Variation in dose: doctor to doctor

[johntPM]

We often hear the following said to help explain the difference in drug regimen between one PD patient and another: "all patients are different".

At its simplest in a regimen formed entirely of carbidopa/levodopa we see daily doses of between 50 and 2000mg, perhaps more.

While it's likely that the patient (stage of the disease, size, whether or not there is dyksinesia, etc.) is responsible for most of the variation in dose, it is also possible that the variation is due to differences between doctors.

Is it a case of all doctors are different?

Does anyone know of research that's been done in this area?

John

[Smittybear7]

Very interested in the response to this!

[Beanie57]

'if every one is different why is everyone treated with the same drug in the first place!!!

[Boscoejean]

somewhat related

ncbi.nlm.nih.gov/pmc/articl...

[Boscoejean]

"Overall, according to the studies included in this review, it seems that the several guidelines published after 2000 [28, 107, 138] recommending starting therapy with DAs or MAO-B inhibitors in younger patients and starting L-dopa in older patients might have had an impact on clinical practice. However, according to the results of the PD-MED study, the recent NICE guidelines did not consider age as a factor in choosing the first-line treatment. Patients' quality of life, instead, was the major factor that affected the treatment decision. According to the NICE guidelines, if motor symptoms do not affect patients' quality of life, then starting therapy with DAs or other dopaminergic therapies (MAO-B inhibitors or L-dopa) is recommended [108]. L-dopa, on the contrary, should be used if motor symptoms affect the patients' quality of life [109].

Gender was examined in multiple studies but with conflicting outcomes. Whilst several studies found no gender relationship in L-dopa and DAs prescription rates [51, 52, 64, 66, 69], others found that women had lower odds of being prescribed L-dopa [45], were less likely to receive PD medications (both polytherapy and monotherapy) [45, 80, 83], and the L-dopa daily dose was lower for women [79]. Whilst this may be linked to the pharmacokinetics, this is under research and does require more investigation into the differences in responses between medications and sensitivity to side effects."

ncbi.nlm.nih.gov/pmc/articl...

[Esperanto in reply to Boscoejean]

I found the research about gender differences in C/L medication rather shocking: healthunlocked.com/cure-par...

[enjoy2013 in reply to Esperanto]

I agree

[Karmaone]

It's not research but I have seen two neurologists who say I'm on a low dose. Then when I met with a pd nurse she said that I was on a very high dose (carbidopa/levodopa), and I should ask to have it reduced as my symptoms are 'mild'...

I discussed this with my consultant and he said the pd nurse normally treats 70+ year olds, and they need less 'fuel'; I'm early onset and he suggested I need more because I'm young and active.

My symptoms may be mild because I'm on the dose I'm on?! My consultant keeps giving me more medication saying quality of life is the most important thing.... It's hard to know how bad my symptoms should be and if I should accept some symptoms, or as my consultant suggests keep upping my meds to try and feel as normal as I can.