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Sinemet Dosing


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#1 zomer

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Posted 12 April 2012 - 10:35 AM

Hello,
I had some questions regarding dosing of sinemet. I was reading through some of the posts already and does the side effects of too much and too little of the drug look the same?
My mother has PD and was taking 50/200, Four times a day. About an hour before her next dose she would go into dyskonia type symptoms (very anxious, fidgity, but can't walk, severe pain (both in legs and twisting muscle spasms in back). She talked to her doctor who told her to increase to 5/day, this dosing causes her last dose of the night to be at 0000 and her next dose at 0600. It has helped a little through out the day but she is still waiting for her next dose (usually 30mins) because she feels the symptoms restarting. Mostly the anxiousness, a little pain, and less AROM (esp in legs). She is still waking around 0400 with worse symptoms. She started the dose increase 2 days ago. How long do we wait to see if this increase will work? I do not want to bother her doctor about a dose increase again if there is a build up period that has not passed yet. When would a COMT be considered to be added or is this class of drugs one to try to stay away from? No matter what should I be calling the doctor to ask for an extra dose to be taken to help with that 0400 time making it 6/day?
One more question, does adding a pain pill ie ultram atc help?

thank you

#2 Dr. Okun

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Posted 15 April 2012 - 10:19 AM

First, adding a pain pill usually is not the best solution.

Dyskinesia is usually from too high of a dose. You describe dyskinesia and also wearing off. The move usually is to decrease each dose (maybe to 1 1/2 tablets) but decrease the interval between doses.

Hope that helps.

Maybe you can print and suggest to your doc.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
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or his parkinsonsecrets.com blog for treatment tips


#3 miracleseeker

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Posted 15 April 2012 - 07:23 PM

Yes Dr. Okun. I question the dosing of Sinemet or any PD drug for night time as well. Being that the patient is sleeping and not moving around why would the drug seem to be "used up' so quickly? My mom takes Stalevo 150mg with .75mg Mirapex at 8:30 pm. I wake her at 2:30 to pee and to take a 25/100 Sinemet because she is so rigid and her eyes are glossy and she just looks so out of it. In the day time she takes the same dosage of Stalevo with Mirapex and 6 hours later she's not as bad as she is at night. Can you explain this please?

#4 Dr. Okun

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Posted 16 April 2012 - 06:21 AM

In many patients the dopamine blood levels drop at night and when they awaken to go to the bathroom they may find themselves stiff and rigid and unable to go back to sleep. They then usually need to re-dose sinemet. This is something you and your doc can discuss.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#5 miracleseeker

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Posted 18 April 2012 - 06:22 PM

Dr Okun,

You indicated here that the blood level of dopamine drops at night however supposedly it does the same when someone has been active? So when is it steady? Why does it drop at night when the patient is asleep and not using any of the dopamine that is replenished by taking medications for it?

#6 Dr. Okun

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Posted 21 April 2012 - 10:22 PM

Thanks for the message. I would like to clarify. In patients with PD who take dopaminergic therapy the blood levels of dopamine drop at night while sleeping because the dopamine therapy has a short half life.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#7 miracleseeker

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Posted 22 April 2012 - 08:21 AM

Sorry but that still doesn't make sense. My mom takes Mirapex 3 times a day at the same dose of .75mg. Why would her blood level drop at night and not in the day time since she's not even moving to use up the drug that is in her system. I was also told by my mom's neuro that Mirapex stays in the body longer than Sinemet or Stalevo so is that wrong? Sounds like they all have a short half life. This almost sounds like it's a waste to even have her take her meds before bed since it's all gone in a snap.

#8 Dr. Okun

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Posted 23 April 2012 - 06:23 AM

Thanks for the post. They are all pretty short on half lives. Many people will need to redose a sinemet in the middle of the night for re-emergence of symptoms. Some people have disrupted sleep on the agonist.

What happens is simply that too many hours pass while you are sleeping without re-dosing the meds.

You can speak to your doc and ask him/her about best timing for night-time doses and whether a redose when you awaken could be helpful.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#9 miracleseeker

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Posted 23 April 2012 - 08:02 AM

Yes she does take a sinemet at 2 am as a booster dose but my question was it had only been about 5-6 hours since her last dose so I don't know why she would have used it up so quickly since she's not moving during this time while after 6 hours in the daytime she's fine. Please understand she's fine in the daytime even after 6 hours between doses. The question is why does her blood level drop at night and not in the daytime? Sorry to be so confusing but I am trying to get an understanding on how this works.

#10 Dr. Okun

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Posted 24 April 2012 - 10:38 AM

I will post this for you. Thanks for the clarification. If she redoses at night I am not sure why she would wear off faster at night. Some people we have seen have more trouble with motor fluctuations late in the day. People have hypothesized there is a problem with the brains dopamine buffer which becomes overwhelmed, but the exact reasons are really unknown.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#11 miracleseeker

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Posted 24 April 2012 - 11:37 AM

Please let me claify. She is fine after taking the booster dose of Sinemet at 2:00am. I wanted to know why she is so confused and breathing hard and her eyes are glossy and staring into space the hours prior to the dosing which is about 6 hours from her night dose of Stalevo with Mirapex at 8:30 pm. In the daytime she's still doing good on 6 hours of the same medications and she's moving around and supposedly using up the medication in her brain. I suppose there is no answer for this.

The reason this matters so much is I need to know what can I do to make her stay asleep at night? She seems to wake when her medication is 'used up" and when she's awake the incontinence doesn't end. I am up 3 times a night changing her and doing laundry.

Thank you so much for your help.

#12 Dr. Okun

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Posted 24 April 2012 - 07:42 PM

A few things to talk to your doc about.

Some people the Mirapex keeps them up at night and they take off the Mirapex at the night-time dose.

Some people will benefit from a sleep study. Apnea and REM sleep disorder are both treatable if present (for example).

Some PD patients get confusion at night (sun-downing) or a change in mental status. In some of these cases adding drugs like seroquel can be useful.

These are a few suggestions for you and your doc.

Hope that helps.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips





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