Re: Help please!

[Brian Collins <bjc@xxxxxxxxxxxxxxx>]

On Sat 14 Sep, Kathy Sedler wrote:

> I spoke with John a few days ago and he (unbenownst to me) has been having
> hallucinations since uping his dose of Permax (3 caps with each meal).  He
> also takes Sinemet (unknown amount) and also told me he suffers from leg
> cramps off and on.  Up to this point, his major concern was the shaking of
> his hands.  The doctors have tried time and time again to up his Permax, and
> each time he has very bad reactions.  I felt badly, not knowing he was going
> through all this (I see him infrequently as he lives a distance away) so I
> did not send him pertinent letters you all had written on those subjects -
> only those I knew he was going through.  I vaguely remember some mention of
> the hallucinations with Permax and would very much appreciate if someone
> could reply once again (my apologies) so that I can print your reply and mail
> to him.  Also, I mentioned to him that I saw something about a PD specialist
> in Calif. bay area (is this right).  Does anyone have any specifics, as his
> dr. is not real well versed in PD.
> Thank you all for your patience in this redundant request.  And thanks from
> John -he expresses his gratitude for the information you provide.
>
> Kathy    SMEHerbs@xxxxxxx
>
Hello Kathy,
            To comment usefully, there are a number of pieces of information
which are needed. For instance:

1)  How much Sinemet does your friend take per day? (In milligrams).

2)  There are a number of different strengths of Permax, so again how much per
day (in mg). As far as I know, a total of 3 mg/day is the recommended max
dosage.

3)  Has he exhusted the potential of levodopa? For instance, has he or his
doctor been unable to find a dosage which stabilises the tremor without side
effects such as dyskinesia (That is random, uncommanded movements of the arms
or legs).

4) The effect of Permax is relatively small. - the big swinger is Sinemet,
which is why it is so important to know how much is currently being used. The
addition of more and more Permax should only be a last resort assuming that
the points raised above have been addressed.

5) There are some new alternatives to Permax either just cleared or soon to be
cleared.  Look out for Cabergoline and Ropinirole (Cleared  in UK: Should be
clear soon in USA.) These are claimed to be more efective than Permax.

I hope this is of some help. Contact me if you have any questions.

Regards,

Brian Collins <bjc@xxxxxxxxxxxxxxx>