Wearing Off or Dyskinesia

Wearing Off or Dyskinesia

Author: Jill Marjama-Lyons, MD and Mary J. Shoman

….possible changes to your medicines…discuss with your doctor.

•Use Sinemet CR (controlled release) or Sinemet ER (extended release).

•Add a dopamine agonist.

•Add a COMT inhibitor to Sinemet (immediate release, CR form, or ER form).

•Take Sinemet more frequently.

Treatment of dyskinesias…may include the following:

•Change from Sinemet CR or ER to immediate-release form.

•Lower the dose of Sinemet and shorten the time in between doses.

•Add a dopamine agonist.

•Add amantadine.

•Try liquid Sinemet.

Liquid Sinemet

For patients who have extreme “on-off” or cannot tolerate a half a dose of Sinemet 25/100 because of dyskinesia, preparing liquid Sinemet and taking it every one hour at a lower dose can provide relief from dyskinesia and lessen off time. (not commercially available, your pharmacist prepares or home made only).

1.Purchase a one-liter plastic container with a lid, a cooler bag, and a smaller 25-to-50 milliliter measuring cup.

2.Mix the following in the container:

•Sinemet 10/100 or 25/100 immediate release (do not use controlled release, CR), 10 pills

•Vitamin C crystals or crushed tablet, 2 grams

•Tap water, 1 liter

3.Gently shake the mixture, and then keep refrigerated, out of sun light.

This formula makes a 1-milligram-per-1-milliliter dose and allows for greater fine-tuning of the dose of Sinemet than does the pill form.

Before taking the liquid Sinemet, gently shake the container. While your doctor will prescribe the dosage for you, a typical starting dose would be 60 to 70 milliliters for the first dose of the day, followed by 30 to 40 milliliters every hour throughout the waking hours of the day. The dose can be adjusted up or down by 5 to 10 milliliters as needed. If you are too slow, then increase the hourly dose by 5 to 10 milliliters, and if you are too fast with dyskinesia, decrease the hourly dose by 5 to 10 milliliters. A fresh batch should be made every one to two days.

[johntPM]

I'd buy in to much of this. But, I'd wish to put it within the context of reducing, as far as is possible, the variation in levodopa equivalent plasma concentration levels during the day.

For instance, I don't think that dopamine agonists have any special properties compared to levodopa that affect dyskinesia other than a longer half-life. Having an agonist as part of the drug regimen can make use of the extended half-life to reduce variations.

For the same purpose, I'd also add a MAO-B inhibitor, such as rasagiline.