Sinemet vs Rytary

In my 5th year and thus far, I’ve been taking Mucuna, azilect and Neupro patch still doing well with slow progression with symptoms only on the left side. I exercise daily work full-time and lead a normal life. I have no off time, my symptoms are pretty much the same all the time. My main complaint is that recently, I walk a little slower than I used to and I am considering adding Sinemet or Rytary. Which medication has less side effects and is anyone taking either in addition to mucuna? By adding the additional medication, will it cause off times?

Thanks

[park_bear]

If you choose Sinimet, I recommend one of the time release options, Sinimet CR or Carbidopa Levodopa ER, over the immediate release version which is usually prescribed by default. Sinemet IR - immediate release - is not a very good choice unless you are doing very frequent dosing, because the plasma value declines to the one quarter of the peak after 4 hours. The high peak value is prone to cause dyskinesia. Sinemet CR, carbidopa levodopa ER or Rytary are much better choices for many patients because the blood plasma level is much more even over time.

[Hidden in reply to park_bear]

Thank you, good info.

[Hidden]

They are both the same thing carbidopa/levodopa, just different time release formulations (instantaneous release versus extended release).

Rytary allows you to extend the time between doses, but is very expensive (i.e., not covered by all insurance).

If properly dosed either can address your slowness with no side effects

[Hidden in reply to Hidden]

Also, check out this post which is a good introduction to levodopa:

healthunlocked.com/parkinso...

[Hidden in reply to Hidden]

Thanks for the reply. I will check to see if my insurance covers rytary.

[janers]

I take a capsule of mucuna in the morning, and then an extended release cardidopa/ levodopa for the middle of the day after brunch, and then perhaps half a pill of the immediate release if I need more in the evening. The mucuna works really well before I have anything in my stomach. Once I’ve eaten, I don’t feel it’s effect as much, so I take the pharmaceutical for that reason. Half a pill of the immediate release works really well for me. I can feel it’s effects pretty quickly, usually within half an hour. The extended release takes longer to feel the effects, but it works well for a long period of time once it kicks in. Hope you find the combination that works great for you!

[Hidden in reply to janers]

Thanks, how many mg is the mucuna?

[janers in reply to Hidden]

My doctor told me to aim for 60 mg l-dopa. I’m currently taking a 334 mg Macuna extract which says it’s standardized to 15% phytochemicals which I guess is l-dopa! So that comes out to around 50 mg of l-dopa. It is a little confusing trying to figure out how much l-dopa you are getting out of the Mucuna product.

[sharron2 in reply to janers]

My husband is on rytary 48/195 3 times a day. He is also experiencing autonomic difficulties such as orthostatic hypotension. His doctors don't want to increase any dosage as it will further reduce his blood pressure. Does mucuna cause drops in blood pressure?

[Hidden in reply to sharron2]

I generally have blood pressure on the low side but I don’t experience drops in blood pressure.

[Crescendo]

Can you be specific about your brand and amount of mucana and what you take with it to pass the brain blood barrier?

[PDBoxer in reply to Crescendo]

I use Teavigo, which is a green tea extract for the blood brain barrier issue that has 94% EGCG. (I order from Vitacost.)

[Hidden in reply to Crescendo]

I take the Hinz amino acid protocol, two 100 mg capsules three times a day along with Cysteine and Neuroreplete. .

[janers in reply to Crescendo]

Currently I’m taking vitacost Which I find effective, and I’ve had good experience with Now rand. I don’t take anything to help it cross the brain barrier. As long as my stomach is relatively empty it’s absorbed. The problem is after eating a heavy meal it doesn’t absorb as readily.

[Judyrsmith]

I started Azilect when diagnosed 9 years ago, It worked wonderfully easing some of my stiffness and slowness, I then added Mirapex. They worked well until 2 years ago. Perhaps I should have just increased the amount. At that time, I also had an operation which forced me to stop any core exercise for 6 weeks, and did not rebuild as I should have. So it may have been my fault.

In March, my doctor switched me to Sinemet, still using azilect. It has offered a miraculous change for me. My stiffness is all but gone and I'm not as embarrassingly slow. As that was the beginning of lockdown, BethIsrael started free zoom classes. This allowed me to start a boxing class 3days a week, making me much stronger. As I don't go out or have any obligations (I gave my company to my son when I was too embarrassingly slow & stiff to represent the company in public), I am able often to get by with one pill only. I feel more like my old self than any time in over a decade.

I want to ask you a question, When I try to sleep and have only had a morning Sinemet, I cannot make my brain "give up" and sleep. Just a fraction of a Sinemet allows me to relax and fall asleep. Does that make sense?

[Hidden in reply to Judyrsmith]

Thank you for your reply. Yes it does make sense. I take two magnesium theornate, L-Serine and Glutathione before bed and sleep 7 hours most nights.