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I think my Prami is causing emotional issues

Muscle Gelz Transdermals
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Wow, that is the most AI I have heard any one use ever, and I have been at this game for quite some time being 51 and all...lol

Sounds like you have the liquid chems and not pharma, is this so?
If it is so then it probably is under dosed.

But, I have bought some liquid clen that was probably double or more what the dose was and that stuff was seriously strong.

The prami I bought from afstore was over dosed too, I felt like I was in a coma with the lowest dose.
I felt terrible on that and gave it away.

One other thing might be happening here, high glycemic meals can spike insulin and although insulin is a storage hormone it does have an inflammatory responce, so you probably might be a bit sensitive to high glycemic carbs.

You dont notice the same effect with low GI/GL foods do you?

For what it is worth, I think you look pretty good in your avatar bro, dont cut yourself short.
 
Ignorant and rude? If you say so.

Thanks for letting me know I have self esteem issues, I was unaware of that, I'm sure I'll sleep much better knowing that tonight. Thanks.

Go to www.pubmed.com and look at all of the studies there, also go through the link I posted as there are numerous studies posted throughout the 21 pages. That's where I got all of my information, along with using it numerous times with blood work results to back up my claims, but you've 1. Never tried it, 2. Never read the studies and 3. are going on here say? Is that about right?

You didn't explain why it's a harsh drug, you listed the sides which you've read about, but actually you didn't read about because you didn't read the studies.

You are talking out your ass. There is no other way to say it. How's you have no idea what you're talking about? Is that better?

Why are you going around calling me an asshole anyhow? I don't agree with much that you have to say but I'm not insulting you or name calling like a 5 year old, grow up. Is this how you react when you don't agree with someone? Maybe, just maybe you have the self esteem issues?

Thanks for trying to be a father figuire, mr. CT, sir. That's what it is, I need to grow and stop telling people they're assholes because they can't take criticism because their post count doesn't allow it. I get it now. Thank you. Telling me I'm talking out of my ass is an insult, to me. And you are an asshole. I'm going around calling you an asshole because you deserved it. Now back to the subject at hand. Prami is no Tylenol. As much CT wants it to be. Are you pushing it, CT? Is that what it is? I tried similar drugs in the past, bromo and dostinex. They come with nasty side effects too. So once again, i'm going to say this, Prami is a hursh drug. Its possible side effects are harsh. I'm sorry to say this, CT but the studies done on this drug do not take away its side effects. You can research all night tonight and post more studies but its still a nasty drug. But thanks for posting the links. I don't know how to post links. You really know your computer, CT!
 
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Thanks bro.

Low GI foods seem to be more gyno friendly for me. But it's VERY HARD to stay low carb all the time, especially when cutting, I need my refeeds or I drop dead during heavy workout days haha as I like to do HIIT.

I ordered my Letro and Prami from CEM Products and was told they are GTG ??
Anybody else think differently?

Thanks for the compliment about my avatar dude, I am a major endomorph with an above average number of fat cells due to being obese as a child, therefore it is MUCH HARDER for me to achieve and maintain a low body fat percentage, but due to psychological issues and being bullied while growing up, I need to stay lean year round in order to be confident in myself.

I think that even though I am lean, the NUMBER of fat cells is causing me to have high aromatase activity. But who knows....

I love the prami, but I just wish I could avoid the abdominal pain, nausea, dizziness, occasional shortness of breath and anxiety. Insomnia is something I have dealt with my whole life anyways, so it doesn't bother me.

I am lowering the dose down to 0.5mg for 7 days, and hopefully going to step it back up to 0.75mg once things stabilize a little better, I think I just increased it too quickly.
 
Thanks for trying to be a father figuire, mr. CT, sir. That's what it is, I need to grow and stop telling people they're assholes because they can't take criticism because their post count doesn't allow it. I get it now. Thank you. Telling me I'm talking out of my ass is an insult, to me. And you are an asshole. I'm going around calling you an asshole because you deservied it. Now back to the subject at hand. Prami is no Tylenol. As much CT wants it to be. Are you pushing it, CT? Is that what it is? I tried similar drugs in the past, bromo and dostinex. They come with nasty side effects too. So once again, i'm going to say this, Prami is a hursh drug. Its possible side effects are harsh. I'm sorry to say this, CT but the studies done on this drug do not take away its side effects. You can research all night tonight and post more studies but its still a nasty drug. But thanks for posting the links. I don't know how to post links. You really know your computer, CT!

Dbol is a harsh steroid, but you don't see everyone getting high BP, gyno, water retention, etc... from it... Not everyone is going to react the same to a drug.

I have seen multiple threads where people are loving it. Apparently I am not one of those people yet because I increased my dose too quickly.
 
Oh, off the top of my head a few things I can intergect to possibly help here, but vague in nature.

Gut issues?
Pro-biotics would be an awesome addition here, as well as digestive enzymes, this will allow you to get more out of your food, better elimination, improve immune system (70% of immune system is actually in your intestines), aid in over production of yeast (sadly I notice this on cycle), and help to have less bloat.

Sounds like you are also having problems with insulin resistance, this may help.
Lower your glycemic index of your carbs, you dont have to eliminate them but you can lower that and it will help with fat management, remember insulin is a storage hormone.

This is what may be happening.
High glycemic foods spike insulin, insulin is a storage hormone, so that meal spikes insulin, insulin lowers the blood sugars. Due to the brain being the highest glucose hog in the body it will call out for food due to the fact last meal got stored and left the brain a bit low.

So, you can lower the glycemic load of a meal using fiber, and oils, monounsaturated oils work well like olive oil and fish oils.
Fish oils will help with insulin resistance, and help elivate PG-1 and PG-3 which are prostaglandins what lower inflammation in the body.
this will help you be more insulin sensitive and lower overall inflammation.

Melatonin is a great hormone that turns on when the sun goes down, this is like a biological clock that sends a hormonal signal to sleep.
Melatonin is awesome and 3mg would work well and it is very cheap.
Not to mention it has anti-cancer properties, a very strong anti-oxidant, can but dont quote me on this one bump GH production during sleep.
Actually is used in Europe for some prostate cancer treatments.
Its safe, not habbit forming but take it a couple of hours before you go to bed.

Your other things I can give you a list of herbs that may help but some of the steroids you are taking have DHT dirivitives and actually cause central nervous system stimulation.
That may be causeing that.

I will post more as time goes on, and when more information hits me from your posts.
 
Oh, off the top of my head a few things I can intergect to possibly help here, but vague in nature.

Gut issues?
Pro-biotics would be an awesome addition here, as well as digestive enzymes, this will allow you to get more out of your food, better elimination, improve immune system (70% of immune system is actually in your intestines), aid in over production of yeast (sadly I notice this on cycle), and help to have less bloat.

Sounds like you are also having problems with insulin resistance, this may help.
Lower your glycemic index of your carbs, you dont have to eliminate them but you can lower that and it will help with fat management, remember insulin is a storage hormone.

This is what may be happening.
High glycemic foods spike insulin, insulin is a storage hormone, so that meal spikes insulin, insulin lowers the blood sugars. Due to the brain being the highest glucose hog in the body it will call out for food due to the fact last meal got stored and left the brain a bit low.

So, you can lower the glycemic load of a meal using fiber, and oils, monounsaturated oils work well like olive oil and fish oils.
Fish oils will help with insulin resistance, and help elivate PG-1 and PG-3 which are prostaglandins what lower inflammation in the body.
this will help you be more insulin sensitive and lower overall inflammation.

Melatonin is a great hormone that turns on when the sun goes down, this is like a biological clock that sends a hormonal signal to sleep.
Melatonin is awesome and 3mg would work well and it is very cheap.
Not to mention it has anti-cancer properties, a very strong anti-oxidant, can but dont quote me on this one bump GH production during sleep.
Actually is used in Europe for some prostate cancer treatments.
Its safe, not habbit forming but take it a couple of hours before you go to bed.

Your other things I can give you a list of herbs that may help but some of the steroids you are taking have DHT dirivitives and actually cause central nervous system stimulation.
That may be causeing that.

I will post more as time goes on, and when more information hits me from your posts.

Great post but I am already doing literally everything that you have suggested. I am a Doctor of Traditional Chinese Medicine in training, and I take regular probiotics (in high doses), I eat healthy fats to slow absorption, I take a great source of chromium to help with blood sugar and keep my GI low except on refeed days. I consume organic walnuts which contain the only source of natural melatonin.

Thanks for your suggestions.
 
chronic you really need to save up and have the gyno removed man. I think it will pay for itself a lot faster than you think considering how much you're losing in gains and how much you're paying in AI's. Are you old enough to be on TRT? Wonder if insurance would cover some of a gyno surgery. Doubtful though I'm sure.
 
Great post but I am already doing literally everything that you have suggested. I am a Doctor of Traditional Chinese Medicine in training, and I take regular probiotics (in high doses), I eat healthy fats to slow absorption, I take a great source of chromium to help with blood sugar and keep my GI low except on refeed days. I consume organic walnuts which contain the only source of natural melatonin.

Thanks for your suggestions.

Oh fantastic I will be getting ahold of you with some Chineese herbal questions if you don't mind?
 
Currently (against heavyiron's recommendation) I am actually taking Letro at 2.5mg ED and Aromasin at 25mg ED because I needed to overlap while adding in the Letro, and now have been overlapping 13 days.

I am not having any libido issues, my joints are fine (might be the NPP ?) and my gyno is still somewhat fluctuating but for the most part is probably down about 15% - 20% in size which may be just a reduction in inflammation and not tissue reduction.

Good lord.............10mg Stane or .25 Letro is more than I have ever needed. I actually like some estrogen... At that it hurts my libido. This is the most I have ever seen anyone need. If you get your E2 checked, please post the results.
 
Good lord.............10mg Stane or .25 Letro is more than I have ever needed. I actually like some estrogen... At that it hurts my libido. This is the most I have ever seen anyone need. If you get your E2 checked, please post the results.
I have seen guys on 5mg of Letro every day. Some guys have high aromatase activity.
 
If that were me, I think I would steer clear of roids.
 
I have seen guys on 5mg of Letro every day. Some guys have high aromatase activity.

Wow, jesus christ !!!!!!!!!

Good lord.............10mg Stane or .25 Letro is more than I have ever needed. I actually like some estrogen... At that it hurts my libido. This is the most I have ever seen anyone need. If you get your E2 checked, please post the results.

I had my levels 9 days ago, so maybe another 5 days and I'll get them checked again.
 
Ignorant and rude? If you say so.

Thanks for letting me know I have self esteem issues, I was unaware of that, I'm sure I'll sleep much better knowing that tonight. Thanks.

Go to www.pubmed.com and look at all of the studies there, also go through the link I posted as there are numerous studies posted throughout the 21 pages. That's where I got all of my information, along with using it numerous times with blood work results to back up my claims, but you've 1. Never tried it, 2. Never read the studies and 3. are going on here say? Is that about right?

You didn't explain why it's a harsh drug, you listed the sides which you've read about, but actually you didn't read about because you didn't read the studies.

You are talking out your ass. There is no other way to say it. How's you have no idea what you're talking about? Is that better?

Why are you going around calling me an asshole anyhow? I don't agree with much that you have to say but I'm not insulting you or name calling like a 5 year old, grow up. Is this how you react when you don't agree with someone? Maybe, just maybe you have the self esteem issues?

How do you not ban this clown CanadaGear? If I was a mod here I would have ban hammered him by now.
 
I have seen multiple threads where people are loving it. Apparently I am not one of those people yet because I increased my dose too quickly.

bro, dostinex makes you feel pretty fucking good too but its not worth the heart problems.
 
So far I have taken 0.25mg of Prami this morning and felt like absolute GARBAGE.

I have been taking 0.75mg for a 3 days prior to this, and am contemplating whether I should take my second dose of 0.25mg (lowering my dosage down to 0.5mg) before bed or if I should just remain at 0.25mg for today and do 0.5mg tomorrow.

0.5mg never caused a problem, however maybe it was because it hadn't had a chance to build up in my system yet? Thoughts ?
 
Funny...I saw this thread but didn't read it until this morning. I just happen to watch Inception last night. Good movie. I also had a vivid dream last night about my dad who passed away a few years ago. I started to get a little emotional myself but I'm not on prami.
 
How do you not ban this clown CanadaGear? If I was a mod here I would have ban hammered him by now.

I'm sure you would have, because you're so tough. A real man. CT, I think Glycomann wants your job.
 
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Thanks for trying to be a father figuire, mr. CT, sir. That's what it is, I need to grow and stop telling people they're assholes because they can't take criticism because their post count doesn't allow it. I get it now. Thank you. Telling me I'm talking out of my ass is an insult, to me. And you are an asshole. I'm going around calling you an asshole because you deserved it. Now back to the subject at hand. Prami is no Tylenol. As much CT wants it to be. Are you pushing it, CT? Is that what it is? I tried similar drugs in the past, bromo and dostinex. They come with nasty side effects too. So once again, i'm going to say this, Prami is a hursh drug. Its possible side effects are harsh. I'm sorry to say this, CT but the studies done on this drug do not take away its side effects. You can research all night tonight and post more studies but its still a nasty drug. But thanks for posting the links. I don't know how to post links. You really know your computer, CT!


I've stated my case time and time again. You just don't get it but you continue to insult me.

Bottom line: Cut the crap or leave. It's fine to disagree but be civil about it.

Insted of you answering any questions you just try and turn it around and question the question, you don't have the answers and you know it.

Bottom line is if you think it's a harsh drug fine, that's your opinion.

When you decide to spit out all of these "sides" that a user will get without ever using it, reading any of the studies or knowing what doses were used then yes......you're talking out of your ass.

Post counts mean nothing, sorry you feel that way.
 
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I've stated my case time and time again. You just don't get it but you continue to insult me.

Bottom line: Cut the crap or leave. It's fine to disagree but be civil about it.

Insted of you answering any questions you just try and turn it around and question the question, you don't have the answers and you know it.

Bottom line is if you think it's a harsh drug fine, that's your opinion.

When you decide to spit out all of these "sides" that a user will get without ever using it, reading any of the studies or knowing what doses were used then yes......you're talking out of your ass.

Post counts mean nothing, sorry you feel that way.

lol, you're a funny guy, CT. You make this post and warn me via PM that you'll ban me if I say anything else. You're turning a discussion board into an army base. You weren't civil about this whole discusion to begin with. Who gave you the right to insult people, CT? Are you special? Where's the studies to prove that var always shuts you down? You conviniently backed down from that argument and decided to butt in on my opinion on Prami.
 
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Muscle Gelz Transdermals
IronMag Labs Prohormones
Guys come on.... this argument is getting old. A debate is fine but you guys are just attacking each other.

Either way, I decided to take the other dosage of 0.25mg making it a total of 0.5mg yesterday and I didn't have as many issues last night. I still woke up once in a panic, gasping for air and my heart was pounding, but nothing too intense. And I didn't wake up feeling like I just smoked an entire pound this morning like I did the last 4 mornings, so I think I'm moving in the right direction :)
 
lol, you're a funny guy, CT. You make this post and warn me via PM that you'll ban me if I say anything else. You're turning a discussion board into an army base. You weren't civil about this whole discusion to begin with. Who gave you the right to insult people, CT? Are you special? Where's the studies to prove that var always shuts you down? You conviniently backed down from that argument and decided to butt in on my opinion on Prami.

My "Warning" said that your acting like an ass and that if you don't like it, leave. 99% of people would have banned you from the start. Tell the truth and how it was really stated. I also never stated that I would ban you if you said anything else, that's just not true and you know it.

Here are the two studies I am referring to:


Efficacy, safety and dose-response of pramipexole: randomized trial.
Inoue Y, Kuroda K, Hirata K, Uchimura N, Kagimura T, Shimizu T.
Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan. inoue@somnology.com
Abstract

AIMS: To assess the safety and efficacy of pramipexole and to investigate factors predictive of early treatment response.
METHODS: Patients with primary RLS and the International Restless Legs Syndrome Study Group rating scale (IRLS) total score of >15 were randomized to receive pramipexole 0.25, 0.5 or 0.75 mg/day for 6 weeks.
RESULTS: A total of 154 patients were recruited. Following treatment, the mean adjusted change in IRLS score in the 0.25, 0.5 and 0.75 mg/day groups was -12.3, -12.5 and -11.8, respectively. The proportion of IRLS responders at week 2, when all patients were receiving pramipexole at a dose of 0.25 mg/day, was 34.0-37.7%. At 6 weeks, when the patients were on 0.25, 0.5 or 0.75 mg/day, IRLS responders defined as those having a ≥50% reduction in IRLS score accounted for 60.4, 58.5 and 49.1%, respectively. Older age above the median value (≥55 years) and low IRLS score at baseline (<21.5 points) were significantly associated with early response to low-dose pramipexole therapy. The type and frequency of adverse events were consistent with the known safety profile for dopamine agonists in RLS.
CONCLUSIONS: Pramipexole at 0.25-0.75 mg/day is efficacious, safe and well tolerated.



The effects of oxandrolone on the growth hormone and gonadal axes.

Malhotra A, Poon E, Tse WY, Pringle PJ, Hindmarsh PC, Brook CG.
Endocrine Unit, Middlesex Hospital, London, UK.
Abstract

OBJECTIVE: We studied the effects of oxandrolone on serum concentrations of LH, FSH, testosterone, GH, SHBG, DHEAS, IGF-I and insulin in men with constitutional delay of growth.

DESIGN: Ten men with constitutional delay of growth, mean age 18.8 years (range 17.4-22.5) were studied. Twenty-four-hour serum concentration profiles of GH, LH and FSH were constructed by drawing blood samples at 20-minute intervals. Three study occasions over a period of 6 months were chosen to assess hormone concentrations before, during and 6 weeks after a 3-month course of oxandrolone (2.5 mg once daily) therapy.

RESULTS: Growth velocity increased during oxandrolone treatment and stayed higher after therapy (pre 3.9 +/- 0.5; on 6.3 +/- 0.8; post 6.4 +/- 0.9 cm/year (mean +/- SEM) two way ANOVA, F = 5.3, P = 0.02). Oxandrolone had androgenic effects, suppressing mean serum LH concentrations from 1.7 +/- 0.3 to 1.1 +/- 0.2 U/I and serum testosterone concentrations from 1.9 +/- 0.6 to 0.8 +/- 0.1 nmol/l. SHBG concentrations were also reduced from 130.9 +/- 14.6 to 30.7 +/- 7.3 nmol/l. Serum GH concentration fell slightly from 5.9 +/- 0.6 to 4.8 +/- 0.5 mU/l. After cessation of treatment, there was a significant 'rebound' in mean 24-hour serum LH (2.6 U/l +/- 0.4) and testosterone concentrations (3.2 +/- 0.9 nmol/l) but no change in serum GH concentrations. SHBG values also rose but not to the same extent as those observed before therapy (82.0 +/- 8.4 nmol/l). There were no statistically significant differences in serum concentrations of FSH, DHEAS, IGF-I and insulin over the study period. In a stepwise multiple regression analysis of factors that might influence the growth rate observed, the 24-hour mean serum testosterone concentration and the treatment (on or off) with oxandrolone were the main influences. The relationship was described by the equation Height velocity = 0.69 (24-hour mean serum testosterone concentration)+1.70 (treatment regimen)+3.37 (adjusted R2 = 0.35, F = 8.39, P = 0.001).

CONCLUSIONS: Oxandrolone has an androgenic action as shown by decreased changes in serum LH, FSH, testosterone and SHBG concentrations. No effect of oxandrolone on the GH axis was documented. We suggest that the growth promoting effects of oxandrolone are related in part to the mild androgenic effects of the steroid and the growth acceleration following oxandrolone withdrawal reflects increasing total serum testosterone concentrations and decreasing levels of SHBG and progress.



Please feel free to post your studies or tell me that these are indeed wrong.
 
I hope nobody minds me airing my thoughts.
The above study with var suggests just 2.5mg dose causes a decline in both LH, and FSH and a reduction in testosterone is shown.

Many people suggest var is non supressive but from personal use, it is.
Lets not forget that 2.5mg a day isnt going to do much of anything other than lower your 7mg daily dose of testosterone to try and maintain homeostasis.
Women use more var than that.

Last var cycle I did was 75mg ED, 7 weeks later I had noticible testicular atrophy.

I want to add the rebounding is due to LH spiking to force the nuts to come back to normal range and mild supression.
Rebounding is just the body trying to get back to homeostasis and not some magical bridge type of thing.
All steroids cause some form of supression, anavar is very tame and at 2.5mg ED, gains would hardly be noticable. Supplementing exogenous steroids and interfering endogenous production is pointless.
 
Today I am experiencing minor muscle twitches, headaches and drowsiness. Definitely better than yesterday though. Yesterday I was considering hanging myself (just kidding)
 
My "Warning" said that your acting like an ass and that if you don't like it, leave. 99% of people would have banned you from the start. Tell the truth and how it was really stated. I also never stated that I would ban you if you said anything else, that's just not true and you know it.



Please feel free to post your studies or tell me that these are indeed wrong.

That makes no sense. You gave me a warning to leave? The truth is you insulted me first but expected not be insulted back. Then pressured me to keep quite via PM by threatening to ban me. You're abusing your moderator's authority. I don't like you but I won't leave because I like the board.

Now regarding the studies. I already posted a quote from the anavar profile on steroid.com which is supported by several studies. They're all posted there. As far as Prami goes:

Pramipexole for levodopa-induced complications in Parkinson's disease
Clarke CE, Speller J, Clarke JA

In the later stages of Parkinson's disease, side effects occur because of the use of levodopa in its treatment. These consist of involuntary writhing movements (dyskinesia), painful cramps in the legs and a shortened response to each dose referred to as 'end-of-dose deterioration' or the 'wearing-off effect'. Dopamine agonist drugs act by mimicking levodopa in the brain, but they do not cause these long-term treatment complications. For this reason, dopamine agonists have for some years been added once these problems develop in the hope of improving them. Pramipexole is a new dopamine agonist recently licensed in the UK for the treatment of later Parkinson's disease. In this review, we will examine the trials performed with this drug to see how effective it is and what side effects it causes.

Four trials have compared pramipexole with placebo in 669 patients with later Parkinson's disease. Two studies were medium term (24 weeks) and 2 studies were short term (4 weeks). Pramipexole significantly reduced the time patients spent in the immobile off state compared with placebo by an average of 1.8 hours. No changes occurred in a dyskinesia rating scale in any of the studies, but dyskinesia recorded as a side effect was reported more frequently with pramipexole. A significant improvement occurred in the Unified Parkinson's Disease Rating Scale (UPDRS) complication score in 2 studies but not in the remaining trials. Significant improvements in UPDRS activities of daily living score occurred with pramipexole in all studies. Significant improvements in UPDRS motor scores in the mobile on state were reported in 3 of the 4 studies. Levodopa dose reduction was allowed in 3 studies and meta-analysis showed a significant difference in favour of pramipexole. There was a suggestion of more side effects such as nausea, vomiting and dizziness with pramipexole and a definite increase in hallucinations in those given pramipexole. There were significantly fewer withdrawals from pramipexole.

In conclusion, pramipexole can be used to reduce off time, improve motor impairments and disability and reduce levodopa dose at the expense of increased dyskinetic side effects. This is based on short and medium term trials (up to 24 weeks). Further trials are required to directly compare the newer with the older dopamine agonists.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 12, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

This record should be cited as: Clarke CE, Speller J, Clarke JA. Pramipexole for levodopa-induced complications in Parkinson's disease. Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD002261. DOI: 10.1002/14651858.CD002261

Editorial Group: Movement Disorders Group
This version first published online: July 24. 2000
Last assessed as up-to-date: January 24. 2000
 
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Seriously? You're quoting studies done on people with Parkinson's disease?
That's like saying studies done on women apply to studies done on men....
 
Seriously? You're quoting studies done on people with Parkinson's disease?
That's like saying studies done on women apply to studies done on men....

Yes, seriously. The study CT has posted used patiends with RLS. That's fine. I know you want to see studies done on guys using test, npp and letro :)
 
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Here's another one. This one was done on patiens with PD and RLS.

Pramipexole
Sifrol (Boehringer Ingelheim)
125 microgram, 250 microgram and 1 mg tablets

Approved indications: Parkinson’s disease, restless legs syndrome
Australian Medicines Handbook section 16.2.1

In Parkinson’s disease, there is a reduced concentration of dopamine in the nigrostriatal system. Dopamine agonists, such as bromocriptine, therefore have a role in the treatment of Parkinson’s disease. Pramipexole is a non-ergoline dopamine agonist which acts on D2 and D3 receptors (see ‘Dopamine – clinical applications i. neurology’, Aust Prescr 1994;17:21-3). Levodopa (combined with a decarboxylase inhibitor) remains the first-line drug treatment for Parkinson’s disease of moderate severity. In advanced disease, the effect of this therapy starts to wear off. Maintaining the stimulation of dopamine receptors may alleviate this disabling complication.

When pramipexole was added to levodopa treatment, in a double-blind trial of 291 patients with advanced disease, it was more effective than placebo. Pramipexole improved motor function and decreased ‘off’ time. The patients’ self-assessments also suggested that the severity of the ‘off’ time was reduced by pramipexole. Compared to placebo, the biggest changes were seen in rigidity, resting tremor, hand movements and finger tapping. At the end of the 32-week trial, the dose of levodopa required by the patients taking pramipexole had been significantly reduced.1

In the trial, the maximum dose was 4.5 mg a day. Usually pramipexole is given in divided doses, beginning with 125 microgram three times a day. The dose is increased every week if the patient is improving without adverse effects. While the dose is being titrated, the dose of levodopa can be reduced.

After a dose-ranging study in early Parkinson’s disease [2], pramipexole was compared with levodopa in a double-blind trial involving 301 patients. Those randomised to receive pramipexole took longer to develop problems with the effect wearing off, on-off fluctuations or dyskinesia.[3]

Pramipexole also has an indication for restless legs syndrome. It was compared with placebo in a 12-week trial involving 344 patients. On a 40-point symptom rating scale, there was a mean improvement of 9.3 points with placebo and a 12.8 point improvement in people taking pramipexole 250 microgram daily. While 75% of patients responded to this dose of pramipexole, the response in the placebo group was 51%.4

In Parkinson’s disease, lower doses of pramipexole are required if the patient has renal impairment as the drug is mainly excreted unchanged in the urine. The elimination half life is increased from 8 to 12 hours in elderly patients. Renal clearance is also reduced by cimetidine which is thought to inhibit secretion in the renal tubules. This mechanism also creates the potential for interactions between pramipexole and ranitidine, diltiazem, verapamil, digoxin, triamterene and trimethoprim.

Some of the adverse effects of pramipexole can be predicted because of its stimulation of dopamine receptors. For example, up to 17% of patients will develop hallucinations. Other common adverse effects include nausea, insomnia, somnolence and dyskinesia. A few patients have fallen asleep suddenly, including when driving, and others have become compulsive gamblers while taking pramipexole.

Pramipexole should be withdrawn gradually over several days. Sudden cessation of antiparkinson drugs can cause neuroleptic malignant syndrome.

There are few published comparative studies of the dopamine agonists. A study in which pramipexole compared favourably with bromocriptine did not have enough power to show a statistical difference.5 There is limited information about the long-term use of pramipexole. This is important because, for example, retinal degeneration has been seen in long-term studies of rats. Although fewer patients given pramipexole develop dopaminergic motor complications, patients given levodopa have a greater improvement in their early Parkinson’s disease. While both drugs cause an initial improvement, after two years the patients’ quality of life scores decline significantly less with levodopa.3

manufacturer provided additional useful information
References*†
Lieberman A, Ranhosky A, Korts D. Clinical evaluation of pramipexole in advanced Parkinson’s disease: results of a double-blind, placebo-controlled, parallel-group study. Neurology 1997;49:162-8.
Parkinson Study Group. Safety and efficacy of pramipexole in early Parkinson disease. JAMA 1997;278:125-30.
Parkinson Study Group. Pramipexole vs levodopa as initial treatment for Parkinson disease. A randomized controlled trial. JAMA 2000;284:1931-8.
Winkelman JW, Sethi KD, Kushida CA, Becker PM, Koester J, Cappola JJ, et al. Efficacy and safety of pramipexole in restless legs syndrome. Neurology 2006;67:1034-9.
Guttman M; International Pramipexole-Bromocriptine Study Group. Double-blind comparison of pramipexole and bromocriptine treatment with placebo in advanced Parkinson’s disease. Neurology 1997;49:1060-5.
 
This study makes me want ot try Prami myself. :callme:

Munhoz RP, Fabiani G, Becker N, Teive HA.
Movement Disorders Unit, Neurology Service, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil.

INTRODUCTION: Several recent reports have linked the use of dopamine agonists (DAs) to a variety of compulsive behaviors in patients with Parkinson's disease (PD). These inappropriate behaviors may include pathological gambling, compulsive shopping, and hypersexuality. AIM: To report the case of a patient with increased range of sexual behavior after use of pramipexole, a DA. METHODS: A 67-year-old man with a 7-year diagnosis of PD treated with levodopa and pramipexole presented with a dramatic change in sexual behavior after an increase in DA dose. RESULTS: The patient, who historically was a very shy and conservative person, started to present increased frequency of sexual intercourse with his wife, during which he began speaking obscenities with an extreme preference for anal intercourse, preferences never requested before. After pramipexole was withdrawn, complete remission was observed with return to his usual sexual behavior.

CONCLUSIONS: Hypersexuality and paraphilias are complications not uncommonly found in patients with PD under dopaminergic treatment. Further studies are needed for the understanding of this complex complication, and particularly the most prevalent relationship between pathological hypersexuality and use of DAs.
 
I'm sure you would have, because you're so tough. A real man. CT, I think Glycomann wants your job.

It's not about tough. Arguing with you is like arguing with a drunk. And yes I would ban you from any board I Mod on. You are a waste of white space and a danger to yourself.
 
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