Stalevo and Comtan

I’ve always been suspicious about it but to me it becomes clearer ever since. The concept of COMT-inhibition does not work so well in Parkinson’s disease. The high level of Cmax make it more difficult to stay in the therapeutic window resulting in dyskinesias and muscular pain. I wonder how many people suffer form these side effects since they use Stalevo or Cmotam.

I've heard of this too and discussed it with my doctor in some detail. We came to the conclusion that it maybe a good idea to wait and see how the Sinemet continues to work before I go that route because the Sinemet is working so well for me now, and she feels that it isn't a good idea to swap medications unless something is broken.

I'm brain dead as it is (just kidding), and I don't need something else to help me along.

John

what a co-incidence...i am just wondering about the dyskinesia (mild) and dystonia after two years of stalevo administration. Initially, stalevo works quite well for me with prolonged life span of "on" time. However, in the last 6 months, the 3rd dosage of stalevo comes with it mounting dystonia. My doctor suggested me to cut down to two dosages of stalevo 100 and replace the 3rd dosage of stalevo with sinemet CR. I am still trying whether the new regime gives me sustained "on" time without the unwanted side effects.

My perception is that PD medicine or more correctly our brain has a very mysterious behavior (tricky response) to long term medication, chemicals that worked well before may not live up its promise in the long run. Sometimes, it may turn out quite messy. Excessive usage (though sometimes unavoidable) tends to shorten the life span of certain drugs.

LING

At one time ldopa was used with a "holiday" approach to attempt to stave off problems. It was a dangerous and excruciating experience that required hospitalization and was eventually abandoned.

But at the time there were few other drugs such as the agonists. I wonder if there would be something to gain by some form of rotation - maybe "x" days on only Requip or something and then "y" days on only Sinemet?

John, I sure would’nt change your medication when it is working so well. Don’t they say “Never change a winning team”
Ling, If your 3rd dosis is the last one of the day I can imagine this doesn’t work so well. I take medication 6 times a day. This is because “half Life” of levodopa is so short. You can prolong that with a COMT-inhibitor but this makes the peak levels of levodopa in the bloodplasma very high (Cmax). The shape of the curve doesn’t change.
It is important to prevent pulsatile stimulation of the postsynaptic receptors. The whole system of neurotransmitters is a matter of equilibrium. The body will react to an abundance of dopamine and try to break it down. (low levels of Vitamine b12 and high levels of homocysteine are indicative for this)
Another reason for what you call “a short life span” could be that the number of dopamine producing cells decrease. These cells function as a buffer; they store dopamine. Less cells also means less buffer capacity and thus more fluctuations.
Reverett, I rotate sinemet and madopar (prolopa) every other dose. I have the feeling this works though not spectacular

Joop