When to start Requip XL
 

I am a new one diagnosed with PD. Even maybe not diagnosed but assumed by my neurologist to have early stage of PD. Tremor in left hand (from end of last year), some stiffness in face muscles and neck…
He proposed to start Requip XL 2mg daily and see what happen with symptoms. But I hesitate… My symptoms annoying but bearable… Is it better to start medication such as Requip as later as possible ? Any thoughts ? If it has started can it be dropped without negative consequences ?

Thanks

A word of caution regarding Requip, it can have some serious side effects.....impulsive/compulsive problems.

to expand on Darrells answer
 

OCD usually affects around 25% of those taking an agonist. Usually one must take over 10 mgs of Requip or 3mgs of Mirapex to get OCD from it. One should IMMEDIATELY advise their doctor if they experience OCD symptoms.
It is not unheard of to get OCD at much smaller doses.
Personally, I would put off drug therapy as long as possible.
Yes, it can be stopped.
Charlie

Hi EugeneS,

Speaking from my own experience, there are two schools of thought about dopamine agonist (Requip and Mirapex). Try to stay off of medication as long as possible and start a agonist as soon as possible. It is believed that dopamine agonist have a neuroprotective ability.

As already mentioned dopamine agonist have some serious side effects. Suddenly falling asleep and Obsessive–compulsive disorder (OCD) are two of the better known side effects.

Here is the 64 million dollar question. How badly do your symptoms affect your quality of life? Are you still able to work without medication? Are you still independent and able to care for yourself and others without medication?

Requip and Mirapex both did absoulety nothing for me except make me want to sleep all the time. Everyone is different and our drugs affect us differently.

I hope this helps,

GregD

selegiline instead
 

your neurologist wants to confirm or disconfirm PD diagnosis via drug testing on you. maybe the least side-effect way is to trail on selegiline instead...just my two cents

I agree with Ling. Of all the PD meds, Azilect seems to be the safest (so far) and is working well for several people. DOPA agonists work well but come with a lot of side effects. I personally feel they are addictive and it has been quite difficult for me to stop mirapex. Thats my two cents worth

girija

Girija;
 

interesting you are having withdrawal issues with Mirapex. I quit cold turkey after my DBS. (Max dose of 4.5 mgs daily) My question is; do you think your
"addiction" is physical or pyschological? I never had any yearnings to go back on it myself.

Charlie

Eugene, I have been taking only 4 mg. Requip XL since last October and although it is helping with my physical symptoms (especially balance), I am experiencing compulsive behaviors. I would advise caution. I still experience alot of stiffness even taking requip, stalevo and azilect, but it might be because I'm sensitive to low doses. FG

Withdrawal well-documented
 

We all respond quite differently to agonists it would seem and I question why neurologists would even use it in differential diagnoses. The response to this drug class varies widely. For me, there is little benefit, if any at all with a low dose and I can't tolerate high doses due to side effects.

girija, I too have had withdrawal effect at a very low dose (.75 mg daily). The withdrawal feels physical, at least in my case. I think feeling like you belong in a methadone clinic and calling your doctor to beg for some sort of substitute to help you get through it, is indicative of a withdrawal phenomenon of some sort. If I even missed a dose of it, my body let me know in no uncertain terms who was boss. Google it and you'll find this is not uncommon.

Just my opinion, but wouldn't Sinemet be the standard to use in running an "ldopa challenge"? This does not mean that Sinemet has to be started at this point, but frankly, if my neurologist were testing me, it's the only drug I think that has been around long enough and works consistently enough to make a definitive diagnosis. Anyone else? My 2 cents.

Laura

Just the opposite
 

My experience with agonists is just the opposite of most of yours. I started nine years ago on Permax. I could have been the poster child for it. I was well until they took it off the market because it was killing people (and still I had to seriously question whether I could give it up.)

The start-up was difficult, it made me sick all the time for about six weeks then not a sign of a side-effect. When they took it off the market I was put of first Mirapex the Requip. I could not tollerate either of them. Sick as a dog. So began the Sinemet. Two years of that working fairly well, but I could not control the dystonia with Sinemet so I tried Neuropro(?) which worked fine but they took that off the market.

Hearing that agnosts worked better with dystonia I started back with Requip, very slowly. Now I take 15mg a day and it is working great. I have had no problems with it at all and it is quite effective on the dystonia with fewer side effects than Sinemet alone.

What can we say, it's a designer disease. I started taking meds as soon as I was diagnosed and I think it freed me. I was working and hiding and the effort pre-medication was exhausting. It all depends on your circumstances.

Good luck,
Pam