Hi Semele, I am on 1.57mg and I could go up again but it was suggested I switch to another agonist to see if they were better. I don't seem to have noticed any improvement since starting medication and I was reluctant to keep increasing the dose because of the side effects. I don't have many just the odd feeling of nausea but I imagine the risk increases with the dosage.
Hi C. That's 1.57mg a day not a dose? There's room to increase it (speaking from experience and not as a dr). The maximum dose is 3.3mg/day as 3 * 1.1mg doses I understand (at least in the UK, I think in America you can go higher still). i take 2.64mg/day as 3* 0.88mg doses.
Nerd's corner: the above are the base figures; the salt figures are much easier to understand: 0.7 base = 1 salt, so in salt terms I take 1.25mg * 3 = 3.75mg. Who's got better chemistry than me and can explain the difference?
S
Has anyone tried Hypnosis to alleviate tremors?
Semele, I think you got the decimal point in the wrong place? You say you take three times a day an 0.88mg tablet, but they do not exist, however, there is a tablet of 0.088mg strength.(equivalent to 0.125mg pramipexole salt), which would give you, taking it three times a day, a total of 0.375mg a day. This is a starting dose.
Camargue, I don't think changing to another DA would make a great deal of difference. People usually change when they cannot get on with a DA because of side effects. I had to go (very slowly) to the maximum dose of Mirapexin(Pramipexole) before I got the desired effect on my symptoms, but after that I then managed for more than two years on this.
Hi Kate, after some discussions with the PD nurse I have decided to have a go at stopping my Azilect to see what difference it makes and then if there is no difference or i get worse to switch to another agonist. I was reluctant to keep upping my dose because of the risk of side effects and I have been told that some agonists work better than others for some people. There is also the option of starting levadopa as well. I will see the neuro physio on thursday which might give me some clarity as to what symptoms are PD related and which are not. Sometimes I think perhaps I should have put off medication for a while if it doesn't seem to help much but maybe I might notice what its doing if i stopped taking all of them. It will be an interesting few weeks.
Hi Camargue
my neuro gave me the option of starting on a DA or Levodopa , his words were , a DA wont work as well as levodopa when i asked him what he recomended he said it had to be my choice i said i wanted some normality back he said levodopa would give me more normality than a DA , when i asked about dyskinesias he was not to concerned about them his words were if and when they occur we have the dbs option , so i opted for the levodopa , it has not been a easy few weeks with nausea and tiredness but the nausea is more of a problem i can deal with the tiredness by having a afternoon nap have had to cut my sinemet to half dose and seeing my gp tomorrow who will hopefully up the domperidone dose so i can gradually go back up to my full dose of sinemet , it was not till i went down to half dose sinemet that i actually realised what the sinemet was doing for me i am really feeling the effects of a lower dose although the levodopa did not take my tremor totally away it did calm it down considerably obviously its now more pronounced on half doses , i also take Azilect as well
Hi Camargue,
From what I have read, the current DAs are pramipexole, rotigotine and ropinirole, and Azilect (rasagiline) is a MAO-B inhibitor.
Just in case that helps in sorting out your meds.
Hi Camargue
Azilect isnt a Dopamine Agonist. It shuts down Mao-b which otherwise breaks down dopamine. It takes Mao-b several week to be replaced which makes it tricky judging the effect of Azilct. Also it may protect neurons.
Azilect cant be increased beyond the usual dose bcause it can cause dangerous sudden high blood pressure.
The advantage of DAs over LD is that they dont cause dyskenisia. They are much more effective than Azilect generally.
cheers
some tips for nausea that others have suggested
- a large glass of water
- a dry biscuit
- a little fruit
there i also madopar if sinemet's other ingredient is the problem
Thanks for all the info, i probably wasn't clear about my meds. I am still taking Pramipexole but have stopped Azilect. It has been suggested that I change from Pramipexole to another agonist as I thought it wasnt having much effect. However over the weekend i forgot to take my usual tablet before i went to bed. We have had friends staying and have been doing lots of different things. I was quite shocked at how much worse I felt yesterday, not only did I have my tremor but my arms were aching with pins and needles in my hands and i developed a twitch in my left leg which is not my tremor side. So maybe Pramipexole is doing more than I thought. It is such a worsening of my condition because before starting meds I only had a slight tremor and a slightly aching arm. So now I am wondering wether i should stick with Pramipexole and up the dose once more or switch to another agonist. Perhaps the tremor is something i must live with and i just need meds to relieve the other symptoms.
levadopa is like the old heiniken advert - it reaches parts that DAs dont. In particular receptor 1. Being the natural chemical it stimulates all receptors whereas DAs only do some. And that is where the problem begins - some areas are over-supplied and this leads to behavioural problems. The bigger the dose the bigger the problem. but levadopa may not help your tremor.
most people add levadopa after 2-3 years on DAs.
I would reconsider dropping azilect for its possible protective role.
lots of people are surprised by the hidden progression of the disease while on meds
Thanks turnip, i have stopped Asilect as an experiment to see if it makes any difference. I started taking it when i was first diagnosed and had pnly a few symptoms. By the time i saw the PD nurse I had been on it a few weeks and I had more pronounced symptoms especially pins and needles of the hands. As this has never gone away with Pramipexole I was just wondering if it could possibly be a side effect of Asilect as it is listed ias one on their leaflet. Who knows, as you say I could have been getting worse and it has been masked by the drugs. I would like to get the best balance of drugs to minimise symptoms now but maybe tremor will just have to remain with me
good luck with the pins and needles. if it is azilect then selegiline does a similar job. yip, the drugs will never get rid of all the symptoms without going into bad side effects. so i will have to stick to lead guitar and never manage rhythm! (cant move more than 2 fingers of left hand at a time). But as i said to my first neurologist - one good hand is better than none.
Hi Kate, sorry for the delay in replying. I said I take a 0.88mg *dose* (as 1* 0.7 and 1 * 0.18 tablets). Sorry for any confusion.
S