hi, you might want to pose your question here: http://forum.parkinson.org/index.php...sk-the-doctor/
really can't offer any advice since i've never taken stalevo. Extended Release(ER)=CR
Downside to ER is it can be unpredictable and not kick in when expected or not at all, i believe it can take 1-2hrs to get to blood concentrations high enough to be effective.

you mention food, if you read the ER drug insert it recommends taking it with food, might take longer to kick in but lasts longer. i haven't really tested this.

I do ok on CR but have not hallucinations.

According to the NIH CL ER has less bioavailibility (which I found also to be true) requiring a higher dose for the same effectivity.

SINEMET CR is less systemically bioavailable than SINEMET and may require increased daily doses to achieve the same level of symptomatic relief as provided by SINEMET. link http://dailymed.nlm.nih.gov/dailymed...6-2520ef505cb0

If you have trouble with high doses (as you say your doc does) then ER would perhaps not be as good as the regular. I don't have PD, as it turns out, but thought I did at the time. I noticed I needed more to remain asymptomatic or "on" with ER. As I tried to get off sinemet I found ER was much less predictable and produced very erratic on off cycles over three hours that differed from day to day and hour to hour. I got much more predicable and stable effects that allowed me to better predict and reduce my dosing.

The mechanism for extended release in this drug appear to be inexact according to clinical data (measured elimination levels in urine).

PS I had more trouble with hallucinations and bad dreams with ER. I think due to it's less stable or predictable bioavailabilty/decay profile. The more sameness I had from day to day the less issue I had with side effects. Anytime you mess with the levels on a short periodic basis I tend to have more audio and visual hallucinations and horrid nightmares.

ashleyk writes:

"It is my understanding that regular sinemet has a half life of 1 hr ..."

That's about right for the plasma half-life. But, fortunately, the clinical effect of the drug lasts longer: perhaps, 4 hours in the early days, but less as the disease progresses. Brooks [1] writes:

"In the early stages of PD, this short plasma half-life is discordant with the clinical effect of the drug, which may persist for many hours, indicating that surviving dopaminergic neurons are able to store the exogenous dopamine generated from levodopa and so buffer variations in levodopa availability. However, with progression and further neuronal degeneration, the levodopa-buffering capacity is lost and deep troughs in plasma levodopa levels correspond with deep troughs in dopamine within the striatum, resulting in pulsatile stimulation of striatal dopaminergic receptors".

A combination of daily rasagiline and controlled release ropinirole, and Stalevo taken four times a day works for me, 9 years post DX.

Reference

[1] Neuropsychiatr Dis Treat. Feb 2008; 4(1): 39–47.
"Optimizing levodopa therapy for Parkinson’s disease with levodopa/carbidopa/entacapone: implications from a clinical and patient perspective"
David J Brooks
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515910/

John

I don't see any such number on either vial.

Interesting prices. I pay $1.68 for 30 generic 50/200s that i cut in half. I was paying $700 (with insurance) for 90 Neupro 6mg.