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Meds, Foods, Supplements: Incompatibilities?


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#1 Appala

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Posted 18 May 2012 - 12:22 PM

Currently, I take the following meds: Sinemet, Requip, Metformin, Isradipine, Levothroid (all low doses). Also supplements: Methyl B12, folate (metafolin), turmeric, resveratrol, ubiquinol, D3, fish oil, creatine. Sometimes aspirin, ibuprofen, propranolol. I'm trying to work out the best schedule for taking them. From what I've heard or read, some apparently require empty stomach (1 or 2 hours before or after eating? for folate, Levothroid?), or are best taken with food (B12, Requip?), or should be taken in the morning (isradipine?), or avoid too much protein (Sinemet), or shouldn't be taken together at same time (Sinemet & ibuprofen?), just as some examples. Very confusing! I'm having a hard time figuring out the best schedule. Any help greatly appreciated.

#2 MComes RPH

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Posted 06 June 2012 - 11:23 AM

I know it can be confusing, so I am going to group things up to make it easier.

Meds to take with food (take the fitst few bites of food, take medicine, then finish the meal): ibuprofen, asprin, metformin, turmeric, resveratol, vitamin D, Fish Oil
Meds to take without food (1 hour before ot 2 hours after a meal): levothyroid, sinemet
Meds to take with or without food ( try without food first, if you get upset stomach, then take with small snack): requip, isradipine, Vit B-12, folate, ubiquinol.

Special medication circumstances:
Isradipine should not be taken with Grapefruit juice. Grapefruit juice will increase the blood levels of isradipine, causing in a severe drop in blood pressure. There is an ingredient only in grapefruit juive that causes isradipine to skip a break down (metabolism) cycle.
Fasting (going too long without eating) will increase levels of levotyroid (T4) beyond normal limits. Also, soy beans, walnuts, and calcium will decrease levothroid.
Sinemet and protein consumption should be seperated by at least 2 hours. If taken within 2 hours, the protein will bind up the liver enzymes used to metabolise sinemet, leaving the sinemet in the intestine longer, where more is absorbed. Sounds like more bang for the buck necause it absorbs more, but reality is...you only get the side effects and very little beneficial effects from this.

Medication interaction:
Aspirin and ibuprofen: can cause severe stomach issues includind ulcers. Make sure to seperate them by at leaset 2 hours. Make sure you take them with food. If you are on a low dose aspirin (81mg), food may not be rrquired.
Ibuprofen and aspirin should not be take with isradipine: ibuprogen and aspirin (known as NSAIDS) appear to block a certain enzyme that isradipine regulates. The result of these taken together could result in an increase in blood pressure. Seperate these classss of meds by at least 2 hours.
Do not take levothroid with metformin: the result Can be that the effectiveness of the metformin may be decreased by levothroid which can lead to irradic sugar levels. Seperate by 2 hours to avoid this interaction.
Sinemet with isradipine may result in severe low blood presssure (orthostatic hypotension) which is known by the initials OH.

People with PD already have an issue with OH. Sinemet can also cause OH. So, use caution when getting up from a sitting or laying position. Do it very slowly.
As far as when to take the meds: first,lay them out with the times you take them normally. Now add in your meal times, this may cause you to move some meds around. Now add in the interqction with food or other meds. This will cause you to have to move them around again. This should lead you to the ultimate medication manahement of your meds. This will also tell you when to take them. With non PD meds, it is important to yake them about the same time every day so you get consistqnt blood levels.
Always remember, PD is the only disease that will tell you wjen you may need your meds, so use common sense when you take your meds also.

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

#3 Andy A

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Posted 13 August 2012 - 11:25 PM

We are trying to figure out the best timing of meds and meals for my mother.

She takes 1 1/2 Sinemet 25/100 at 8 am, 1 pm, and 6 pm. And 1 mg Azilect at 8 am.

She eats at approximately 10:30 am, 2:30 pm, and 7:30 pm.

She has experienced significant weight loss (down from 107 to 93 pounds in the last year and a half), so our dietician has recommended a high calorie diet that includes fats (milk, benecalorie, which has high protein). She is on soft foods to help her to swallow. She is also very anemic so we are trying to get iron in her diet, and give her an iron supplement at 10 pm.

We have noticed that she has the least mobility and most hand tremors in the morning, moderate mobility/tremors in the afternoon, and the most energy and mobility and least tremors in the evening. She does not have diskinesia.

Do you have any suggestions on what changes we can make to help her mobility and lessen her hand tremors in the morning and early afternoon?

#4 MComes RPH

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Posted 13 September 2012 - 09:02 AM

It sounds like the medication and food timing is perfect. At this point she may have to increase her sinemet in the morning and afternoon. Another possibility could be to tryand replace a short acting with a a long acting sinemet in the morning or afternoon. This way she will not get the big up and down of sinemet but rather a steady amount. This could help with her metabolism and keep weight on while maintain her sinemet levels so she can function.
Keep me updated.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#5 trubrit4

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Posted 18 September 2012 - 04:20 PM

Stalevo 125 @6am 10am 2pm 6pm 10 pm, it takes an hour to kick in, and can create tremors and shakes, I now have Gabapentin 300mg x2 3times daily.What is the best way to take them. I take the Stalevo and 15 mins. take the Gabapentin. The Stalevo does no work well when I eat prior to dose I eat 8am cereal, latte ,noon Banana, 3. 30 meat and veg,,7pm Snack fruit. I also take potassium
i also take Lasix 20mg once daily and Atenolol 25mg 2x daily. I have continous pain from a pinch disc . Have benefited from gabapentin with improved nights sleep.
How do I get more from my meds,Stalevo says with or with out food but does not work for me with food. Could Lasix be flushing meds out?
Thanks for your help

#6 trubrit4

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Posted 19 September 2012 - 12:37 PM

How does one determine if drugs are compatible. I have to take Stalevo 125 5 timmes a day and Gabapentin 3 times (for pain)Atenolol)(for Atrial Fib, Lasix (water retention). The Stalevo takes an hour to kick in sometimes not at all, GAbapentin is causing vision problems.My schedule now is Stalevo 6am,10am,2pm,6pm,10pm Gaba 6.30am,2.30pm,10.30pm
Atenolol 8.30am,8pm Lasix 9.00am,colace before bed,Potassium with a meal
Also need to fit in meal to not affect meds. I am 76 female, Gaba has improved sleep Thank you

#7 MComes RPH

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Posted 05 November 2012 - 08:37 AM

I would try to separate the lasix about 2 hours from your stalevo . Any med that can speed up or slow down the few of urine can affect the absorption of the medication. At that time of day to you take atenolol and lasix?
Let me know so I can help more.

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

#8 MComes RPH

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Posted 05 November 2012 - 08:49 AM

The colace may be the issue here. In the previous post you did not mention it. Anything that can slow the bowel movement can affect the rate at which at medication is absorbed .
The usual rate of onset of stalevo is about 45 to 60 minutes. With that in mind, you may need a fast acting low dose sinemet about an hour before the stalevo. Maybe a sinemet 10/100 or sinemet 25/100. It is a fast acting and will work in about 20-30 minutes. That is what you should talk to your Dr about.
Also, no grapefruit juice with atenolol. And be careful when standing or getting up from a seated or laying position. The combo of meds can cause a drop in blood pressure which can dizziness, or even cause you to pass out, so be careful.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org




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