I experience a gap in my medication that starts 30–40 minutes before my next dose. It begins suddenly with discomfort, negative thoughts, and feelings of sadness and/or depression; later, tremors set in, along with a general feeling of lethargy and sluggishness, making it difficult to move. These symptoms occur in the evening. When I’ve felt this, I’ve immediately taken 1 Quick Mite, which provides relief, and I take my regular dose of Madopatk on time. I take q8 M and 2 M depot at night. Is my dose too high? I’ve now been experiencing stomach problems, nausea, a bloated abdomen and diarrhoea. My neurologist thinks it’s just ordinary anxiety and that I should just take it easy and not worry about what it is. There’s no Parkinson’s monitor at the clinic… how can I check if it’s a dosing error? What can I do, or what should I do about the dosing error?! Am I doing something wrong at the moment, given that my stomach has started playing up? I can’t get through to the doctor. It’s getting worse and worse.

It’s not that easy to measure a dose gap, but motor dose gaps can sometimes be detected using measuring instruments such as the PKG watch. But if the symptoms appear so predictably before your next dose and are relieved by an extra dose, it’s likely a dose gap, even if it’s ‘just’ anxiety. The simplest way to prevent dose gaps is to take your levodopa a little more frequently, or alternatively to add another Parkinson’s medication. Discuss this with your neurologist. The stomach problems could be due to an excessive dose, but may well be caused by other factors as well. /Dag Nyholm