Some time ago I wrote an app that models how levodopa levels vary as a result of the medications that we take. This is based on pharmacokinetic values such as the half-life of a drug.
To use it, for every dose that you take per day, you enter the time of the dose, the name of the drug and the size of the dose. The app then draws graphs showing your estimated situation updated every minute.
On the attached graph you can see the effect of taking four 100 mg doses of C/L taken 4 hours apart. You get a saw-tooth pattern. If you know your "on"-"off" threshold, you can see the times that you're likely to be "on" (the horizontal green line). And, if you know, your levodopa induced dyskinesia threshold, you can see the times at which dyskinesia is likely to occur (the horizontal red line). You can also see the effect of stacking where the peaks increase slightly during the day. This is due to the new dose being added to what is left of the prevous dose.
Please remember that this is just a model. It is based on data found in the literature, but this varies from study to study and from person to person. It doesn't take into account such things as food eaten during the day, or gastric emptying. It doesn't look at endogenous (locally produced) dopamine.
John
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johntPM
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Thanks for the information! I take Baclofen with thec/l.c/l 25-100mg every 8hrs. Baclofen 1 5mg every 12hrs. I also take many supplements. How would all these react to the effectiveness of the CL? Thanks for your help!
Hello johntPM. I just used your terrific graphing tool for the first time and it's so helpful. My doctor has showed it to me several times in talks about various med options. But, playing around with it myself has been fascinating. Might you be able to Inbrijia to the list of drugs. I've just started adding that to my day and would love to add it to my graph. Thank you!
It would be possible to expand the app to include inbrija. But, I'm unlikely to do it - I just don't have the required programming strength anymore. (19 years post DX.)
The first step is to search the literature for inbrija's pharmacokinetic values (e.g. half-life). See:
Hello John, Sorry to take so long to respond. I somehow lost this page and am happy to have found it again. I'm sad to hear you no longer have the strength to work your magic with this very smart gift of a web site you have given Parkinson's patients everywhere. My support group recently had a meeting were we all compared our graphs and it was very insightful. The Rytary question from Craig below was also a question two of our members had. I am. happy to be able to give them a response.
I will cross my fingers that some smart person comes along to help you continue this very special endeavor. In the meantime, here are the numbers for Inbrija. Just incase they might be helpful.
Inbrijia (Inhaled Carbidoba/Levadopa)
1 dose = 2 capsules = 84 mg pf levodopa
CMAX = 50% of that following immediate-release oral tablets
Rytary, unfortunately not. I have never been able to find in the literature all of the parameters required.
The Rytary capsule has three types of bead: immediate release, slow release and slower release. If you could find the pharmacokinetic parameters required, you could add it to the model. Each dose would require three rows.
The aim is to build an approximation of Rytary from a number of simpler drugs. I played "what if" with the program, trying different possibilities. Out of this process came the following regimen that approximates the pharmacokinetics of 390mg of Rytary:
Dose 1: 100mg IR C-L, 0 hours
Dose 2: 60mg IR C-L, 1.5 hours
Dose 3: 60mg IR C-L, 3 hours
Dose 4: 60mg IR C-L, 4.5 hours
To use this, you would fill in 4 rows for each dose of Rytary during the day.
The regimen could be optimised further, but it is important to note that we're dealing with estimates. Moreover, there are practical concerns, such as how to get a dose of 60mg, which make it not worth making the regimen even more complicated.
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Awakenings... 
ARE YOU A NON TREMOR DOMINANT PD PATIENT WITH DYSKINESIA? IF SO, PLEASE HELP.
