Increasing Sinemet and Nourianz

[jcavana]

Basically my mom has been on the same sinemet dose since diagnosed with Parkinson’s in 2016 (1 sinemet every four hours and 1 azilect). So my moms doctor has prescribed nourianz and increased her sinemet from 1 tablet (25-100) every four hours to 1 1/2 tablet every four hours. Has anyone had success increasing sinemet (her doctor said she is now under dosed)? Has anyone had success on Nourianz? Thanks 😊

[Hidden]

I do not know nouianz.I know carbidopa levodopa.

I had developed severe symptom. One tablet would not touch .

Two tablets every six hours did.

Three times a day.

[jcavana in reply to Hidden]

Why six hours? Before going to two pills were your doses 6 hours apart?

[Hidden in reply to jcavana]

Four hours apart.

My interpretation reading Dr. Ahlskog’s treatment book. Resist dyskinesia.

[Hidden in reply to jcavana]

are appropriate to the patient’s needs.10. LEVODOPA DYSKINESIAS ARE OFTEN BENIGN AND TREATABLE

Around the same time that the short-duration levodopa responses become apparent, patients may experience hy- perkinetic movements, primarily manifest as chorea; these are termed . Just as too little brain dopamine translates into motor slowness, too much dopamine results in excessive movements, ie, dyskinesias.

Because dyskinesias represent an excessive response to dopamine replenishment, they can be abolished by reduc- ing the individual doses of carbidopa/levodopa. Note that dyskinesias are tied to the most recent dose; thus, carbi- dopa/levodopa doses taken more than 6 hours previously have lost this dyskinesia potential.

[Juliegrace in reply to jcavana]

If your mom is doing well with the increase of Sinemet at six hour intervals there is no need to worry about shortening the time between doses.

[Juliegrace]

Increasing the Sinemet dose is reasonable and quite common. What is the doctor’s rationale for prescribing the Nourianz? I thought it was for hallucinations, but there may be other applications.

[jimcaster]

I may be mistaken, but I believe Dr. Ahlskog advises to keep the same dose if it has been effective, but to shorten the interval between doses. I would be inclined to continue taking one pill, but take it every three hours instead of four, for example.

[Hidden in reply to jimcaster]

This is what Dr. Ahlskog says:

excerpt from Dr. Ahlskog's book

[jcavana in reply to jimcaster]

I was thinking the same thing.

[sharoncrayn]

"Repurposed" drug.

Nourianz was approved in the US in 2019 as an adjunct drug to C/L. It is an expensive drug retail costing at least $1,500 per 30 tablets or $18,000-$20,000 USD/year. In general, US Medicare/Medaid do not cover the cost.

"Off" times decreased with stat significance, but Dyskinesia did increase which is problem with this drug. The 4 CTs are very clear that this is problem that should not be ignored. Also, generally avoid taking with other CYP3A4 inhibitors.

Peak plasma = 4 hours, but half life can extend for days if taken with high fat meals.

Does not effect C/L's pharmacology.

sharon

[johntPM]

Any anti-PD drug that has a long half life gets my attention.

Do the benefits of Istradedefylline (Nourianz) come from affecting levodopa's half-life (as grapefruit does) or does it meet some unmet need for a non-dopamine neurotransmitter?

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