Levodopa question

[Parkinsonjisung]

Do people find increasing their levodopa dosage helps extend their on time for longer or improves the quality of their on time?

[Nitro53]

For me it’s just quality.

[Hidden]

Hi Parkinsonjisung

"Do people find increasing their levodopa dosage helps extend their on time for longer..."

Some people don't respond to levodopa, but if you do, increasing your levodopa dosage and/or using adjuncts like entacapone and selegeline will extend your on time.

Other ways to increase your on time are with extended release formulations like C/L CR and Rytary. Note that adjuncts like entacapone and selegeline can also be used with these extended release formulation to get an even further increase...

"...or improves the quality of their on time?"

I don't really have different levels of on... When I am on, it is always a "good" quality on (ie, I am as if I don't have PD)...

The other thing to consider if your raise your levodopa blood concentration too high, you may experience dyskinesias or other side effects...

[johntPM]

A commonly used theory of the effect of levodopa on the body (pharmacodynamics) is to link it to the amount of levodopa in blood plasma (pharmacokinetics). Two thresholds are assumed: - the effect threshold (any concentration less than this will have little effect), above this one is "on", and any extra dose will have little extra impact except on the duration of the "on";

- the dyskinesia threshold (any dose that takes you above this will give you levodopa induced dyskinesia).

The half life of levodopa with carbidopa is about 90 minutes. So if the dose took you exactly to the effect threshold, and no further, its decay would cause plasma levels to drop below instantly giving you no "on" time; taking twice that dose will give you 90 minutes of on time.

In reality things are more complicated than this early on in the progression of the disease the body will still be producing some of its own dopamine (endogenous dopamine) and will have reservoirs to store excess amounts. As the disease progresses the therapeutic window narrows, making it difficult to avoid crossing the LID threshold.

[Parkinsonjisung]

Thanks for the responses

[Sapeye2020 in reply to Parkinsonjisung]

there is an other state you may have , that is that you may experience head aches when your dosage goes above a certain or below a certain level, patient specific. That is where you are on IR ( instant release) and not CR. The CR (constant release ) allows for a lower amount to be released at any given time. The dosage is set and then you and your Neurologist try different time between dosage to keep you in the sweet spot, "not too hot and not too cold". like the 3 bears like it.

[AaronS]

Regular exercise and good sleep will help i find. If im not doing either my on time lessens, some animal proteins will also interfere with on times. To illustrate poor routines im good for 2 hours per on times, good routines im back up around 4 hours-ish