Too little or too much L/C ?

[evenshoshan]

Dear CP community friends, I have a question to you please.

Whilst my PD symptoms are still quite mild into my 6th year after diagnosis (right-hand tremor and Restless Leg Syndrome), my neurologist here in France put me for the last year now on a L/C dose of 125 mg/12.5 mg, 3 times a day.

I think that my L/C is 'Immediate Release', but truth is that I don't have the slightest clue...

However, in regards to the dosage itself, when reading through the latest CP posts, I get the impression that the average dose is around L/C 50 mg/12.5 mg, also 3 times day, i.e. literally less than half of what I've been subscribed !

I've also read in some of the CP posts that one can experience a L/C 'overdose'.

Thus I'm worried !

Are there any objective criteria or guidelines by which to judge or question the appropriate L/C dosage ?

Thanks from the heart for your kind attention /contribution.

[Esperanto]

Bonjour evenshoshan. I'm curious which brand you take with the 125/12.5 dosage. In France, it is quite common to prescribe Sinemet IR (immediate release) tablets at 100/10. The starting dosage is typically 3 times a day at 100/10. If you need only that dose 6 years after your diagnosis, that’s great! 👍

Usually, this dosage for IR is increased to 5 times a day, and often an additional 200/50 LP is prescribed for bedtime. If your symptoms are mild, you might consider starting with half doses of 50/5. However, your neurologist may have a somewhat skeptical view on that. Additionally, spreading out doses with IR by taking smaller doses more frequently ensures a more even absorption. This can further reduce the likelihood of side effects.

[evenshoshan in reply to Esperanto]

Hello Esperanto, thank you so much for your advice.

As suggested, I'm going to try half doses 50/5 and see where that takes me.

To answer your question, I currently take the L/C brand 'teva' (please see attached image).

If I may ask, how does one know if it's IR or ER ?

Bye for now.

L/C

[Esperanto in reply to evenshoshan]

Merci! Teva 250/25 is a (cheaper) generic medication of IR Sinemet. Teva 200/50 is the LP (extended release) version.

[Esperanto in reply to Esperanto]

It's strange that the packaging of Teva 250/50 does not clearly indicate IR. One could assume that this is the case, as the 200/50 packaging clearly states LP.

[CuriousMe12 in reply to evenshoshan]

I thought you said you were on 125mg. The picture shows 250mg.Im about 8 years in. I started meds 1-2 year ago and my approach has always been to start low dose and slowly increase.

[evenshoshan in reply to CuriousMe12]

Hello CuriousMe12,

Sorry for the confusion !

I forgot to mention that the L/C pills I take are breakable ('sécable' in French) into two equal halves (each 125 mg / 12.5 mg) and that I've been prescribed to take 3 halves a day, one at 06:00, the second at 12,00 and the third at 18:00, at least one hour before any meals.

If it helps, I will also mention that I follow a very strict 16/8 eating window, aka Two Meals A Day (TMAD). I eat my first meal at around 13:00 (lunch) and the second at around 19:00-20:00 (dinner). I'm religious about it. And of course, no snacks, none ! It all makes the L/C timing a bit easier.

Thanks for your sharp observation, much appreciated.

[CuriousMe12 in reply to evenshoshan]

Good to see you've a lot of regimented self discipline, it's an important quality with pd.

[evenshoshan in reply to CuriousMe12]

Hello again CuriousMe12.

In regards to your wise advice "to start low dose and slowly increase", yes indeed common sense should've guided me down that route.

The truth (my truth) is that I panicked upon diagnosis, was in full speed negation mode, and behaved like a sulking idiot.

Today, at 71 years old, I'm beginning to accept my situation and even realising, that for me, it is a blessing.

Yes a blessing because It took the arrogant cockiness out of me, infused me with genuine humility, with awareness of the suffering around me, appreciation of what I have (glass half full) and a more level-headed thought process of how best to help myself.

That's the main reason why I love people like you and the whole CP community.

[CuriousMe12 in reply to evenshoshan]

It's great you can see the positive evenshoshan.This condition is very humbling. It made me see everyone in new lights and in many respects makes me appreciate what I had and have left.

Going from a very fit 55 year old to pd, certainly makes you aware of the fragility of life.

The other parkies I've met are all so nice, all from different walks of life.

[park_bear]

The optimum level of levodopa medication relieves Parkinson symptoms as much as possible without creating new motor symptoms of its own, or other adverse effects. The most common motor symptom of too much levodopa is dyskinesia - involuntary muscle contractions, oftentimes rhythmic but slower than tremor. Levodopa can also cause dystonia, distinguishable from Parkinson's dystonia because it occurs at the peak of levodopa levels rather than the low.

[evenshoshan in reply to park_bear]

park_bear, hello.

Thank you for the information, I now have some practical guidelines by which to differentiate between the two. I'll be on the watch-out !