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Sinemet Timing Off


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#1 wuliu5656

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Posted 31 May 2012 - 07:33 PM

Dr. Comes:

I am trying to establish my timing for taking Sinemet, but it seems every pm (around 1pm-4pm), it gets thrown off. The On time is either much reduced or stays OFF for some reason. Avoiding protein for lunch does not seem to help.

I was wondering if my other meds might have anything to do with this? I take

1. Requip 6 mg at around 9:30 pm
2. Ativan 0.5 mg at around 10 pm
3. Azilect 1.0 mg & Requip 6 mg at around 7:00 am

I appreciate your asistance.

WYG

#2 MComes RPH

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Posted 08 June 2012 - 11:59 AM

WYG,
there is an interaction between Azilect and Sinemet. Azilect may exacerbate the side side effects of levodopa (an ingredient in sinemet) causing the sinemet not to be as effective and creating effects as if you had not taken the sinemet at all.
There are a couple of possibilities you van try to avoid this inyeraction.
1- possibly try to take the Azilect earlier.
2- possibly take the Azilect at night.
3- take the sinemet between 12:00 pm and 12:30 pm. This gives enough time for the Qzilect to het into the system and start working, and the sinemet is being taken as far away from the Azilect qs possible so as not to create the interaction.
Keep me posted.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#3 wuliu5656

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Posted 08 June 2012 - 02:59 PM

Dr. Comes:

Thank you and will keep you posted.

WYG

#4 MComes RPH

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Posted 13 June 2012 - 10:28 AM

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

#5 wuliu5656

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Posted 05 December 2012 - 12:08 AM

Dr. Comes:

To follow up on my previous question, the possile Azilect interaction with Sinemet is no longer an issue, because I stopped Azilect mothes ago due to some bad side effect.
I am now taking Amantadine 100 mg at 7:00 am, 12 mg Requip at 9:30 pm and Ativan 0.5mg as needed during the day for anxiety.

I am however continuing experience pm OFF episode, and am really puzzled by it.
In the mornning, Sinemet lasts about 3 hr, by the afternoon, somehow, it reduces to 2 hours, or sometimes has no effect.,

Any insight on what's going on? suggestions?
Thanks again,

WYG

#6 MComes RPH

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Posted 07 December 2012 - 01:12 PM

WYG,
So now you are on sinemet, amantadine, an ativan. There are a couple of questions and recommendations I have for you
1- at what time in the afternroteioon are you taking it? I get this question a lot the fact that the morning dose works great but the doses after that do not work on time. The answer to this is usually something so commom we many times forget about it. The morning dose usualy works best because we take it first thing in the morning when we have no food in our stomach, which is the ideal time to take sinemet.
Protein is something that will drastictly alter the sinemet, but an emty stomach can also also alter the timing of when the med will work. Usually 1 hour before or 2 hours after (or as close as you can get) would be the PERFECT time. We all know that cannot happen, so...
2- You may want to speak to your dr about:
-increasing the dose of the regular sinemet you are currently taking, or
-***Talk to you're Dr about a long acting sinemet. It is usually only taken 3 times daily and you could add the short acting in between the long acting doses to stay away from the off times.
Dependind on the success of that combo, you may be able to eliminate or decrease the amantadine, since you have not been on it so long.

Hope this helps and keep me updated
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#7 wuliu5656

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Posted 17 March 2013 - 05:57 PM

Dr. Comes:

Dr Comes: Thank your help. After more observation, I have a feeling Requip XL maybe the cause of my pm anxiety attack which in turn causes Off symptoms.
If this is the case ,other than reducing it, Is there a different timing / dosage to take them to avoid the pm episode ?
When is the peak effect of Requip during the day?

I am currently taking Requip 12mg around 9:00 pm. In the morning, i start first dose Sinemet at 6 am then 2 1/2 hrs afterwards till about 5:00 pm. Also, I started Lexpro 10-mg, 2 months ago for anxiety, and just increased to 20 mg about 2 weeks but have yet seen improvement.
Look forward to your response!!

WYG




#8 MComes RPH

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Posted 28 March 2013 - 09:49 AM

The lexapro make take up to 4-6 weeks at a particular dose to see any affects. So, hang in there with that. In some people it make take a little longer.
As for as the requip, may trying a regular strength in the PM may help. That way you do not have the long lasting to hang around to aggrevate her. It may take 2 separate doses of the regular strength tabs, but it may give you better control. With the xl, once it is in there, it will be about 4-8 hours or longer to get it out. So, it may build up. The regular strength can get in and out and still do its job.
Keep me posted
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#9 wuliu5656

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Posted 14 June 2013 - 08:17 PM

Dr. Comes:

It turned out all the problems have been caused by Requip
As soon as I reduced it to about half, all anxiety issues, nervousness, and pains went away. No more Ativan, or Lexapro.
It took a whole year to figure this out..
Thanks for your kindness,

WYG


#10 MComes RPH

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Posted 21 June 2013 - 01:00 PM

I am very happy for you. With PD, sometimes it is hard to see the forest through the trees. A lot of times a Dr wants to add meds to eliminate symptoms and forget to look at taking away or lowering the dose of a med you ate already on.
My concern was that if you lowered the dose of requip you may not have the symptom control you need.
I am glad it worked out.
Please keep me updated.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#11 Island Woman

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Posted 21 June 2013 - 07:46 PM

Hi Mark, need a better understanding of when to take what. Presently I take sinemet at 7am wait an hr. have breakfast then take azilect plus vitamins...next sinemet at noon then lunch....dinner then final sinemet around 9pm. My question is the timing of azilect?

Thanks, Patricia

#12 MComes RPH

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Posted 23 June 2013 - 08:22 PM

To get the greatest effect of AZILECT, you would take it sometime in the morning to late morning.
I would take the sinemet first thing in the morning to give your body a "jump start" of dopamine. Then take the AZILECT after breakfast and before lunch. With or without food is ok. There have been studies about interaction of most prescription meds and over the counter products (vitamins, herbs, and supplements) so to be on the date side, I would take you're vitamin with dinner. Take the first few bites of food, take the vitamin, then finish you're meal.
Keep everything else as is.
In short, keep everything where it is except the vitamin. Money that to half way through dinner.
Hope it helps. Keep me posted.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#13 wuliu5656

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Posted 10 December 2013 - 11:42 PM

Dr Mark:

I mistakenly stopped Lexpro after taking it about 8-9 weeks, thinking the anxiety was caused by Requip (see previous post.) I did enjoy a month of honey moon, during which anxiety was completely eliminated and I was only taking Stalevo 150 about 5-6 hours daily, in stead of 2-2.5 hrs previously.

The anxiety problem soon returned after stoping Lexapro . I restarted Lexapro 20 mg soon after I became aware of the mistake. However, after 12 weeks, I still wasn't able to get full relief as before.

My doctor prescribed Paxil 25mg CR & reduced Lexapro to 10 mg. I have been taking this new combination for about 13 weeks, still not getting the full effect.

Any idea why the same med wouldn't work after stopped awhile?
Any suggestions what to do (try)next to get consistent treatment for anxiety.

Thank you for your help!
WYG




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#14 MComes RPH

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Posted 11 December 2013 - 11:42 AM

As to why the lexapro would not give you the same affect as before, I am not sure. It could be you need to be on it for a longer time the second time before you see any affects. I am not quite sure.
What I would talk to the Dr about is eliminating the paxil and keeping the lexapro. In place of the paxil you could try cymbalta or abilify. The lexapro and cymbalta are a great combo not only for depression but also works well as an add on to lexapro for anxiety to give long term relief. It will also work on nerve type pain in the extremities if you have that.
Now I am sure you have seen the commercials that say,"If you're antidepressant is not working, try adding abilify.". That is true if the antidepressant portion is not working, it does not work unfortunately if the issue is anxiety. And, as you know, depression and anxiety are two different beasts.
Hope this helps &keep me posted.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#15 wuliu5656

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Posted 12 December 2013 - 12:25 AM

Thanks for your quick reply.
Just to clarify, are you suggesting keeping Lexapro 10 or 20 mg then add cymbalta?
Does it again take many weeks to see effects?

WYG

#16 MComes RPH

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Posted 17 December 2013 - 10:55 AM

Usually about 4-6 weeks at the correct dose. You should notice some finding a difference about the 4 week mark on the 30 mg. If not you may need to give it another couple of weeks or the Dr may decide to increase to 60mg.
You should also keep a diary or note book to keep track of your daily goings on. This will help you and the Dr to see a trend or pattern ofwat is going on in your daily activities and see something that you and I may have missed. The more info for the Dr, the better.
Keep me posted.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#17 wuliu5656

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Posted 10 December 2014 - 07:13 PM

Dr. Comes:
You might recall I mistakenly stopped Lexapro last year in May without realizing it started working after 8 weeks or so.
When retaking it again, it stopped working any more.
Since then, my Psychiatrist discontinued the Lexapro,
added Paxil 50mg, then Buspirone HCL 30mg, then Remeron 15mg at bedtime (it help greatly with sleep), then increase Buspirone to 60mg. While trying out the meds, I'm pretty much relying on Klonopin, now 2x daily (1.5mg & 1.0mg.) to help me thru the daytime for 1-1.5years. with Klonopyn working, I'm finding out my stalevo 150 wears out about 4 hrs now.

I'm very confused, especially trying to distinguish between anxiety vs PD symptoms.
When I tried to reduce Klonopyn, I'm having very tough time.

My Questions:
1. In your experience, is my progression of PD within normal?
(5-6 hrs to 4-hrs between doses in one year)
The answer of this question could hopeful help to determine which symptom is which
2. What's your recommendation since it's very likely, the anxiety is still not under control without Klonopyn.
3.Is it realistic to expect to return to the condition of last year in terms of anxiety control(or free)。

I was told that I need "constant " treatment for anxiety. This bothers me great deal.
Theses 'attacks" comes randomly. I have no way to even predict or prevent them. I understand you seem to have similar issues before, could you share your treatment experiences.?

I again very much appreciate your advice.

WYG

#18 MComes RPH

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Posted 26 December 2014 - 09:11 AM

Everyone's PD progression is different. If you are speaking of time interval between doses, than yes, you are within normal limits.
As far as the anxiety goes, there are different types that can be treated differently.
Situational anxiety is one that happens in certain places or circumstances. This can be treated with low doses of benzodiazepines (xanax or valium).
Generalized anxiety is a low level.of anxiousness that happens all the time. This can be treated very well will certain antidepressants. This seems to be the safest and most effective way to handle this type of anxiety.
Keep me posted after you have spoken to you're dr about these options.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org




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