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Drinks, make sure you look before you drink


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#1 MComes RPH

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Posted 21 December 2011 - 02:13 AM

The other day I felt dehydrated, so I headed up to the store to get a "Gatorade" like product. I saw that they had a similar product to Gatorade on a 2 for 1 sale, so I bought it. About 30 minutes layer I needs to take my sinemet. About 30-35 minutes after that I noticed my symptoms were not subsiding. In fact, they were getting worse. I thought back on what I ate, what Meds I took (maby I took the wrong one), and what times I took them. Everything I did was correct. Then it hit me to look at the bottle of drink. There it was written along with the amout of sugar, amount of carbs, etc...and THE AMOUNT OF PROTEIN.
Truthfully, I had no idea that this type of a drink would have protein in it. But, it does make sense. It is mainly used to help replenish electrolytes, fluids, etc... For someone who has usually worked out.
This gave me a new motto that I would like to pass along to all of you. It sounds like a beer commercial, but it is a tad different. "Think of what you drink." Make sure you check the labels, I think we would all be surprised at the amount of products do have protein in them and we would never have thought twice about it.
Drink Responsibly:)
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#2 miracleseeker

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Posted 21 December 2011 - 04:23 PM

You have PD? What is your regimen?
Protein doesn't really make a difference for my mom. I can feed her steak for dinner and her meds are absorbed the same way as any time.

#3 Beachdog

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Posted 21 December 2011 - 07:41 PM

I look before I drink .... so I don't miss my mouth. :wink:

As the year winds down, a word of thanks and appreciation for moderating this section! :!: You bring help to a lot of us in the boat with you.

Happy Holidays!

#4 MComes RPH

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Posted 02 January 2012 - 12:00 PM

Dog,
Thank you very much. You were the first to welcome me here, and lityle did we know how long this enchanting forum called "Ask the pharmacist would last."
Thank you again, and my New Years wish is the same as every year. "May we find a cure for PD before PD finds more people."


I look before I drink .... so I don't miss my mouth. :wink:

As the year winds down, a word of thanks and appreciation for moderating this section! :!: You bring help to a lot of us in the boat with you.

Happy Holidays!


Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#5 MComes RPH

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Posted 02 January 2012 - 12:05 PM

Is she the one who chews her meds? By chewing the meds, there are just pieces beinng absorbed at different times, so protein will have little effect. When the tablet is taken whole, it is the whole amount of medication trying to get in at the same time. That is why their is a difference.



You have PD? What is your regimen?
Protein doesn't really make a difference for my mom. I can feed her steak for dinner and her meds are absorbed the same way as any time.


Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#6 miracleseeker

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Posted 02 January 2012 - 11:17 PM

Is she the one who chews her meds? By chewing the meds, there are just pieces beinng absorbed at different times, so protein will have little effect. When the tablet is taken whole, it is the whole amount of medication trying to get in at the same time. That is why their is a difference.



#7 miracleseeker

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Posted 02 January 2012 - 11:19 PM

Yes sir my mom used to chew her pills but now I crush them. she still has that high effect but it's better absorbed and she's walking better and even talks more. So... even though it's crushed I still don't see any harm in having protein.

Do you have PD? I'm sorry but I don't know your history with the disease.

#8 MComes RPH

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Posted 04 January 2012 - 02:57 PM

Yes I do. I was diagnosed 8 years ago and hqve been a pharmacist for 20 years, I am 43. I jave studied every possible factor about PD medication and the resulting outcomes. For your mom, the effect with proyein does not seem to be a factor because it is alrready in "pieces." that can effect all areas of the breakdown, absorbtion, and metabolism. If it is chewed and pieces of protein are added, little pieces are absorbed piece by piece, as is the protein. It is almost like a race of brown ants amd red ants to an apple.


Yes sir my mom used to chew her pills but now I crush them. she still has that high effect but it's better absorbed and she's walking better and even talks more. So... even though it's crushed I still don't see any harm in having protein.

Do you have PD? I'm sorry but I don't know your history with the disease.


Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#9 miracleseeker

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Posted 04 January 2012 - 03:09 PM

Sounds like you have it under control even after 8 years. That's a long time. You must be taking the right combo meds for your level. Good for you. I wish I can have a sign from someone to tell me what I have her take is the best for her right now so I can stop looking.

#10 MComes RPH

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Posted 09 January 2012 - 11:05 AM

Well, I will tell you it has not been all roses And cavier. I have gone through some very tough times. But, I am better For it. To me, the gauge Of success is an increase in quality Of life. If The overall quality of life has increased, then you have success. You can never compare one person who has had PD for 5 years with another who has had it for 5 years. You can only compare that person's today with yesterday, this week with last week, this month with last month, and this year with last year. With many, it is just today with yesterday.
It is a horrible disease that slowly takes what we Take For granted. The tougher job is The caregiver. It is much easier To have PD than it is to Take care Of someone with PD. My hat's off To you And all The other care givers. You have The toughest job in The World.



Sounds like you have it under control even after 8 years. That's a long time. You must be taking the right combo meds for your level. Good for you. I wish I can have a sign from someone to tell me what I have her take is the best for her right now so I can stop looking.


Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#11 miracleseeker

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Posted 16 January 2012 - 08:52 AM

May I ask what PD meds you take and how often? My mom has had it for a little longer than you and although I know everyone is different I am still curious. Thank you.

#12 MComes RPH

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Posted 17 January 2012 - 11:13 AM

My medication regime is:

7:00am: 2 Parcopa ODT (oral dissolving tabs) 25/100
9:00am: 1 adderall XR 25mg
1 lexapro 20mg
1 baclofen 20mg
1 meloxicam 15mg
1-2 sinemet 10/100
11:00am: 1 sinemet cr 50/200
1 exelon 1.5mg
1 xanax 1mg
1:00pm: 1-2 sinemet 10/100
1 baclofen 20mg
2:00pm: 1 sinemet Cr 50/200
5:00 pm: 1-2 sinemet 10/100
1 Baclofen 20mg
1 xanax 1mg
1 exelon 1.5mg
6:00pm: 1 sinemet cr 50/200
9:00 pm: 1-2 sinemet 10/100
1 xanax 1mg
1 baclofen 20mg
10:00pm: 1 ambien cr 12.5mg
On nightstand, just in case: 1 ambien 10mg and 1 Parcopa ODT 25/100

That is who I am. It is hard, as we all know to get it "right." I still have good days and bad, good hours and bad. But, it beats the alternative.



May I ask what PD meds you take and how often? My mom has had it for a little longer than you and although I know everyone is different I am still curious. Thank you.


Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#13 miracleseeker

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Posted 17 January 2012 - 01:03 PM

Good lord! I applaud you for your cocktail mix and having it work for you. If only I could be so intuitive with the meds to have my mom function like she used to in her good days.
Her neuro insists that anymore than what she's currently taking is overdosing so I'm chicken to experiment anymore.

#14 MComes RPH

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Posted 21 January 2012 - 10:18 AM

Well, it has not always been successful. I produced a "medication schedule" to keep track of meds, times, and any issues that may have happened that day. I have shared this with all my physicians (who thought it was a great idea) and it is also available to you.
At the top of the forum you will see "medication schedule." You must have microsoft Excel to use it.
You can either download it and fill it in by pen/pencil or, the best way is to download it to your computer and fill it out and save it on your computer.
This program allows you to:
Put in a date
Name of each med
Strength of med
How many tabs you take at a specific time
The best part is that there is a spot at the bottom for notes of what else may have happened that day as far as side effects, off times, exercise, naps, food, etc.
This will allow you to trach change in meds along with success or failure.You can do this as you change meds or times.
A few days before the next appointment, you can either print and fax the sheets or, better yet, e-mail them to the Dr. This can save a ton of time at each appt. As you know, the first 15 to 20 minutes are spent discussing what happened since the last appt. With my method, the Dr can go over the sheets BEFORE the appt, which allows the Dr, patient, and caregiver to get right to the issues and concerns.
Take a look, I think you will like it. I can assure you that the Dr will like it. The more info they have, they netter job they can do.



Good lord! I applaud you for your cocktail mix and having it work for you. If only I could be so intuitive with the meds to have my mom function like she used to in her good days.
Her neuro insists that anymore than what she's currently taking is overdosing so I'm chicken to experiment anymore.


Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#15 miracleseeker

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Posted 21 January 2012 - 05:59 PM

It's amazing you can still work and be awake with how much you take. I take Xanax but only half of .25mg in the morning. That stuff will knock me out if I take anymore than that. You also must be a very organized person to keep track of what and when you take them but unfortunately you have to be aware of what time it is all day long.

Question: My mom takes 25/100 Sinemet at 2am and then stays awake until her dose of 150mg stalvo with .75 Mirapex at 5:30am. It's working well because she's relaxed and able to get up and brush her teeth at that time due to the sinemet in her system. Dr Okun said Sinemet does not stay in the system and it also doesn't last long which is why people need to take it frequently throughout the day. I do not see it that way. My mom has been so much more active and aware of her surroundings and talking so much more (gibberish most of the time but still talking) since this addition of Sinemet during most of her waking hours. I feel she should take another Sinemet in the daytime to have the same effect all day long. I tried it at 10:30 am this morning but all it did was make her fall asleep. I don't understand. Why would it keep her up at 2:00 am but not when it's taken at 10:30am. I have also tried this a month ago at 5:00pm with the same effect. I tried to give it to her about 5-6 hours after her regular dose of Stalevo with Mirapex but it's not working the way I hoped. Any ideas? She takes Stalevo with Mirapex 3times a day at the same dosages.

2nd question: My mom also takes mobic like you but only as needed. She probably should take it daily because she gets leg pains from all the shaking that occurs daily about 4 hours after her Stalevo/mirapex is wearing off. I don't because I'm afraid of it harming her liver and stomach lining. Does this concern you as well? Do you feel there is any problem with taking this on a daily basis?

#16 MComes RPH

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Posted 22 January 2012 - 12:49 PM

I have copied your post so we can handle one issue at a time.

It's amazing you can still work and be awake with how much you take. I take Xanax but only half of .25mg in the morning. That stuff will knock me out if I take anymore than that. You also must be a very organized person to keep track of what and when you take them but unfortunately you have to be aware of what time it is all day long.
REPLY: as far as organized, that is up for debate. I do have a "medication schedule" application on my iphone which is my reminder. Plus, I also have a very caring wife who reminds me. When she is not around to remind me, I also have 4 wonderful daughters (ages 9, 10, 12, and 15) that are also there to remind me. Plus, co-workers who care enough to remind me. So, I have many reminder resources.
As far as the Xanax goes, my belief is that my anxiety "absorbes" all the Xanax so as not to lead to drowsiness. If I were to take it and lay down, I would probably sleep. I try to keep my mind active all the time.

Question: My mom takes 25/100 Sinemet at 2am and then stays awake until her dose of 150mg stalvo with .75 Mirapex at 5:30am. It's working well because she's relaxed and able to get up and brush her teeth at that time due to the sinemet in her system. Dr Okun said Sinemet does not stay in the system and it also doesn't last long which is why people need to take it frequently throughout the day. I do not see it that way.
REPLY: Dr Okun is correct whwn speaking of the regular release sinemet. Your mom is also taking Stalevo, which not only has sinemet, but entacapone. As you are aware, the entacapone helps the sinemet work longer. This is probably the reason for the success you have been experiencing, as opposed to if she was just taking regular sinemet.
My mom has been so much more active and aware of her surroundings and talking so much more (gibberish most of the time but still talking) since this addition of Sinemet during most of her waking hours. I feel she should take another Sinemet in the daytime to have the same effect all day long. I tried it at 10:30 am this morning but all it did was make her fall asleep. I don't understand. Why would it keep her up at 2:00 am but not when it's taken at 10:30am.
I have also tried this a month ago at 5:00pm with the same effect. I tried to give it to her about 5-6 hours after her regular dose of Stalevo with Mirapex but it's not working the way I hoped. Any ideas? She takes Stalevo with Mirapex 3times a day at the same dosages.
REPLY: I think the sleep issue may not be as closely related to the sinemet, but rather her sleep cycle. If her body is accostumed to falling aslepp at a certain time, and has for some time, it will continue to do so. I usually compare it to someone working 1st shift for 5 years, then all of a sudden they are switched to 3rd shift. They do that for 3 years, then are put back on 1st shift. It is a cycle that can take time to change. It is a slow process of altering the med times slowly to eventually reach the conclusion you are looking for.

2nd question: My mom also takes mobic like you but only as needed. She probably should take it daily because she gets leg pains from all the shaking that occurs daily about 4 hours after her Stalevo/mirapex is wearing off. I don't because I'm afraid of it harming her liver and stomach lining. Does this concern you as well? Do you feel there is any problem with taking this on a daily basis?
REPLY: I do not feel it is a problem to be take every day, I have for about 5 years. Keep in mind, it is truly not intended for "as needed" use. It is a medication that must be taken consistantly to maintain blood levels to inhibit the enzyme that causes the inflammation cycle. I use it for arthritis pain in the joints of my spine, shoulder, hips, and knees. If hers is more muscle pain, maybe a product like Baclofen may work better. It is a muscle relaxer specifically aimed at people with PD, MS, and muscle spasms due to spinal cord injury..
Hope this helps, and once again, thanks for the support you have given to me and also this forum.



It's amazing you can still work and be awake with how much you take. I take Xanax but only half of .25mg in the morning. That stuff will knock me out if I take anymore than that. You also must be a very organized person to keep track of what and when you take them but unfortunately you have to be aware of what time it is all day long.

Question: My mom takes 25/100 Sinemet at 2am and then stays awake until her dose of 150mg stalvo with .75 Mirapex at 5:30am. It's working well because she's relaxed and able to get up and brush her teeth at that time due to the sinemet in her system. Dr Okun said Sinemet does not stay in the system and it also doesn't last long which is why people need to take it frequently throughout the day. I do not see it that way. My mom has been so much more active and aware of her surroundings and talking so much more (gibberish most of the time but still talking) since this addition of Sinemet during most of her waking hours. I feel she should take another Sinemet in the daytime to have the same effect all day long. I tried it at 10:30 am this morning but all it did was make her fall asleep. I don't understand. Why would it keep her up at 2:00 am but not when it's taken at 10:30am. I have also tried this a month ago at 5:00pm with the same effect. I tried to give it to her about 5-6 hours after her regular dose of Stalevo with Mirapex but it's not working the way I hoped. Any ideas? She takes Stalevo with Mirapex 3times a day at the same dosages.

2nd question: My mom also takes mobic like you but only as needed. She probably should take it daily because she gets leg pains from all the shaking that occurs daily about 4 hours after her Stalevo/mirapex is wearing off. I don't because I'm afraid of it harming her liver and stomach lining. Does this concern you as well? Do you feel there is any problem with taking this on a daily basis?


Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#17 miracleseeker

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Posted 22 January 2012 - 11:39 PM

Actually my mom does not fall asleep rather she just closes her eyes but will open them if she's stimulated enough. This happens about 5 hours after taking Stalevo/Mirapex. I know it's because the drugs are wearing off and her eye muscles get affected first. So when I gave her Sinemet to 'boost' her energy level, it didn't happen. It made her very comfortable to the point of falling asleep which is not what I wanted yet when it's given at 2am she stays awake. I know Stalevo lasts longer than Sinemet but what I meant was ever since adding Sinemet at 2am my mom is so much more alert and aware of what's happening from 6am to about noon. She wasn't like this before Sinemet.

I've also noticed she's just not as alert in the afternoon after her dose of Stalevp/Mirapex like she is in the morning. The only thing missing is the Sinemet. Am I on to something here. I can see it in her eyes. She's alive in the morning and very animated but after her nap in the afternoon she's slow and has trouble expressing herself and her facial gestures are limited. But this is a case of what am I doing wrong? I gave her the Sinemet around 5pm once and she just fell asleep. Why can't she be the same way in the afternoon like she is in the morning? It is so strange. Oh... she also takes Namenda 10mg 2 times a day which means she takes it in the morning but not in the afternoon. Could that have something to do with it? Maybe I should have her take the 2nd Namenda in the afternoon instead of evening? Is that ok to spread it out that way? Do you think Namenda is the cause of her surge in mental clarity in the morning?

By the way, you are indeed very blessed to have a family of women no less to be your alarm clock. You are also very lucky to be so sound minded even though you are a one man drug machine. I will keep the mobic info in mind when I see my mom's doctor next week. I think it's muscle spasms but it could very well be arthritic pain. I can't tell because my mom doesn't express herself enough to tell me.

Thanks so much for your input.

#18 MComes RPH

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Posted 01 February 2012 - 11:45 AM

I copied your post so we can deal with this one issue at a time:

Actually my mom does not fall asleep rather she just closes her eyes but will open them if she's stimulated enough. This happens about 5 hours after taking Stalevo/Mirapex. I know it's because the drugs are wearing off and her eye muscles get affected first.
REPLY: Actually it sounds more like "Sudden Sleep/Somnelance Syndrom" caused by Mirapex. It appears the patient is sleeping, but rather have short sleep spurts caused by Mirapex. This happened to me when I was taking it.
So when I gave her Sinemet to 'boost' her energy level, it didn't happen. It made her very comfortable to the point of falling asleep which is not what I wanted yet when it's given at 2am she stays awake. I know Stalevo lasts longer than Sinemet but what I meant was ever since adding Sinemet at 2am my mom is so much more alert and aware of what's happening from 6am to about noon. She wasn't like this before Sinemet.
REPLY: What it seems is happening is that the 2:00 am sinemet is pushing her dopamine levels over her required amount, which will cause the to affect the "pleaseure centers." This will make the patient want to stay awake as to not miss anything. When it wears off (about 5-6 am) she is then at therapeutic levels which allows her to function normally.

I've also noticed she's just not as alert in the afternoon after her dose of Stalevp/Mirapex like she is in the morning. The only thing missing is the Sinemet. Am I on to something here. I can see it in her eyes.
REPLY: It may be the same issue she is experiencing in the evenin.
She's alive in the morning and very animated but after her nap in the afternoon she's slow and has trouble expressing herself and her facial gestures are limited. But this is a case of what am I doing wrong? I gave her the Sinemet around 5pm once and she just fell asleep. Why can't she be the same way in the afternoon like she is in the morning?
REPLY: I think it is more of a timing issue than a medication issue. Of course they go hand in hand, but I think you see what I mean.
It is so strange. Oh... she also takes Namenda 10mg 2 times a day which means she takes it in the morning but not in the afternoon. Could that have something to do with it? Maybe I should have her take the 2nd Namenda in the afternoon instead of evening? Is that ok to spread it out that way? Do you think Namenda is the cause of her surge in mental clarity in the morning?
REPLY: The Nemenda could be adding to the effect the is experiencing. A possibility could be a change from Nemenda to Exelon might also help. Exelon is specifically used for PD related dimentia and memory loss. This may be something you may want to speak with the Dr about. This slight change may make a big difference in itself.

By the way, you are indeed very blessed to have a family of women no less to be your alarm clock. You are also very lucky to be so sound minded even though you are a one man drug machine. I will keep the mobic info in mind when I see my mom's doctor next week. I think it's muscle spasms but it could very well be arthritic pain. I can't tell because my mom doesn't express herself enough to tell me.

Thanks so much for your input.
REPLY: if you could forward me her exact drug regime: name, strength, and times taken. Along with what effects happen at what time(ex. Drowsiness at 3pm, awake at 5am, etc.) I will look at it and see what we can do to "fine tune" the regime for her.







Actually my mom does not Actually my mom does not fall asleep rather she just closes her eyes but will open them if she's stimulated enough. This happens about 5 hours after taking Stalevo/Mirapex. I know it's because the drugs are wearing off and her eye muscles get affected first. So when I gave her Sinemet to 'boost' her energy level, it didn't happen. It made her very comfortable to the point of falling asleep which is not what I wanted yet when it's given at 2am she stays awake. I know Stalevo lasts longer than Sinemet but what I meant was ever since adding Sinemet at 2am my mom is so much more alert and aware of what's happening from 6am to about noon. She wasn't like this before Sinemet.

I've also noticed she's just not as alert in the afternoon after her dose of Stalevp/Mirapex like she is in the morning. The only thing missing is the Sinemet. Am I on to something here. I can see it in her eyes. She's alive in the morning and very animated but after her nap in the afternoon she's slow and has trouble expressing herself and her facial gestures are limited. But this is a case of what am I doing wrong? I gave her the Sinemet around 5pm once and she just fell asleep. Why can't she be the same way in the afternoon like she is in the morning? It is so strange. Oh... she also takes Namenda 10mg 2 times a day which means she takes it in the morning but not in the afternoon. Could that have something to do with it? Maybe I should have her take the 2nd Namenda in the afternoon instead of evening? Is that ok to spread it out that way? Do you think Namenda is the cause of her surge in mental clarity in the morning?

By the way, you are indeed very blessed to have a family of women no less to be your alarm clock. You are also very lucky to be so sound minded even though you are a one man drug machine. I will keep the mobic info in mind when I see my mom's doctor next week. I think it's muscle spasms but it could very well be arthritic pain. I can't tell because my mom doesn't express herself enough to tell me.

Thanks so much for your input. alert and aware of what's happening from 6am to about noon. She wasn't like this before Sinemet.

I've also noticed she's just not as alert in the afternoon after her dose of Stalevp/Mirapex like she is in the morning. The only thing missing is the Sinemet. Am I on to something here. I can see it in her eyes. She's alive in the morning and very animated but after her nap in the afternoon she's slow and has trouble expressing herself and her facial gestures are limited. But this is a case of what am I doing wrong? I gave her the Sinemet around 5pm once and she just fell asleep. Why can't she be the same way in the afternoon like she is in the morning? It is so strange. Oh... she also takes Namenda 10mg 2 times a day which means she takes it in the morning but not in the afternoon. Could that have something to do with it? Maybe I should have her take the 2nd Namenda in the afternoon instead of evening? Is that ok to spread it out that way? Do you think Namenda is the cause of her surge in mental clarity in the morning?

By the way, you are indeed very blessed to have a family of women no less to be your alarm clock. You are also very lucky to be so sound minded even though you are a one man drug machine. I will keep the mobic info in mind when I see my mom's doctor next week. I think it's muscle spasms but it could very well be arthritic pain. I can't tell because my mom doesn't express herself enough to tell me.

Thanks so much for your input.


Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#19 miracleseeker

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Posted 01 February 2012 - 06:33 PM

Here goes:

2:00am to 3:00 am 25/100 Sinemet (is awake around this time after sleeping from 8:00pm dose then takes Sinemet and sleeps comfortably but wakes an hour after)
5:30am 150mg Stalevo, .75mg Mirapex, 10mg Namenda (nods off for an hour then she's up which is good. Gets the shakes after 4 hours and closes her eyes here and there)
1:30pm 150mg Stalveo, .75mg Mirapex (sleeps for about 90 minutes)
5:30pm 10mg Namenda, 10mg Norvasc (nothing different)
8:00pm 150mg Stalevo, .75mg Mirapex (from 4pm to 8pm her right leg starts to shake for an hour or so and her eyes are closed on and off but not fully asleep)

She has tried Exelon and Aricept in the past but they gave her nightmares and she shaked more.

Thanks a lot.

#20 miracleseeker

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Posted 01 February 2012 - 06:35 PM

Almost forgot to mention. Just last week I discovered there is 8 grams of protein in the yogurt my mom takes with her crushed PD meds in the afternoon. That I thought was the reason she's not as "on" as the morning when she takes them in apple sauce that has zero protein. But... not much difference since she's off of yogurt with the meds. I was so sure that was it but no. :(




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