Brief Answer:
You really need to clarify things with your primary doctor

Detailed Answer:
I am prefacing my comments with the following disclaimer.

No comments, suggestions, or opinions regarding your medication regimen should be implemented without speaking to your doctor first. No online doctor can possibly have the same amount of information about you and your medications than your own treating physician who I am assuming is a neurologist as well.

You should understand that manufacturer medication dosing limits are generally meant to be relative stop points given what they believe to be the likely "average" patient. When confronted with patients who are not "average" then, those limits can be surpassed or not adhered to by the treating physician because prescribing practices are always at the discretion of the treating physician.

If your doctor is starting at a higher than recommended dose then, my guess is that it is necessary in his opinion since you are on a significantly higher dose of sinemet than most average PD patients.

Having said that I can tell you that in my own practice of how I dose Rytary (and just about any drug that requires titration) I nearly always start my patients out at the very lowest possible dose of the drug and then, SLOWLY (sometimes painfully slowly) increase the dose until I find either the clinical effect I'm looking for or an intolerable side effect that causes us to either discontinue the medication or back off to a lower dose and start again.

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload more specific information regarding lab tests and diagnostic studies if done and I'll be happy to look at them in the context of your question.

Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.

Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.

This consult request has taken a total of 22 minutes of time to read, research, and respond.

If your doctor didn't give you any specific instruction on what to do with the Selegiline, Entacapone, and Baclofen then, my assumption is that you are to continue taking these medications.

If I were in your position I would ask to have a conversation with the doctor and let him know that I was feeling a bit uneasy about taking the dose that he had prescribed. I would listen to the explanation and if still uncomfortable would politely ask if he had any other patients on that high a dose of Rytary and if so, what's been his experience over the long term.

There do not seem to be any significant drug to drug interactions between Rytary, Sinemet, Baclofen, or Entacapone.

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload more specific information regarding lab tests and diagnostic studies if done and I'll be happy to look at them in the context of your question.

Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.

Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.

This consult request has taken a total of 23 minutes of time to read, research, and respond.

---