Neupro and augmentation

[MissRita]

What does augmentation mean? Thx!

[kaypeeoh]

My guess is it means not stopping Sinemet but adding Neupro for additional effects.

[park_bear]

Yet another downside of dopamine agonists. The list is never-ending.

medicines.org.uk/emc/produc...

"Augmentation refers to the earlier onset of symptoms in the evening (or even the afternoon), increase in severity of symptoms, and spread of symptoms to involve other body parts. In long-term clinical studies with rotigotine, the majority of augmentation episodes were seen in the first and second years of treatment."

[sharoncrayn]

Augmenation is a term/concept seldom used. It usually refers to the combination of 2 or more drugs with different mechanisms of action to improve efficacy initially but the combination actually makes matters worse over time. Sinemet or Modopar would be examples. Both drugs work initially but loose effectiveness over time. Ultimately, they create dyskinesia in at least 15%-20% of PWPs.

Augmentation problems are not exclusive to DAs as some one suggested (see depression meds and augmentation). However, 5%-7% (from previous CTs) of PWPs on DAs will experience augmentation problems when combining DAs and Sinemet or Modopar.

Neupro is initially titrated under your physician's care. AEs in Neupro's CTs = at least 25% (if not higher!) for all participants which is significant IMO. Typically physical edema or dyskinesias. UPDRS scores did improve, but usually decline after 2 years.

Use with caution.

Sharon

[MissRita in reply to sharoncrayn]

Hi Sharon,

I was on Mucuna from 2016-late January 2021, after experiencing Dyskinesia and way too much vomiting and I’ve been on 25/100 L/C since February until currently. Depending on symptoms I can take up to 6-8 a day and I’ve experienced dyskinesia with that too no matter how little or much I take. I’m starting Neupro hopefully this week if my insurance approves. My Dr told me to stop the LC when I start the Neupro.

What does AE CT DA mean?

[kevowpd in reply to MissRita]

Probably Adverse Event (bad thing), Clinical Trial and Dopamine Agonist.

[sharoncrayn in reply to kevowpd]

correct

[sharoncrayn in reply to MissRita]

retail price for 30 patches = $700-750 or $23.35 per patch

YES --- COVERED BY MEDICARE (US)

Vomiting results from too much L-dopa, whatever the source and also problems related to your gut microbiome health and GER (your stomach contents come back up into your esophagus which means they don't empty properly). VERY, very, very common with L-dopa meds as people age.

Duopa will reduce your need for sinemet by 10-20% (on average but sometimes greater), but will not probably eliminate the need entirely. Get a 2nd opinion before dropping sinemet!

typical dose is usually 4-6mg/24 hrs, but start at 2mgs.

avoid if you are PWP with CVD.

Duopa can work, but watch it carefully. I'm serious.

Sharon

[MissRita in reply to sharoncrayn]

Good to know. I have Blue Cross blue shield so I’m hoping they cover all of it as well. I’m just waiting on the approval.

[MissRita in reply to sharoncrayn]

Yes I am definitely getting a second opinion in May when I go to Rochester strong Memorial.

[MissRita in reply to sharoncrayn]

OK I ended up looking up what you mentioned. Duopa is much different than Sinemet and it seems to be a game changer given the fact that you’re on much longer. I don’t know much about it.

[MissRita in reply to sharoncrayn]

Why would you need to watch it carefully?

[sharoncrayn in reply to MissRita]

Ninety-nine per cent (99%) of patients experienced at least one AE in SP702 with similar results in SP716.

None of the dyskinesias were classified as “completely disabling” in either extension study, with the majority falling under the classification of either “not disabling” (62% in SP702 and 46% in SP716) or “mildly disabling” (30% in SP702 and 31% in SP716).

watch it if you have dyskinesia.

Sharon

[MissRita in reply to sharoncrayn]

Well after reading what it does, I do not want anything external or a pump. Currently I’m using Sinemet and looking to use Neupro as Sinemet doesn’t seem to work that great.

[sharoncrayn in reply to MissRita]

Make sure your diagnosis is correct relative to your DaT SPECT. If not, find somebody who knows.

[MissRita in reply to sharoncrayn]

I won’t do a DaT scan because of the damage that It could do to my thyroid. I have Hashimoto’s and I do not want anything to get in the way of that treatment.

[MissRita in reply to sharoncrayn]

Because I’m going in for a second opinion in May with a different doctor at a center of excellence in Rochester New York, I’m wondering and hoping if they could just do a standard MRI to see what’s going on in the brain.

[MissRita in reply to sharoncrayn]

I was also told that a DaT scan technically doesn’t tell you if you have Parkinson’s it basically tells you how much dopamine you don’t have. Is that correct?

[kaypeeoh in reply to MissRita]

It shows damage to the part of the brain that makes dopamine. It MIGHT be coincidental, meaning something else is using up dopamine so less is in the blood, but that's a stretch.