I was diagnosed with
Parkinson's in the USA and my dosage is half a tablet three times a day an hour before meals. Now I'm in the UK and my new neurologist says that is wrong and I should space the pills eight hours apart. Who is right? I'd be grateful for any advice
You are on a very low dose currently. Whatever works for you but I have never heard the 8 hour spacing and I didn't find food made a difference to the meds working until about 5 years diagnosed.
Parkinsons UK has a help line which is great if you want to discuss this with someone.
I am not medically qualified to comment on dosage. But as you are seeing a new neurologist perhaps you should follow the new instructions, and keep a carefull diary of your symptoms. Take the diary to your next neuro appointment. Hope this helps.
In the early stages of the disease it is certainly more common to be on a three dose a day regimen, with the three doses separated by four hours, and with nothing during the night. This strategy is based on the pharmacokinetic properties of Sinemet, particularly the short half life of levodopa.
However, the pharmacodynamics of the situation is more complex. Brooks writes [1]:
"Conventional levodopa/DDCI is rapidly metabolized in the periphery, resulting in a short plasma half-life of ~60–90 minutes ... . In the early stages of PD, this short plasma half-life is discordant with the clinical effect of the drug, which may persist for many hours, indicating that surviving dopaminergic neurons are able to store the exogenous dopamine generated from levodopa and so buffer variations in levodopa availability. However, with progression and further neuronal degeneration, the levodopa-buffering capacity is lost and deep troughs in plasma levodopa levels correspond with deep troughs in dopamine within the striatum, resulting in pulsatile stimulation of striatal dopaminergic receptors".
This suggests to me that your new neurologist may have a good idea. But the proof of the pudding is in the eating. You could measure your bradykinesia using the tap test and see what regimen works best for you. To get a smoother concentration over time of dopamine in your brain you may wish to consider agonists, controlled release levodopa and MAO-B inhibitors.
Reference
[1] Neuropsychiatr Dis Treat. 2008 Feb; 4(1): 39–47.
PMCID: PMC2515910
"Optimizing levodopa therapy for Parkinson’s disease with levodopa/carbidopa/entacapone: implications from a clinical and patient perspective"
David J Brooks
ncbi.nlm.nih.gov/pmc/articl...
John
I live in the States. Take 1& 1/2 tabs 4 times a day. Important to fast, both one hour before and after taking them. take at 5am 11am 5pm and 11pm.
BillDavid
I certainly take mine every 8 hours & that works well, but I don't know why your method should be wrong. Did it work for you?
Do u take a slow release at bedtime
No but its certainly a consideration
Do either of the neuros know when you eat your meals? If you eat meals at 8am, 4pm, and midnight, they are both right.
how can anyone reply to this when there is no indication of what the med is, if it is extended release or not? if it is working this way or not? if Peter is on Sinemet, it may or may not be a good dose for him. if he is on Rytary, the standard dose is 8 hrs. apart, not to be confused with the timing of dosing with regular c/l. am i missing something or what?
Glad you noticed there was no information of the drug being taken. Also nothing about symptoms. Personally I would never take advice about my PD drugs from anyone outside my neuro team.
I would agree with you ordinarily but in this case, as I have moved 8,000 miles to the east, I have no choice but to swap neurologists. I was looking for some advice from PD suffers as regards the discrepancy between these two professional clinicians. The advice I have been given here has been useful to me.
Isn't 3 times a day the same as 1every 8 hrs?
Maximum dose of levodopa
Fast acting Levodopa?
Optimizing levodopa
Missing doses 
