example: High Dose Levodopa and Sleep

J. Eric Ahlskog, PHD, MD

Professor of Neurology at the Mayo Medical School

Chair of the Mayo Section of Movement Disorders, Mayo Clinic

More than 30 years of treating patients with Parkinson’s disease

Per Dr. Ahlskog’s book he authored: “Often, insomnia is experienced when PD is not well controlled; the restlessness and discomfort of Parkinson’s are incompatible with relaxation necessary for sleep. To those taking three Carbidopa/Levodopa doses daily, the long interval from the last dose before supper until bedtime may be the cause. Adding a fourth full dose about an hour before bedtime usually solves this problem. Note that the dose should be the same as that used during the daytime. Restated, this should be the Carbidopa/Levodopa dose identified as optimal; the sleep benefit requires a full dose. Another dose may be taken upon awakening in the middle of the night, if necessary to sustain sleep.”

Full optimal dose, two 100 mg tablets for a total of 200 mg.

To those taking three doses of C/L daily that would be 600 mg per day.

Plus the fourth full dose about an hour before bedtime, which would be 800 mg per day.

Another dose may be taken in the middle of the night, which would be a total of 1,000 mg.

Full optimal dose, three 100 mg tablets for a total of 300 mg

To those taking three doses of C/L that would be 900 mg per day.

Plus the forth full dose about an hour before bedtime, which would be 1,200 mg per day.

Another dose may be taken in the middle of the night, which would be 1,500 mg per day.

Here we have Mayo Clinic at 1,500 mg per day.

Roy Propsner seeks 1,500-1,600 mg per day with the INTENTION of working that dosage lower every week, with the outcome being the optimal dosage to prevent paralysis.

[Jockboy17]

His book is excellent because of his clear and easy to understand writing style. Highly recommend getting it. Thanks for posting RoyProp

[marcet]

very interesting and useful, thanks

[Hidden]

Hi Roy:

Dr. Ahlskog advises that you should first find the single dose that relieves your symptoms satisfactorily (starting from a low dose and working your way up) and then determine the inter-dose interval that keeps you "on" across doses.

[ParlePark in reply to Hidden]

Exactly what I did when starting c/l. Went up 1/2 tab till tremors stopped. Then I tweaked timing of and between doses. Actually makes sense. By prioritizing symptoms relief first you can then work on staying “on”. For me it’s working around protein intake. Excellent advice, great book, thanks.

[Hidden]

See page 216 - "Duration of the Levodopa Response" section

[Hidden in reply to Hidden]

In ten years no doctor has given such instructions and I suspect they do not know.

[Hidden]

I think what Dr. Ahlskog writes makes sense. There are two fundamental aspects to dosing that must be considered. The first being the dose size. The second being the time between doses. Maybe I misunderstand you, but you seem to be focusing solely on the first one...

[Juliegrace]

Count yourself lucky that you can tolerate a large dose for symptom relief. You can find a new neurologist who will prescribe for you. You could be like those of us who suffer from dyskinesia with the smallest dose; those who cannot take another full dose to get a decent night’s sleep.