/L. I see a lot of newly diagnosed pd'ers paying huge copays for azilect and then later adding an agonist and wonder would they be better off physically and financially on C/L? And then add to that how incredibly expensive any new formulation of C/L will be, i haven't seen the projected price of rytary from impax labs, it's a new extended release C/L waiting for FDA approval but wouldn't be surprised if $10/pill. imagine being prescribed that and azilect?

I'd bet most PWP's take Azilect for its potential disease modifying effects. Without this benefit (?), its probably not worth much.

DA's like Neupro, are to keep the dyskinesia monster away by delaying the start of C/L.

At least, that's how I see it.

No disagreement about the copays.

[Tupelo3]

Originally Posted by soccertese

[url]

it's amazing after 30 years since C/L came on the market were're still debating starting agonists vs C/L. I see a lot of newly diagnosed pd'ers paying huge copays for azilect and then later adding an agonist and wonder would they be better off physically and financially on C/L? ?

Soccertese, you certainly have pointed out the number one dilemma for recently diagnosed PWP (1 - 4 years). It does appear that there is a huge debate between agonists and C/L when implementing second stage meds. However, there does seem to be more of a movement toward C/L rather than delaying with an agonist. I've spoken to three MDS over the past month and they have all told me that, although its case specific, they are leaning more toward low dose C/L than agonists as there second stage med. They all said they are finding a longer honeymoon period with earlier L/C implementation and clearly fewer side effects than agonists.

I also agree with you and Gerry that JPD is a great journal and Jon Palfreman has one of the best PD blogs on the internet.

[soccertese]

1. the first pd'ers who received C/L, i think back in the 1970's, many if not all developed DSK fairly soon, indicating it might correlate to how many years you had pd rather than just C/L
2. high doses of apomorphine may cause DSK, so not just C/L
3. DSK are reduced when the C/L can be delivered continuously as with dudopa or the soon to released extended release C/L rytary, even stalevo. even after duodopa is discontinued and oral C/L, reinstated, dyskinesias don't start up right away, indicating the even C/L DELIVERY modifies neurons some way.

hope i got the above correct.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096539/
Immediate-release preparations of levodopa have a half-life of 1–3 h,18 the length of which can be modestly increased by inhibition of peripheral catechol-O-methyltransferase (COMT) using either entacapone or tolcapone.19,20 This nonphysiologic stimulation further disrupts an already unstable striatum and is believed to be the basis for the motor fluctuations seen with chronic levodopa therapy.21,22 In fact, continuous infusion of levodopa has been shown to reduce ‘off ’ time and dyskinesias in patients with PD and motor fluctuations,23–25 and longer-acting dopaminergic drugs, such as dopamine agonists, are associated with dyskinesias to a lesser extent.26,27 These findings have led to the evaluation of long-acting levodopa strategies to treat the motor symptoms of PD.28

=================
i wish i could tolerate agonists, a patch or 1 pill/day would be nice. after 7years on C/L, never had DSK.

[lab rat]

Originally Posted by Tupelo3

They all said they are finding a longer honeymoon period with earlier L/C implementation and clearly fewer side effects than agonists.

Does this apply to Neupro ??? Seems to be effective and well tolerated. No eating restrictions and a smooth 24 hr delivery via a very small patch. Makes me feel (almost) normal. Just very expensive.

The MDS I go to hands out free samples like candy.

[soccertese]

Originally Posted by lab rat

Does this apply to Neupro ??? Seems to be effective and well tolerated. No eating restrictions and a smooth 24 hr delivery via a very small patch. Makes me feel (almost) normal. Just very expensive.

The MDS I go to hands out free samples like candy.

that's great if it's working for you at what i assume is a very low dose. how well do those patches stay on and any skin irritation? the concept is great, deliver the agonist directly into the blood and avoid the digestive system. do you wear a patch at night?

[lab rat]

Originally Posted by soccertese

that's great if it's working for you at what i assume is a very low dose. how well do those patches stay on and any skin irritation? the concept is great, deliver the agonist directly into the blood and avoid the digestive system. do you wear a patch at night?

You change the patch every 24 hrs. It is about a half inch square. It stays on just fine. It can be worn anywhere on the body. The manufacturer recommends not to repeat a patch location for 14 days.

I have no side effects at 6mg. Can go higher, but side effects could appear. The OVERWHELMING advantage is continuous delivery.

Co pay is high -- but well worth it. A HUGE improvement vs. Mirapex.

[soccertese]

MIRAPEX DOSE, side affects?
your neupro dose, cost, side affects?
taking anything else?
i have a friend paying thru the nose for azilect to add to their mirapex for a minor improvement, maybe it might be worth trying neupro.
and in the final analysis, would cheap old C/L work just as well?