Yea I remember but I simply ascribed it to your being English!!

anytime you up your Mirapex dosing, you run the risk of developing OCD.

Charlie

Am on requip..not mirapex...x

Steffi...Requip has been known to cause OCD, too. Being in the same "class" of drugs, I suppose that's no surprise. In our case, it is such a shame that Mirapex had such dire and dissastrous side effects because it worked so well for Doreen. She was as "happy as a lark" while all the while spending, spending, spending without a thought as to what that could mean for her..for us. I believe it was Charlie...maybe Greg...who mentioned having known someone to spend $250,000...I have often heard of this and, too, that many marriages have broken up due to the side effects of Mirapex. It is ironic that I am the one who first brought the OCD behavior side effect to both Doreen and her neurologist's attention...yet, it is I who will "venture/risk" asking him if he would consider prescribing Mirapex at a lower dosage than the 4.5 mg. that she was taking during one of the most terrible times of our lives. Actually, I suffered more than Doreen...she was having a "merry time of it" while I looked on and saw her changing before my eyes. Thankfully, I read about the possible OCD side effect at another forum...had no clue until then. I really didn't intend to go off on a tangent, here, about Mirapex...just wanted you, Steffi, to be aware of the same possibility with Requip for SOME people.

Therese

Hi All,

I was d/x four years back and my current problem is tremor which defies all attempts to reduce it.
My neuro asked me,
"Does Sinemet ever reduce the tremor."
Well......sometimes it appears to suppress it for a while about an hour after taking a Sinemet Plus 25/100mg. But mostly it appears to aggravate it.
At times I suffer from Sinemet build up and feel overdosed. At such times I reduce my intake to a half a pill, four times a day instead of a whole pill four times daily. This half dose I maintain for a few days until I feel under medicated, at which time I resume the full four a day routine.
When I started to take an additional Sinemet controlled release each night
it was initially better until Dyskinesia kicked in causing me to twitch and
jerk. I stopped the C/R and the Dyskinesia went away.
If I exceed my four a day Sinemet plus (ie 400mg per day) then the involuntary movements set in.
I also take Mirapexin (not generic Pramipexole) 0.088 at three per day.
This is useful and gives improved mood without causing any OCD
problems which did occur when I was taking Mirapex 0.35 at three per day.
At the higher dose of 0.35 I was seeing spiders, curling up on the floor and
had hypersexuality problems.
So with Mirapex it proved to be low dose good, high dose bad!
Clonazepam 0.5mg at night gave relief from tremor and anxiety for some months but then it's effects diminished requiring a higher dose.
This is the Clonazepam trap which for some can lead to Benzodiazepine dependence. This is not a good place to be, so caution is advised with Clonazepam although I am grateful for the relief they provided for a while.
My next trick in the battle against tremor will be to try a tricyclic anti-depressant. Either Amitriptyline or Mirtazapine are said to assist with tremor control although I am basing this only on reports from this site.
Maybe we can hear from a few more contributors whom have tried either of these two .
I would like to hear any suggestions for the reduction or elimination of tremor.
My present regime is: Sinemet Plus 25/100 four per day; Mirapexin 0.088
three per day; Melatonin 2mg, one at night to assist sleep and control restless leg syndrome. I am 64.
Any advice you can render on tremor is welcome.
Best Wishes,
Arsene

Arsene,

From what you write you seem to have a narrow gap between having enough dopamine in the body to reduce the tremors and having too much, which causes dyskinesia.

The issue then is how to increase the amount of time you spend in the good zone. Since we can't control dopamine levels directly, I find it useful to see things in terms of levodopa, levels of which we can control to a certain extent by, for instance, changing the timing and size of dose. Other Parkinson's drugs have a levodopa equivalent and we can use this as a common denominator to combine the effects of different drugs. See the "Levodopa Dose Equivalency" thread:

http://neurotalk.psychcentral.com/thread169655.html

The later posts in this thread describe how you can draw a graph of estimated levodopa levels during the day, which takes into account the half-life of the drugs.

You should then discuss with your doctor ways to smooth out levels. For instance, by using controlled release drugs, rasagiline, changing the time, size and frequency of the doses, pumps; using immediate release (except, of course, that it's not really IR) levodopa, perhaps dispersed in orange juice, as required, to smooth out the peaks and troughs.

I don't think the above approach will get rid of your tremors - they are still likely to be affected by stress.

I'd like to hear more about your "Sinemet build up" episodes, which last for a "few days". I don't know how to explain this in terms of half-life, etc.. But when something similar happens to me, I put it down to the good news that part of my internal dopamine production is still working.

John

Arsene,

I can't imagine taking that much medication but I do understand your frustration. I too am tremor dominant and was going nuts trying to calm it down until a friend suggested I take a different approach. I am not a crystals kind of woman and the only reason I tried this was because he is my friend and I felt I had to. He said to lie on my back on my bed, listen to New Age type instrumental music and breathe with the music saying "peace" on the inhale and "quiet hand" on the exhale. So I lay there with my arm bouncing around and tried this for a half hour! (amazed at my persistence) and the tremor stopped! Later in the day I tried it again and it took 15 minutes, then 5 and pretty soon I could stop it on demand by just concentrating, no bed, no music. This was several years ago and I have tremor when I'm anxious or exhausted, but it's not a constant companion. Meds? I'm consistent about the times I take them. Sinemet 25/100 at 7 am., 11 a.m and 3 p.m. .5mg clonazapam at bedtime for REM disorder, Requip XL 8 mg with the morning Sinemet. For what it's worth. Best of luck.

Johnt,
Sinemet "build up" is how I describe the feeling I get after many weeks of consuming my prescribed dose of four Sinemet Plus each day.
I reach a stage where I feel that I have more problems from the Sinemet than
from the PD. My tremor increases, my mind feels like it is spinning and I am reluctant to go out or unable to function in any useful way.
To test this thesis, I simply reduce my dose by half for a few days and then if feeling better stop taking the Sinemet.
I am aware of the possible danger of neuroleptic malignant syndrome, but have not had problems.
However I find that abstaining from the Sinemet gives me less tremor, a clear head and more energy; if only for a few days.
My longest period with no Sinemet was for ten days. By that stage all the PD symptoms had returned in spades and my movement was stiff while my head went into "washing machine" mode.
The safest way to try this is to titrate down and see if things improve.
Do not stop "cold turkey." If you do you will pay a price when the body/brain start screaming at you.
Arsene.