I am currently dosing Stalevo 100 every 2.5 hours-- for multiple reasons, I would like to extend the duration ( if I was still "on") to 2.75 or 3 hours. Outside of protein avoidance before and after dosing, has anyone increased dosing interval successfully using any intervention, "trick", etc.?

schwad01,

Ways to get more out of Stalevo:

Are you really careful to avoid all protein?

It has been reported [1] that a high-fat, high-calorie meal may delay absorption of levodopa by about 2 hrs.

I find exercise immediately after taking Stalevo enhances its effect.

If your aim is to take less drug in total, there may be benefit in taking smaller doses more frequently.

If your aim is to get the dose to last longer, and you were prepared to take an agonist, you could take a longer lasting agonist like ropinirole CR to give you a relatively stable foundation. If you wanted to avoid taking an agonist, rasagiline is an alternative.

You may find the levodopa equivalent plasma calculator [2] useful in order to visualize the pharmacokinetics of the situation. You could investigate the pharmacodynamics of Stalevo on you by repeatedly doing the tap test during the duration of a dose, see [3].

References:

[1] http://www.pdr.net/drug-summary/Stal...e-levodopa-441

[2] http://www.parkinsonsmeasurement.org...cokinetics.htm

[3] http://neurotalk.psychcentral.com/thread183360.html

John

don't have time for a well written response but you can pose your question here and/or search the other forums
http://forum.parkinson.org/index.php...sk-the-doctor/

i am on 200mg entacpone +150mg C/.L, ON for only 2.75hrs, neuro said up C/L to 200mg, just trying that as i type but that's not helping you. i did try taking 100mg C/L + a 50/200CR a few days ago and got over 3 hrs, ony tried it once so no guarantee it will help but if you have the CR you could play around with that. told my neuro about that and he said he wanted my to find the right C/L dose first.

seems a lot of the brits are taking REQUIPXL and STALEVO for a reason, half life of C/L is too short and in advanced PD'ers dopamine must breakdown extremely fast in the brain such that to get to that 3hrs of ON time would require +200mg which risks dyskinesia and low B.P. That must be why neuros advise spacing your doseages closer together rather than increasing the amounts. My neuro keeps mentioning DBS, he must be thinking, geez, if that guy got the DBS he'd be a much easier patient to manage.


o

thanks- obviously know your stuff-- i can't the statement about high cal-high fat in ref #1-- I do try and avoid "all protein" to an extent (lol) -limited because of my desire t omaintain muscle and weight--I still lift every day

great resource
http://www.parkinson.org/sites/defau...on_Matters.pdf

protein strategies start on page 12 but regardless what you do, there is going to be some period where amino acids from food will block entry of L-DOPA thru the BBB.
there is the 7:1 and 5:1 carbohydraterotein ratio strategy is mentioned that might overcome the BBB problem, haven't tried it

I tend to just eat most of my protein at night and just put up with the OFF's during the day, "i want to eat a whole egg"!. as soon as i feel "OFF" coming on i'll take a 25/100 and then 1/2 of a 25/100 every half hr until i start going "ON", giving up after 200mg. obviously not a science and you have to be careful you don't take too much.
sometimes depending on whether i have taken a CR in my last dose before eating or not, I'll take a 50mg regular C/L and a 200CR, knowing that the 200cr will take at least an hr to kick in and if the 50 doesn't do anything i'm pretty sure the 200CR will. i try not to take 200CR's in a row, every once in awhile there is a delayed on and the 2 doses overlap and i just feel yukky!!

i believe the SINEMET insert menions it lasts longer if taken with food, i assume that will delay gastric emptying, the pill will stay longer "upstream" from the area of the small intestine where l-dopa is absorbed rather than going past that area. i still haven't found an article really describing where the pill goes. if someone looks in your stomach are they going to find the "carcasses" of used up 50/200's? i put one in water, never changed shape after 2 days, just turned into the consistancy of a gummy bear.

as far as the affect of fat, that is mentioned in an article for dosing RYTARY by hauser, fat slows down gastric emptying, he SPECULATES eating ice cream would be a good choice.
google "how to dose rytary hauser" and pick the first link.

i've played with cooking carrots in the microwave, drizzle a piece of carrot with a tsp of olive oil and taking with a 50/200CR and for the few times i tried it didn't notice any longer "ON" but i might try it again. just getting lazy and apathetic.

Nagayama et al. looked at the effect of adding ascorbic acid (Vitamin C) to a dose of levodopa/carbidopa. They found [1]:

"significant increases in AUC and Cmax, and a significant reduction in Tmax by adding AsA were observed in 25 patients with baseline AUC < or =2500 ng.hour/mL. In conclusion, AsA can improve LD absorption in elderly PD patients with poor LD bioavailability".

Unfortunately, the paper is behind a pay wall and the abstract doesn't give enough information to determine the size of the difference. (Significance here means "statistical significance" - unlikely to happen by chance - it may or may not mean "clinical significance" - i.e. whether the effect would be noticed.) Also, check whether this was a post hoc analysis and, if so, whether it was statistically examined correctly.

Others in this forum have reported benefits coming from taking levodopa with grapefruit juice. Before going down this route check that this is not prohibited by any of the drugs in your regimen.

soccertese, you mentioned that you had not managed to dissolve Sinemet in water. Try dissolving in Vitamin C.

This observation leads nicely to the suggestion that you can alter the duration of a dose by changing the acidity of the stomach by, for instance, drinking water.

Reference:

[1] Clin Neuropharmacol. 2004 Nov-Dec;27(6):270-3.
"The effect of ascorbic acid on the pharmacokinetics of levodopa in elderly patients with Parkinson disease."
Nagayama H1, Hamamoto M, Ueda M, Nito C, Yamaguchi H, Katayama Y.
http://www.ncbi.nlm.nih.gov/pubmed/15613930

John

Thanks!- I have a copy of the full manusccript i will send you if you send your email--dave--

went back thru my notes, saw that i tried 25/100 + 50/200 + 200MG ENTACAPONE one time and got at least 3hrs, my notes said i was still on after 3 hrs but haven't tried it again. mentioned this to my neuro and he wanted me to not deviate from the plan, get the best dose of 25/100 + ENTACAPONE and then deviate from that.

Exercise does help. Not sure why, but maybe just feeling better and dropping weight.

I had added 200mg Comtan (Entacapone) to my 2 - 25/100 C/L. Helped as just C/L would last four hours, but with comtan I was close to six hours. Well now it is on for four hours. So add 1 C/L four hours into my six to make it the fulls six. When doing intense physical exercise, I add 1 25/100 C/L before exercise.

Rock Steady Boxing -- We work out on speed bag for one minute. When I am on, I am able to hold a rhythm on the bag. Basically my hands are doing circles around each other. When off, I keep hitting my own hands! It is really obvious I am skipping a beat. Hence supplement C/L before exercise so I can get through a work out session.

Dear wife asked "Sunday Breakfast?" Uh, 8:30AM now... meds at 10:00AM. So not possible unless we had left an hour ago, or wait untill 11:00AM. Just life.