Hi.

I have been using Neupro for 3 1/2 weeks and the side effects since use of the maximum concentration patch have been worse than the disease itself. I started with 4 mg patch during 1st week. Not a problem except for a minor involuntary movement of left leg while watching TV. 6 mg during 2nd week, same side effect as during 1st week. Then, beginning 3rd week I started with the 8 mg patch. In the past 4 days I have had more intense involuntary movement.

During these 6 years of diagnosis, my biggest problem has been only stiffness, neither tremors nor involuntary movements but with Neupro, I have experienced involuntary movements in the past days as never before, to the point that have started to cause pain in my abductor muscle (leg).

Yesterday, my neurologist suggested me to reduce dose from 8 mg to 6 mg. Is this involuntary movement normal at the beginning of treatment? Is one month good enough time for screening or still too soon to reach conclusions? Will side effects (involuntary movement) disappear over time? Should I monitor involuntary movement for a couple of days and if it still persists consider use of the 4 mg patch only?

I also take Sinemet.

I would be appreciative of your advice.

Regards,

Lobo

I don't know if this will be helpful, but I took Neupro, 6mg, for over a year until I started getting chemical burns and nausea. I switched to Sinemet (3 25/100/day) and RequipXL, 8 mg to help smooth out the Sinemet. I've been on this since May 2014 and am a happy camper.

Thank you Nan for taking your time to respond.

Do you remember how many days it took you to conclude 6 mg was the ideal patch concentration? I assume you gradually increased the concentration to get to use the 6 mg patch on a permanent basis.

I don't think my neurologist is in position to specify proper dosing "at one shot" but me and with my feedback - side effects/benefit - then he either may object or support my decision. On the other hand, we, patients, are the ones who actually feel improvement or drawbacks and can provide useful hints or advice.

Again, thank you for your time.

Lobo

you might pose your question here

http://forum.parkinson.org/index.php...sk-the-doctor/

I had been using RequipXL before the Neupro and my MDS told me that 8mg requip = 6mg. Neupro, so I just switched with no problem. I had to leave RequipXL when they switched to a generic med and I reacted poorly to that (6--8 hours of nausea each day). When we added Sinemet, we went back to RequipXL (non-generic...quite expensive) but I have many benefits and few side effects so far. This has been a year.

I think it would be worth discussing with your doctor whether your involuntary movements were peak-dose dyskinesia.

You mention two sources of medication: the patch and sinemet.

The patch takes a few days to reach maximum effect. (Cmax for a single dose is after about 20hrs [1] and plasma levels are still considerable when the patch is changed after 24hrs, so the second day has a head start.) But plasma levels should be fairly stable after that.

Levodopa, on the other hand, has a much shorter period of action, 3-4 hours, with maximum effect after about 1hr - it varies considerably from person to person and from time to time. Therefore, levels will vary through the day.

Do your involuntary movements correspond to the time of maximum levodopa levels?

How much Sinemet do you take?

Put simply, your Sinemet dose may have been too low to get optimal symptomatic relief, but the addition of 6mg per day of Neupro patch may be too much for now.

Reference

[1] "Single dose pharmacokinetics of the transdermal rotigotine patch in patients with impaired renal function"
Willi Cawello,1 Sascha Ahrweiler,1 Wladyslaw Sulowicz,2 Agnieszka, Szymczakiewicz-Multanowska,3 and Marina Braun1
Br J Clin Pharmacol. 2012 Jan; 73(1): 46–54.
doi: 10.1111/j.1365-2125.2011.04053.x
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3248255/

John

First of all, John, I salute and thank you for taking your time in responding my question and concern.

I have been taking half a pill of Sinemet 25/250 mg at 8 am, second half at 11:30 am, third half at 3:30 pm and fourth half at 7 pm for the last 9 months. Since administration of Neupro, I started with Lexapro 10 mg - gradual increments to complete 1 tablet during breakfast. I apply the patch around 9:30 - 10:00 am.

I was considering to quit treatment since the 4 mg patch has a marginal benefit weighted against the rigidity is causing to my left leg late afternoon and early evening (I guess that is the time when supposedly the patch reaches "half life" concentration). The 6 mg patch is apparently more effective but make me limp in the same time period. But after reading your advice, maybe I should not be too radical and "fine-tune" the
peak-dose dyskinesia with neurologist and give it one more try.

During the first two weeks of incrementing gradually from 4 to 6 mg, the side effects were not that cumulative; but they indeed were past one week using the 8 mg patch. That might be the reason why when I dropped only one day from 8 to 6 mg I could still have in my system the cumulative concentration of the higher dose.

To answer your final question: side effects start between 3rd and last Sinemet half pills.

I am very appreciative, John, for your insight.

Lobo

Dear johnt:

Hi. It was wise to follow your suggestion. I visited the neurologist yesterday and he recommended me to use a 4 mg Neupro patch in the morning (I apply it at 6 am) and a 2 mg patch before going to bed (around 10 pm) while still keeping the 4 mg patch applied in the morning; in this fashion for 2 weeks. On 3rd and on, 4 mg patch in the morning, another 4 mg patch at bedtime.

This morning I had no dystonia during my hourly walk in the woods and I have felt no dyskinesia so far.

Thanks again for your advice and suggested reading.

Lobo