[Formydad]

My dad was prescribed Comtan about a month ago, but started taking it regularly early last week.
He was currently taking 3 25/100 Sinemet every three hours starting at 7am.
His doctor told him to add the 200 mgs of Comtan to EVERY dose throughout the day, and said nothing about reducing the Sinemet at the same time.
My dad said he felt like the Energizer bunny and by day 2 of taking Comtan w/ every full dose of Sinemet, he was horribly dyskinetic and it was like he was on speed, even at 10:00 at night, when he'd usually be heading for bead. In looking around, it seems like most people (and Dr. Okun on the other forum had mentioned this as well) back off of the dopamine when they start Comtan.
Did anyone who takes Comtan have success with it and did you back way off on your Sinemet in order to achieve a decent balance? He has noticed that it definitely works, in that it has increased his on time, but he hates the way it makes him feel so speedy, and the dyskinesias are really bad, especially by the end of the day. He's already very thin, so he doesn't need to lose any more weight from all the extra movements, plus they make it hard to do anything.
He's taken to breaking the Comtan in 1/2 and taking at every other dose, but only reduced his morning Sinemet dosages by 1/2 a tab. Should he back way off and see what happens? I mean, worst case, he just doesn't get "on" and has to taper back up again right?
Thank you all.

[johnt]

Comtan is entacapone. This can be taken in addition to Sinemet (which is levodopa and carbidopa). So, your father is taking every three hours:
300mg levodopa
75mg carbidopa
200mg entacapone
It is the levodopa that does the job, the carbidopa and entacapone increase the availability of the levodopa.

The same effect can be found by taking Stalevo which contains all three (levodopa, carbidopa, entacapone) in one pill.

Wikipedia states [1]:
"The most frequent undesirable effects caused by entacapone relate to the increased effects of L-DOPA, such as involuntary movements (dyskinesias). These occur most frequently at the beginning of entacapone treatment."

The entacapone increases the effectiveness of the levodopa by about 33% [2]. So, in your father's case it's equivalent to increasing his levodopa from 300mg to 400mg every three hours. This is a significant difference, and must be considered a possible cause of the "speedy" feeling.

I would discuss the situation with your father's doctor.

I am not a doctor, but if I were in this situation, I would slowly reduce the levodopa, not the entacapone. This is because the levodopa acts more directly. In Stalevo, all pills across wide range of levodopa strengths come with 200mg entacapone [3].

There may be good reasons for it, but you father's daily intake of levodopa is high.

References

[1] http://en.wikipedia.org/wiki/Entacapone

[2] http://www.birmingham.ac.uk/Document...hLEDReview.pdf

[3] http://en.wikipedia.org/wiki/Stalevo

John

[dilmar]

When I was started on comtan the neuro said to work up gradually one tablet at a time. I found i am able to increase the time between meds, effectively reducing my intake of L Dopa.

Diagnosed 2008
Current meds Madopar 100/25 x 4 (or 5) Ropinerole 2mg x 6. Entacopone 200x4

[soccertese]

adjusting pd doses is an art, not a science, but above all, you have to communicate with your father's neuro. can you talk directly to the neuro because if not you have what appears to be a serious gap in your father's medical care if you feel the need to intervene.
what are the directions on the comtan prescription vial? what does the drug information sheet say for comtan and what to do if you experience side affects?

300mg every three hours starting at 7AM is a high dose of sinemet, the neuro didn't want to increase the sinemet so prescribed comtam.

but this is something you need involve his neuro with, and it appears that's not easy?

some neuros don't recommend controlled release sinemet - SINEMET CR - but if your father hasn't tried it that might be a better option than COMTAN

[lindylanka]

Yes, I have been on Comtan for ages, but initially I had to regulate my sinemet down until I got a good balance. It then gave me a lot more on time and still does today. I did this slowly, week at a time.

[Formydad]

Thank you.

Johnt- you are correct. The last two days he has gone down to 2 1/2 Sinemet for the first three doses, but it still seems like that is too much. We have noticed a bit of compulsive behavior that is some thing new, so I suspect it is too much dopamine staying in his system.

He was having some falling off and unpredictability, so that's why the neuro said to try the Comtan.

I am not sure what the prescription bottle said, but the doc wrote him out a handwritten chart with the 3 Sinemet and 1 Comtan every three hours. I am trying to impress upon him that it is what works for him, and if that's not exactly what the doc wrote down, that's OK. I have met the neuro several times when I've gone to appointments and he has flat out told him to slowly adjust on his own (timing, etc) if he feels it necessary - a whatever works to optimize your on time with the least side effects.

I told him to cut way back on the Sinemet because he can always take an extra tab if he feels under medicated. Would that be the case? I am going to gets his doctors info this weekend and contact him soon. Dads next appt isn't scheduled until late January.