Living with Levodopa. Part1 of 5

[Brian Collins <bjc@xxxxxxxxxxxxxxx>]

Hello everyone.     A short while ago, I offered  to re-issue a short note
which I wrote for my local PDS branch called 'Living with Levodopa'.
Several people expressed interest, so I sat down and started.....I seem
to have learned a lot more since then, and the note grew and grew!  so
to avoid bringing the system to a grinding halt, I will transmit it in 4K to 5K 
chunks, and leave it for you tZo re-assemble.

   This note has been written in small portions due to a rather
high workload, and I would not be surprised if there are mistakes
in it. I see a note such as this as a dynamic, up-to-date thing,
and if anyone cares to argue or discuss any of my assumptions, I
will be pleased to hear their views, and re-issue the relevant
parts if that is called for.

So here  we go: This is

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   LIVING WITH LEVODOPA:                                  PART 1 OF 5



1.  Introduction

The introduction of Levodopa about 33 years ago was probably the most
important single event so far  in the long history of Parkinson's disease,
yet after all that time, and all those pills, many People With Parkinsons
(PWPs)  look on the drug with fear and trembling.  One has only to read the
comments made by various drug companies when promoting their Dopamine
Agonists, to see where such fears may be acquired. But hold on a minute -
Why should we necessarily believe what is said about levodopa when the
person saying it would dearly like to persuade us to replace some levodopa
with his company's expensive new Dopamine agonist?

In this booklet, I will try to pass on the things that I have discovered
while taking levodopa over a period of 18 years, and a total estimated
consumption  over that time in excess of 100,000 tablets (of various sorts)
I will inevitably refer occasionally to Dopamine agonists, as the two types
are complementary. I have tried to keep away from areas which may be
considered to be contentious, but inevitably my strongly-held convictions
(about for instance taking only as much levodopa as you need, rather than
as much as you can tolerate), will break through.  All I can do is try to
signal the areas where I am theorising rather than talking about facts.

2.  The Available Tablets - Brand Names

Essentially there are two Brand names associated with levodopa: Sinemet
and Madopar. (there may be many companies who manufacture 'generic'
tablets, but these are just copies of one or other of the names mentioned,
(possibly with more relaxed tolerances on the active ingredients).

    Of those two, only Sinemet is available in the USA.  This is a pity
because although in 'normal' use the two formulations are in my
experience interchangeable, you will see as you read on that in some
applications Madopar has a slight edge. Table 1 shows those countries in
which Madopar can be obtained.- I am always grateful if someone can add
more.

3.0  The effect of the Digestive System on Sinemet/Madopar.

The normal path for the drug is :- From the mouth to the Lower Intestine:
>From the Lower Intestine into the bloodstream: From the bloodstream to the
brain: and finally to the Substantia Nigra. This section starts in the
Lower Intestine.

   3.1 Fatty foods tend to slow down the emptying of the stomach (into the
lower intestine), effectively creating a 'traffic jam'. Also, the products
of protein digestion compete with levodopa  for transport accross the wall
of the lower intestine. In addition, the longer the tablet stays in the
intestine the more likely that some of it will be lost (Even with the
Carbidopa protection). (One of the most annoying moves which has been
forced on me is that I have had to give up Cheese! It was taking 2 hours
and more for the way to become clear, and normal service to resume after I
had eaten some cheese.)

--
Brian Collins  <bjc@xxxxxxxxxxxxxxx>