what is ER AND IR

[Teetogreen]

what is ER AND IR

[park_bear]

IR = Immediate Release ER= Extended Release, carbidopa levodopa

See: healthunlocked.com/cure-par...

[Teetogreen in reply to park_bear]

Thanks so much. I’m just getting used to this disease. 🙏❤️

[park_bear in reply to Teetogreen]

Yes there's a lot of new terminology to absorb. A quick summary of some key points:

Prescription medications are for symptom relief only, not disease modification. Levodopa medication, usually in combination with carbidopa, is the mainstay. Doctors prescribe the immediate release version by default but many people do better with extended release. Dopamine Agonists - Pramipexole / Ropinirole / Rotigotine should only be used if levodopa does not work because they can have devastating side effects.

In addition to prescription medications it is essential to adopt disease modifying interventions. All agree that exercise is extremely important. The best exercise is whatever you like doing because you'll keep at it. Some other possibilities to consider:

• High-dose thiamine. Dosing instructions and other information at the link. Allow four months for full effect: b1parkinsons.org/

• Cinnamon. Allow two months for full effect. My report healthunlocked.com/cure-par...

• Qigong. My story here: healthunlocked.com/cure-par...

Implement the thiamine and the cinnamon one at a time and see how one works before proceeding with the other.

[DogsWoode in reply to park_bear]

What about mucuna parkbear?

[park_bear in reply to DogsWoode]

Mucuna as a way to take levodopa has its advantages, but it is for symptom relief only and not disease modification

[DogsWoode in reply to park_bear]

Okay I see. And b1 therapy is for disease modification. So start with b1 therapy I guess, and then add mucuna if still necessary to replace levodopa? I wasn't sure which was the best way to proceed.

[park_bear in reply to DogsWoode]

The first priority is to get your symptoms under control so you can take care of your activities of daily living, exercise, and be comfortable in your body as much as possible. If you do not need medication so much the better. If you do need medication, adjust for appropriate dosage if you have not done so already. Mucuna versus levodopa medication is an individual choice. Either one can work.

Disease modifying interventions are a long-term project of trying out various ideas, and sticking with what helps. Exercise program first, then B1 is good to try next.

[DogsWoode in reply to park_bear]

Thank you so much. I am taking C/L I/R QID however cannot tolerate more than that. So as notice exacerbation in symptoms am preparing for next step.

Medication for 3 years now, misdiagnosed in 2019.

Will look at commencing B1. Will check your link. Thank you for this valuable advice.

[Specterishot in reply to park_bear]

Thanks Park Bear for sharing your incredible knowledge with us. I am confused about Ceylon Cinnamon because of the high lead content. Idea’s/ suggestions??

[MarionP in reply to Specterishot]

Consumer Reports looked into that and came up with a number of specific brands to avoid and number of specific brands to buy.

[park_bear in reply to Specterishot]

Cinnamon got a bad name for lead contamination from a bad actor who contaminated cinnamon in kid's applesauce with a lead compound. I've compared the amount of lead from various brands of Ceylon cinnamon to the daily overall lead ingestion from diet and found the contribution was small. Details here, scroll down a bit after clicking link: healthunlocked.com/cure-par...

[Specterishot in reply to park_bear]

Thank you!! I have seen consumer reports, but there are no recommendations for safe Levels in the Ceylon cinnamon and I know that is preferred form for Parkinson’s. Appreciate the info you sent, Park Bear. Would like to add Ceylon Cinnamon to our stack

[Esperanto]

Carbidopa/levodopa immediate release (IR) tablets are commonly the first levodopa formulation prescribed to patients with PD. The IR formulation has a peak onset of 30 minutes to 1 hour with a half-life of 1.5 to 2 hours.3There is also an orally disintegrating tablet (ODT) formulation for patients with difficulty swallowing pills.4 The ODT has a peak onset of 30 minutes and does not require water for administration. However, as PD progresses, the window of levodopa’s effectiveness is significantly reduced, resulting in more “off” time and subsequent requirement of increased doses and/or frequency.5 Dyskinesia and motor “on/off” fluctuations develop in about 50% of PD patients within 5 years of treatment. For those new to therapy, pharmacists should counsel patients to space doses evenly throughout waking hours. Spacing doses throughout the awake hours helps to optimize observed benefits during activities of daily living. Additionally, patients should be advised to avoid taking doses with high fat, high caloric meals because this can delay gastrointestinal absorption up to 2 hours.

Carbidopa/levodopa extended release (ER) formulations have a bioavailability of 70% relative to that of IR formulations with an initial peak at 1 hour.8 The ER formulation allows for an extended duration of action due to its unique formulation of time release beads. Each capsule consists of one-third of IR carbidopa/levodopa beads, which allows it to start working immediately, while the other two-thirds consists of ER carbidopa/levodopa beads, which, when coupled with the IR beads, allows it to maintain serum levels for up to 5 hours. In addition to IR/ER beads, each capsule also contains an excipient containing tartaric acid. This is intended to provide an acidic environment to enhance levodopa absorption.6Because of its duration of action, ER formulations can be initiated at 3 times a day and titrated to a maximum of 5 times a day. ER formulations are not interchangeable with other carbidopa/levodopa formulations due to variations in dosages and pharmacokinetics. The prescribing information should be consulted when converting to the ER product. For patients who have difficulty swallowing, the capsule may be opened, and the contents of both halves sprinkled into applesauce and consumed immediately.

Carbidopa/levodopa controlled release (CR) tablets provide a sustained release formulation. It has a bioavailability of 70% to 75% relative to that of IR formulations, with a time to peak of 1.5 to 2 hours.5,7 Because the time to reach maximal concentration is delayed, some patients may concomitantly take an IR formulation with the first morning dose. The CR tablets utilize a polymeric based drug delivery system that is designed to release carbidopa/levodopa over 4 to 6 hours allowing for 3 times-per-day dosing. However, CR is less systemically bioavailable than IR formulations and may require higher daily doses in some patients to achieve the same level of symptomatic relief. As such, levodopa doses > 800 mg may be divided every 4 to 8 hours during the waking hours. In clinical trials, the CR formulation provided the same therapeutic benefit as the IR formulation; however, with less frequent dosing when compared to IR. Pharmacists should advise patients not to crush, chew, or cut the CR formulation as this may result in carbidopa/levodopa being released too fast.

pharmacytimes.com/view/unde...

[Teetogreen in reply to Esperanto]

good info. Thanks so much.

[LAJ12345 in reply to Teetogreen]

Some people including my husband have a bad reaction to the ER so if you try them and get worse quickly it is probably due to the new meds.

He does best on the IR tablets 50/12.5 taken regularly every 3 hours with an extra half in between the first 3 doses of the day. I suppose that has the same effect as the ER spreading the dose but at much lower levels.

[park_bear in reply to Esperanto]

A lot of confusion has been created by ambiguous terminology adopted by the manufacturer of Rytary who also refer to their medication as "Carbidopa/levodopa extended release (ER)". This is the same name given to the generic form of Sinemet CR, which is what I was referring to in my comment above. This current comment is referring to Rytary. These are different medications and should not be confused. In my opinion it is best to refer to Rytary as ... Rytary.