Which pill for Parkinson's disease provides the fastest relief from "off" symptoms when chewed and swallowed: carbidopa-levodopa 25-100 mg Orally Dissolving Tablets, or ropinirole Immediate Release, or pramipexole Immediate Release ?
It seems like the ODT (Orally Dissolving Tablet) form of carbidopa should work fast, but the levodopa requires conversion to dopamine in the brain, which takes time. Dopamine agonists can work immediately when they reach the brain, without any conversion required.
Anecdotal replies are solicited as well as links to PubMed abstracts or papers.
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advancedPDguy
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Thanks, folks. I asked my Movement Disorders neurologist, who told me that the standard immediate-release or ODT (oral disintegrating tablet) form of carbidopa/levodopa is the fastest-acting ORAL rescue medicine for severe "off" symptoms. However, I am still waiting for a reference or citation supporting that opinion.
As far as parenteral or non-oral delivery meds like apomorphine and inhaled carbidopa/levodopa, I want to restrict this discussion to currently available oral medications.
I have read that dopamine agonists, like pramipexole and ropinirole, may act faster for rescue of "off" symptoms because they do not require enzymatic modification in the brain, as does levodopa, which must undergo enzymatic conversion to dopamine.
In the brain of a patient with advanced PD, like me, the conversion of levodopa to dopamine may be slowed down due to lack of enzymes and dopaminergic neurons. That is why I would like to see the results of a controlled study testing whether sinemet ODT or a dopamine agonist is faster for acute relief of freezing and other "off" symptoms.
Since we all vary so much in what works for us and what doesn't, I doubt whether a controlled study would tell very much. For me, agonists such as Ropinorole and Mirapexin do nothing positive. I take Madopar (levodopa + benserazide) in capsule and dispersible form and find that, when 'off' I will begin to feel benefit from dispersibles within ten to fifteen minutes. Capsules take around half an hour. My normal dose, taken every three hours, or sooner if I start dyskinesia, is 1 x 50mg/12.5mg dispersible and 1 x 100mg/25mg capsule. I am 16 years since dx; 22 years since first symptoms.
I was diagnosed 11 years ago and was symptomatic for 8 years before that. I am puzzled why dyskinesia prompts you to take levodopa sooner than scheduled. For me, dyskinesia is always worsened by more levodopa, and relieved only by not taking any dopaminergic medication for a while. Did you mean dystonia? That is an "off" symptom for me. When my foot starts to twist inward, it's time for a double dose of sinemet IR, or I will not be able to walk, and very soon.
No, I meant dyskinesia which for me is a phase I go through on the way up and on the way down. It took a while to realise this as I thought it was a sign of too much L-DOPA rather than too little. The downside of this is the better I keep "on" by taking enough L-DOPA, the worse the shut down dyskinesia at the end of the day. Curiously, Madopar CR (controlled release) does nothing for me at all so is no help in getting through the night unmedicated. My main symptoms when "off" are dystonia and bradykinesia.
Thanks. Interesting that your dyskinesia can be relieved by levodopa. Just proves how correct your first comment was: PD patients are not all the same!
Interesting question i havent read any studies on this David and there are so many other factors such as disease duration and individual metabolism so im thinking that the answer to this could be unique to each person.
I have followed a formula to work out how long it takes for my ldopa to kick in.
No dopaminergic drugs for 7 hours (overnight) on waking take one standard dose of L Dopa immediate release. Drink only water, dont eat until relief of symptoms.
This will give you your time to on and i guess could be used for agonists too (though there could be a problem with nausea).
Anecdotally i have understood the madopar dispersible is quickest but i havent used it.
At a recent lecture the neuro said regular sinimet can take up to one hour to be effective and long acting sinimet takes 2 hours. I found this in my experience so it was reassuring to hear that i was in the parameters of 'normal'
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One whole tablet or two halves?
Liquefy your L-dopa
