CHEAP SINEMET CR OR EXPENSIVE RYTARY. WHICH WORKS BEST FOR YOU?

[OREOLU]

Hi Friends, my MDS is about to switch me to expensive Rytary.I keep wondering why Rytary instead of a cheaper Sinemet CR.If you had an experience with this two drugs as a patient or a caregiver,please your input will be appreciated.I am currently having off periods due to generic Sinemet,not working well anymore.Please share your experience.

[Grumpy77]

I think in order to get the best advice it would be very helpful to give a little background about yourself (preferably in your profile so that you don't have to repeat it in every post you make). For example an advice given to a PwP with early onset or intermediate stage tremor dominant PD would be different from an advice to a PwP with advanced stage PD or rigidity dominant PD. Information about age and current medications and supplements you take in your profile, are also a very important factors to consider when giving advice. So your post would only have to focus on your current enquiries... this is just a suggestion, you don't have to do it if you don't want to

[Hidden]

This is my experience as someone who responds well to treatment with c/l.

If generic c/l is no longer working well, you should first evaluate how well you are managing you protein intake/timing and how well your digestive track is working.

The true test is to fast for a day (when your bowels are moving regularly), taking you c/l as you normally would, and then tell me how well your c/l works! If it doesn't work well when fasting, go to the next step.

If you have your diet and digestion sorted, consider if a change in dosing will help (i.e., dose amounts and/or inter-dose interval time).

This tool is "golden" (to help you visualize what your dosing is doing in your blood): parkinsonsmeasurement.org/t... and can suggest if a tweak to your current generic c/l dose plan may be possible.

Lastly, you can improve the performance of generic c/l by taking a combination of IR c/l, CR c/l, and entacapone (this is what I currently do).

Btw, I think Rytary is good (I have personally used it), but IMO it is too expensive (e.g., if your insurance doesn't cover it, or if you can't get need-based aid)...

[OREOLU in reply to Hidden]

Hi Levod,

I always will appreciate your advice. Your story is similar to mine. I have been doing daytime protein fasting,and some days I avoid eating food during the day,but only at dinner. The only thing I have noticed is that the working period decreases,with increased off period for Sinemet IR. Just like you,insurance would not cover Rytary. I will discuss adding CR Sinemet with MDS. But why did your doctor add entacapone to your schedule?I thought the CR c/l should have done the job.

[Hidden in reply to OREOLU]

You certainly can take only CR, but adding IR and/or entacapone can possibly give you better performance. Read on...

It takes 120 minutes for CR c/l to reach maximum concentration in your blood (i.e., Tmax).

It takes IR c/l only 60 minutes.

So you may want to take some IR c/l with your CR c/l, for the same reason that there is some instantaneous release c/l in Rytary - it will get you going a lot quicker. This is true for the first dose of the day, and any other doses if you happen to go off...

Entacapone prolongs the on time and gives you a more steady/consistent delivery.

Note that you don't get anything for free. Entacapone increases Tmax of IR c/l for 60 to 90 minutes.

References:

jnnp.bmj.com/content/jnnp/6...

“The duration of “on” time was prolonged when entacapone was administered with both standard Sinemet™ (30 minute increase, p=0.03)and Sinemet CR™ (48 minute increase,p=0.05) in comparison with the responses when placebo was added (fig 1).”

“The duration of “on” time assessed with a tapping test was also longer when entacapone was administered with either standard Sinemet™ (48 minutes increase, p=0.01) or Sinemet CR™ (54 minutes increase, p=0.03)in comparison with the responses obtained after addition of placebo (figure 3).”

pdfs.semanticscholar.org/21...

“The addition of entacapone to each dose of levodopa–carbidopa given three to five times a day leads to a less pulsatile profile of plasma levodopa levels by avoiding deep troughs”

[OREOLU in reply to Hidden]

Thanks again Levod.

[Tfrk]

Hi have been Ritari going on six years now so it’s almost like proving a negative as to how I would’ve done off of Ritari but I will say that I have not felt as well on Rytary as I used on generic controlled release carbadopa/levodopa

[Tfrk]

(continued). I suffer from adult compulsion disorder so my neurologist did not feel it was advisable to go back to generic carbidopa levodopa as that higher level of levodopa was feeding my compulsive cravings.

[Jebbie]

Good advice from Levod. I will add though that I had inconsistent results from CR, We called it crappy release,