Switch Mirapex to Requip

[sandor]

Dear Doctor

I have to stop Mirapex because I can't get more. I took 3 mg per day for about 1,5 years.
My doctor prescribed me Requip, wich approved here this time, and will available  next week. The problem is: I have got The "Patient Starter Pack" wich allowes to increase dosage slowly, during 4 weeks up to 3 mg per day. As I know, 3 mg Mirapex is equivalent approx. 8 mg Requip. I'm afraid, I will get worse becuse of the lack of  dopamine agonists such a long time.
Maybe you have experience, how to change the meds, how to avoid worsening?
May I take them together reducing M. and increasing R? Or after taking Mirapex no sence to start Requip from 0?
Thank you in advance for any suggestion or idea. Here, in Hungary both drugs new, and nobody can have practice or experience in this topic.

Sandor
PS
While I was waiting possibility to post this, my Mirapex got over, today I take 3x 1,25 mg Requip, and I'm rather stiff.
I take Sinemet CR 2x250, and Jumex 2x1 tablets.
How fast I must increase Requip up to 6 mg or more?
Thank you for any suggestion.

[CCF Neuro[P] MD, RPS]

Dear Sandor:

No, we think that once sinemet is started that the effects are put into motion and whether it is stopped or not will still persist (no one really understands why sinemet might affect long term treatment as it does.  But when one looks at the data, there is a definitive correlation).  Anyway, I did not say "alittle" funny to offend you.  I just did not what to imply that the general thought among a group of neurologist who treat PD is to start the agonist first and then as the disease progresses to add sinemet.  There are some who still believe that sinemet should be used initially, but I think the data is becoming more convincing.  So, please do not get emotional that you were made fun of, that is in NO WAY the implication of "alittle".  You should respond to Requip as you did Mirapex.

Sincerely,

CCF Neuro MD

[sandor]

Dear Doctor,
Maybe it's funny, but not for me. When I was diagnosed, in 1995, I was started to treat with Sinemet. (Since that, dosage is the same).
I have heard about dopamine agonists first, only at 1998. The only available here dopamine agonist, bromocriptyne was bad for me.
I did well with Sinemet 2x250cr and Mirapex 3x1mg.
I must switch medications because of the lack of Mirapex.
Now I feel worse, hope Requip to help, but not sure.
Nobody never told me that dopamine agonist helpes alone.( I was exemined in Cleveland Clinic Ft. Lauderdale, in Barcelona by prof. Tolosa,) My neurologist is one of the best in PD in Hungary, but she couldn't have experience, how to swith a not approved drug to a just approved one. That's why I'm seeking information ewerywhere I can.
Tell me please, is it possible teoreticly, after 4 years use left Sinemet, and start again later? Could this way make longer the treatment and save my condition?
Thank you
Sandor

[CCF Neuro[P] MD, RPS]

Dear Sandor:

It seems alittle funny that you would be taking sinemet and also the dopamine agonist.  We usually like to use the dopamine agonist initially and save the sinemet for alot latter in the disease.  But, that is what we do and everyone has their take on the medications for Parkinson's.  What does your physician say?  Since he/she is the one managing you, you need to check with them.  I would say that you should be able to increase the dose at a little faster rate than if you had been a virgin to the medication.  But, call you physician and see what they would like to do.

Sincerely,

CCF Neuro MD