[Mike]

Hi Mike,

This is not about cost or price problems. I afraid that Dopamine agonists will be resistance and not work a long time if  I start dopamine agonists. 1-1.5 year later, I will need carbidopa/levadopa support.

Hi Cemal,

I have patients who have been on DA therapy much longer than 1-2 years without needing the addition of LD/CD, so it is far from certain, that it will be a short term solution.

if I start agonists, and also carbidopa/levodopa will work 2-3 years, And after ? what will I do ? I don’t want finish all treatment in 3-4 years later. I want to find another way for  late start dopamines. I can not retire on 47-48 or 50 y.o. Because I have 2 little child and must be power . 

The reality is, everyone is different, so there are no fixed time frames for how long a medication will be effective for. I have patients that have been diagnosed 20-30 years, who still live at home and manage their daily lives with help from family, etc.

There are also other medications like Entacapone/Opicapone/Tolcapone/Safinamide, which can be added at a later date.

But  I know, I need something because my symptoms blockes me ! my right hand not working properly. ı do not have tremor on my arm and right hand, I have Bradykinesia on my right hand and arm .

Liaise with your Neurologist or Nurse and try to find out which is the best option for you. Wishing you the best of luck, Mike 

 

[Mike]

Hi Cemal,

Here in the UK we rarely use Amantadine as a single therapy for Parkinson’s. It is more often used to reduce the impact of longer term levodopa side effects, especially dyskinesias. In terms of symptom control, it can be useful, but would lack the efficacy of levodopa, or dopamine agonist therapy.

Can I ask why you have not been given dopamine agonist therapy, e.g. Ropinirole, Pramipexole or Rotigotine? Is there a cost factor involved? (Cost issues are not such a problem in the UK).

We would usually use dopamine agonists in younger onset Parkinson’s, with levodopa added later at low doses if a little extra was needed.

BW

Mike