Wendy,

I'm not a doctor, so make of this what you will.

Ideally, you and your neurologist should go through the process described below together. However, if you are having difficulties accessing good medical care, you don't want this matter to lie unresolved for months. So, you may decide to DIY it. You will, though, need him/her to prescribe for any change of medication.

Also, I'm assuming that you have straight IPD with no complications. If you do have complications, I would keep very close to your doctor's ideas.

For at least 3 days before making any changes keep a diary showing the times of:
- when you take your drugs and the dose;
- when you eat;
- the times of "on" and "off" periods;
- the times of dyskinesia.
Keep the diary when you makes changes.

Attachment 9661

The graph above shows theoretical plasma levels using my drug regimen. To get your graph run this program using your data:
Parkinson's Disease Measurement: PwP, surveys, trials, analysis
(Unfortunately, I've not added pramipexole [Mirapex] to the program. Rather than be stuck in your tracks, you may want to assume that 1mg pramipexole is approximately equivalent to about 5mg ropinirole.)

Add to the graph your diary information. You should find a correlation between the plasma levels and the periods of "on", "off" and dyskinesia.

I would start with a single objective: in your case, reducing the end of day dyskinesia. You need to move in small steps, changing just one thing at a time. Use the graph to inform you as to what to do next. For instance, you could move your last dose of pramipexole 30 minutes later. If you're lucky, this itself may solve the problem, but if you're unlucky, it may make things worse. If so, go back a step. Alternatively, it may cause other problems. If so, repeat the process one step at a time.

Good luck!

John

This is REALLY interesting, thank you, John. I've been playing with the graph, trying to level out the "mountains" and to stay closer to the way the graph is in the mornings when I feel the best. I totally agree that small steps are best but this gives me a much better idea where to start.

I only see my MDS once a year because it's a 5 or 6 hour drive, but he's good to respond by phone at other times. He's used to me playing around with my meds, and prescribes so that I can.

I'd like to use Mirapex in the graph if I can. Its TMAX is 2 hrs, THALF is 8-12 hrs. depending on age, and the conversion factor is 100. The LED is 0.25 - 1.67, mean is 1.1 mg. How do I figure out the CMAX?

Thank you for your help. This is the most interesting and helpful thing I've run into in a long time!

My apologies go to eds195 for not keeping on topic.

Wendy, I've continued our discussion in its true home:
http://www.neurotalk.org/parkinson-s...valency-2.html

John

No sweat johnt, it's all good and interesting....miss the uk....used to run a $/£ desk back in the day.....sorry, back to crappy PD........

Eric

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