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Hallucinations

Hallucinations

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#1 jrousos@embarqmail.com

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Posted 20 August 2012 - 03:21 PM

Good Afternoon,

My Dad has Parkinson's and is currently taking the below medication.
This past week, my Mom added Flomax to his day and 2 days later he started having hallucinations during the day (when she is at work).
She stopped the Flomax and the following day he had another one. They are visual hallucinations, he saw people in the house. It's odd that it's happening only when he's home alone. She is currently looking to retire to be a full time caregiver. My question, do you think the flomax could have caused this? This is the newest medicine added.

Once she stopped giving it to him it happened one more time. After discontinuing the flomax, she gave him .25 of xanax the following night and the night after. He was fine (but was also not alone) during the day and then yesterday he complained of nausea. I suspect the nausea was from the xanax. So she has discontinued it.

One last thing to add. The Wellbutrin. Do you find it's the most popular anti depressant given to patients? I'm convinced he needs something different or more of what he is currently taking, but I just don't know. He has an appointment soon with his neuro.

Thanks for your time!
Any input would greatly be appreciated.


8:00 am
2 buPROpion Hydrochlorine 75mg ; 1 Namenda 5mg; 1 and 1/2 Cardilopa=levodopa 25-100


12:00 noon
1 and 1/2 Cardilopa=levodopa 25-100


400pm
1 and 1/2 Cardilopa=levodopa 25-100


800pm
2 buPROpion Hydrochlorine 75mg ; 1 Namenda 5mg; 1 and 1/2 Cardilopa=levodopa 25-100; 1 Lipitor 10mg ; 1 81mg aspirine.



9:00 1 Tamsulosin 0.4 mg (Flomax)

#2 MComes RPH

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Posted 02 September 2012 - 12:17 PM

I think it may be a combo of things happening.
There is an interaction between flomax and Wellbutrin. Both are metabobolised by the liver by the same system. The Wellbutrin will cause and increase in the amount of flomax in the system. This will cause lightheadedness, dizziness, and balance issues.
Levodopa and Wellbutrin , in some people, can cause an increase in Wellbutrin. The cause is really unknown and also is the degree of effect on the patient.
A speculation could be that these effects, along with his dementia issue, could bring about the lessening effects of the how the other meds may work.
Thee best way for me to explain it is that our body is full of chemicals that all have to be at certain levels for our bodies to work properly. It is all a balance. Let say we have chemical A and chemical B. Now let say A is too high. Our body will show 2 possible reactions: 1- symptoms of A being too high or 2- symptoms of B being too low. Since tests on dopamine levels, serotonin levels, norepinephrine levels, etc... (these are chemicals that dictate brain function etc) May not be available, we do not really know what it is that is the cause. Here is what I would recommend.
1- check with thru Dr on changing from namenda to exelon. Exelon is specifically used for Parkinson's induced dementia.
2- maybe a change from several short acting Wellbutrin to 1 long acting (Wellbutrin xl). This may help keep the levels constant.
3- a change from Wellbutrin may help, but since this just happened, not sure that will help.
4- do not add, change, increase, or decrease more than one medication at a time. If a side effect happens, you do not know what caused it.
Remember, people with memory or dementia issues have trouble with change. What may seem minor to us may be major to them. They may feel anxiety, stress, feel like they are "losing their mind", or going crazy. This can result in the mind trying to help the person cope, which can present itself in many different ways.
Please keep me updated.

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

#3 jrousos@embarqmail.com

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Posted 01 October 2012 - 06:09 PM

Thank you for your response.

We went to the Dr. this week.
For the last 2 weeks his cinimet was lowered by 1/2 pill two times a day.
We asked about Exelon but it turns out he had already tried it a while back and could not tolerate it. I'm in the process of getting his history from my Mom just to have as a reference. I asked for them to give him something either with or in addition to the Wellbutrin and they gave him 5mg with the lexapro. We thought when the cinemet was lowered he was having less visual hallucinations, which he was, but he's still having them. Now we are going to start charting them because the only consistency is that he has them when no one is around. (could he be dreaming?). The Dr. did throw the word Dementia in there, but as you can imagine, I blocked that out. So today he mentioned after he woke up from his nap he saw two guys that are on tv. He has this mixed preception of TV vs reality sometimes. So, needless to say I'm frustrated and mad and hoping to find an answer soon. I'm going to go for a second opinion as well.

The Dr did say that he would not consider increasing the sinimet again since it helped his hallucinations, but I'm not so sure it was a HUGE help...and still stuck on the idea that the wellbutrin or namenda either one or both combined could be doing something too. SO for now, we're watching what happens with the addition of the lexapro and take it from here.

The good news is that he's unaffected by his visual hallucinations, the bad news is that we are not in hearing about them ourselves.

Hoping to hear from you with any additional info you may have for me. THANK YOU!

#4 MComes RPH

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Posted 13 October 2012 - 12:15 PM

I think you are on the right track with thinking of the wellbutrin. I do believe the Dr made a move in the right direction with the lexapro. With PD and elderly patients it is so difficult to tell if the hallucinations are generated from medication, progression of PD, or the onset of dementia that has worsened.
I have read many studies and talked with many people who say that being on wellbutrin has helped their PD. But in your case, it may be adding to the hallucinations. No one really knows . The true way to find out would be to tapped him off the wellbutrin and slowly add the lexapro. Finding the exact combo of meds that will increase the quality of life for a PD patient is like playing a chess match blindfolded. There are a few rules I always stand by:
1- find the one symptom that is hindering the quality of life, and work on that first.
2- never, never, never change, increase, or decrease more than 1 medication at a time. The reason for this is that if there is an adverse effect or an increase in the quality of life, you don't know what medication caused it.
3- document everything. The more information the Dr has, the more able he is to help. If you bring in all the documentation, he may see a trend that others may not see
4- if you don't believe you are getting the most out of the Dr, get a second opinion. If you took you're care to get something fixed and every month you brought it back with the same problem and no improvement, you would not think twice about going somewhere else. I know PD is different than a care, but a second set of eyes looking at the same issue may see something the first one may have missed.
That is the toughest part of PD. It is an octopus (called PD) with many tentacles (Estonia, rigidity, speech issues, dementia, tremors, fatigue, insomnia, pain, etc...), so don't feel guilty getting a second opinion. Any Dr worth their weight in salt would agree to a second opinion If they feel they are doing everything correct.
Best of luck and keep me updated.
In closing, find the main issue and go after that. A second pair of eyes may not hurt
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#5 jrousos@embarqmail.com

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Posted 13 October 2012 - 12:20 PM

Thank you once again, we have an appointment with a Dr. scheduled at Robert Wood Johnson. He's the new head of Neurology and has some ground breaking research in Parkinsons. Hoping to hear something new or just confirm we are on the same path. My Mom is now officially home with my Dad. He is getting his feet stuck on things and falling a lot, so hopefully that will help as well. I didn't mention it before just realized it but he has Post Polio as well. Not a good combination.

#6 MComes RPH

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Posted 15 October 2012 - 01:41 PM

I wish you all The best and please keep me updated.
Thank you.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#7 jrousos@embarqmail.com

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Posted 15 April 2013 - 09:02 PM

Me again, long story short. My Dad fell, broke his humerus in 4 places, had internal bleeding, 4 bags of blood transfused, he's now in rehab.
Taking :8:00 am
1 buPROpion Hydrochlorine 75mg ; 1 Namenda 10mg; 1 and 1/2 Cardilopa=levodopa 25-100


12:00 noon
1 and 1/2 Cardilopa=levodopa 25-100


400pm
1 and 1/2 Cardilopa=levodopa 25-100


800pm
1 buPROpion Hydrochlorine 75mg ; 1 Namenda 5mg; 1 and 1/2 Cardilopa=levodopa 25-100; 1 Lipitor 10mg ; 1 81mg aspirine;10 mg of lexapro

9pm Seroquel 12.5 mg

My question, he was starting to have visual hallucinations and the Neurologist lowered his Sinemet. They went away but he was moving slower, it was clear he needed more Sinemet so they increased the Sinemet again and added the Seroquel.

Would you say the Seroquel is too low to see any changes just yet? He's been on it for a week? Or would you say the dosing is too low? Or would you side with it possibly not working? Any info would greatly be appreciated. Thank you!



9:00 1 Tamsulosin 0.4 mg (Flomax)

#8 MComes RPH

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Posted 23 April 2013 - 07:01 AM

First off, when did he get out of the hospital? Because the anesthesia can still have side effects, like hallucinations, for sometimes up to 2-3 weeks post-op when given with sinemet.
As far as the sequel goes, a week is too short of a time frame to see any type of positive effects from it. With seroquel, it can ne anywhere from 4-6 week, sometimes longer, to see the benefits of the medications.
It is my belief that the Dr's plan is just use the seroquel until the hallucinations are gone. At that point, everything should be back to normal.
Hope this helps. Make sure the physical therapist knows he has parkinson's, because if the do not know, they may have him doing exercises that person with PD just can not do (ie... Balance, certain muscle toning-even the slightest- can start up a bout of dystonia, and most of all do not let them push him too had. When someone with PD uses there muscles more than normal, this can deplete dopamine faster, which may require more sinemet. So the should give him as much time as needed between exercises to rest. He does nor have to be superman.
Keep me updated and tell him good luck, and good luck to yourself also
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#9 jrousos@embarqmail.com

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Posted 23 April 2013 - 08:05 AM

He went in on the 4th of April, went to Acute Rehab on the 9th, and on the 20th went into sub acute rehab.
Thanks so much for your help!

#10 MComes RPH

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Posted 23 April 2013 - 09:20 AM

No problem. I think just little longer, maybe a couple of weeks, and all should be good.
Best of luck.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#11 greggardner

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Posted 10 May 2013 - 09:24 AM

Are you aware of any new treatments and solutions for medication-related (induced) hallucinations? My father's Sinemet seems to cause chronic hallucinations and the med taken to reduce them, Seroquel, is no longer working. An alternative med we are hesitant to us is Clozaril. There are too many potential side affects. Thank you.

#12 MComes RPH

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Posted 13 May 2013 - 02:19 AM

Seroqeul is usually fF first choice in treating PD related hallucination's. Due to the fact has fewer side effects on your body.
The next choices would usually be Risperdal or Zyprex. The reason they would be hesitant to use these 2 is because they may cause or exacerbated some cardiovascular issues possible with the heart. If je has no issues with the heart, this is what they may try.
The clozaril is a great medication, but as you expressed, all of the issues and the constant blood testing usually male this one that the last choice.
Hope this helped,
Mark
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#13 miracleseeker

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Posted 13 May 2013 - 07:49 AM

uh no... I think Risperdal would NOT be on the list of drugs to try for hallucinations if you have PD. It is now widely known that it interferes with the absorption of the PD meds. We found out the hard way 10 years ago from an idiot neuro who prescribed it for my mom and when I told him it wasn't working and she was also shaking more for some reason he told me to increase her dosage. I got a six sense about this and stopped it altogther and then when that worked I gave him a piece of my mind. He's lucky I didn't report him.

Serooquel gave my mom nightmares. She would scream bloody murder every night and it took awhile before I figured that one out too. She also had delusions of me as a child and asking everyone to call the police because I was missing.

As for now she puts imaginary food in her food and likes to pick up imaginary things off the ground. I think that's pretty harmeless and would rather have that then to have her take yet another drug with multiple side effects.

Sometimes I think it's best to leave well enough alone. Not all "conditions" should be taken care with another med. This is how people end up taking 20 drugs at a time. That is very scary.



#14 MComes RPH

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Posted 16 May 2013 - 08:30 AM

I totally agree with you. When someone asks a question, I like to give them ALL the possible options that are out there. The risperdal can be an issue if taken too close to the sinemet, you are correct on that. I like to give options and let the patient choose what to do with that info. And doing nothing is an option.
You also hit the nail right on the head when you referred to people taking meds to cover up the side effects of other meds. PD can cause fatigue, well so can sinemet, mirapex, and many other PD meds. What a person needs to do is figure out....is it the PD or the meds. This,aon with the age of the patient, may decide whether to give a med to help them stay awake, alert, and focused (especially if they can drive), or just let them nap during the day. It is a tough call, because some times a person HAS to take a med to overcome the side effects of another med. My belief is that this is only done if it is imperative to increasing the persons quality of life. Which is why we take meds anyway. Is to improve our quality of life.
Truly, the one thing we all want, whether we have a disease or are completely healthy, is a good quality of life. Some of us with a disease just may need a little pharmaceutically necessary help.
Take care and please keep me updated.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#15 miracleseeker

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Posted 16 May 2013 - 03:54 PM

1.Why does so many drugs cause drowsiness? Why can't they take it out or counter it with something that makes you stay awake all in one drug?

2. Do you believe that it's possible these hallucinations are actually real? People just can see things others can't or the meds brings out the visual awareness. Just a thought

#16 MComes RPH

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Posted 23 May 2013 - 01:04 PM

1- since many of these meds deal with altering chemicals in the brain, unfortunately that chemical change can cause the drowsiness. It would be nice if the could add something to the med to counteract the drowsiness, but since it may not happen in the "majority" of people during testing, it just not done
2- as far as the hallucinations. People do have them, some while on medication and others while not on meds. It is real, it does exist. There are visual hallucinations, auditory (hearing) hallucinations (which is common in sinemet, and tactile (touch) hallucinations), where you feel like someone or something is touching you. They are all a real thing, and I am sure can be very scary to the person and caregivers.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#17 johnnys

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Posted 02 May 2014 - 06:43 AM

Hi, I have a freind who lives in a va nursing home.he is on limited sinemet due to hallucinations. he has little dysknesia.
Im looking for a drug (not a antipsychotic) to help him so he can tolerate more sinemet .He could then regain some mobility and finaly get him out of that awful bed.
Im also hoping the new duodopa pump will be able to help him .Its supose to be approved this year,finaly.Such a shame since its been approved many years ago in other countries
thank you for all your concern helping others here.
john

#18 MComes RPH

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Posted 06 May 2014 - 03:30 PM

Lodosyn is a product that is just carbidopa. Many people use it when they can or tolerate higher gloss of levodopa. This might be something to add, if I am understanding you correctly.
Another possibility could be comtan, which is a medication that allows sinemet to work longer. This way, you could possibly use lower doses of sinemet but it would last longer in the system.
I hope this is what you were looking for. Anything to eliminate the hallucinations would be like an anti - psychotic med (like seroquel).
Which does work well.
If you need more precise info, let me know.
Keep me posted.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org





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