Rytary vs sinemet

[luckyrock]

I switched from 25/100 sinemet four-five times to Rytary 36.25/145 three times a day. I am experiencing increased dyskinesia on Rytary. I was expecting it to decrease. Anyone else have this issue?

[felixned]

Do you have dyskinesia or an increased OFF time? You significantly reduced your intake of L-Dopa since the equivalency coefficient for Rytary is 0.6In any case you should discuss this issue with your movement disorder specialist.

[IUPUOSU]

Approximately a month ago, I also switched from Sinemet 25/100 to Rytary. I had been taking one Sinemet 25/100 three times a day and then one Sinemet CR at bedtime. I started to experience slight dyskinesia on the Sinemet and also was unable to sleep more than 4 to 6 hours because I would wake up with “off” symptoms even after switching the bedtime dose to the CR formulation.

My neuro NP recommended that I try Rytary, as many of her patients have had much success with it smoothing out their symptoms and improving their quality of sleep. I take a different dosage than you, however. I’m taking the 23.75mg/95mg formulation - 2 pills four times per day. She encouraged me to experiment with the dosage, if needed, up to 3 pills four times per day.

My quality of sleep and duration have greatly improved and now I easily get 6 to 8 hours uninterrupted! My symptoms seem pretty well controlled during the day - probably similar to the Sinemet 25/100, but with a smoother transition to the next dose (less noticeable “off” time).

I will say that I am trying to determine if I am having a touch of dyskinesia even on the Rytary, but I need to monitor my symptoms a bit longer to figure it out. I recently was diagnosed with young-onset PD and dystonia is my dominant symptom. I experienced brief, flutter-like “dance moves” on my affected leg during peak dose times of immediate-release Sinemet, which I feel confident is dyskinesia. But prior to switching to Rytary, I also had begun to experience occasional uncontrollable shrugging of shoulders and drawing in of my affected arm while performing fine-motor coordination tasks with my hands, such as chopping vegetables, writing, or folding laundry. These episodes seem to coincide with peak levodopa times (1-2 hours after a dose), so I theorized that it is dyskinesia. My neuro NP believes this sounds more like dystonia, especially because my muscles are very tense during the episodes. She recommends that I try increasing my dosage to determine if this symptom improves or not. I feel like I’m just getting the Rytary dosage stabilized so I have not tried the increase yet.

Regarding your dyskinesia, perhaps you should consider discussing changing your dosage with your provider, such as trying the 23.75mg/95mg formulation, to try to reduce or eliminate the dyskinesia.

My neuro NP did mention that some of her patients on Rytary experience increased dyskinesia towards the end of the day, which may be attributed to the accumulation of the sustained-release component of the medication. She stated that since this is a newer medication (it contains both immediate-release and sustained-release components, as I am sure you know!), the levodopa response curves are not yet well established. For these patients, decreasing their bedtime dosage or perhaps their last two dosages of the day may be sufficient to reduce or eliminate their dyskinesia. So, if you are observing that you do not have dyskinesia early in the day, but it occurs or worsens as the day goes on, perhaps you and your provider could discuss modifying your later dosage(s).

[Godiv]

Felixned might be right on. I'm having some kind of weird stuff with Rytary -- lots of dyskinesia, but I think mine is wearing off too. I increased recently 145x2 4-5 times a day, and I have to wonder if the more you take, the harder you fall (during wearing off). And like Felixned said, the two meds aren't equivalent. You have to take more Rytary for the same CL effect. Maybe chart it carefully and then maybe the doctor could help figure it out too. It can all be so confusing :(.