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Maximum dose of Sinemet


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#1 Ljubica Lojan

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Posted 24 February 2013 - 10:45 AM

My husband is now on 12 Sinemet 100& 25 mg daily. What is the maximum dose? We had this dose for a long time.

#2 Dr. Okun

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Posted 24 February 2013 - 02:02 PM

There is no such thing as a maximum dose. The key is changing the dose and interval to fit the individual symptoms. Having said that, it is rare pure dose to have patients on more than 3 25/100 pills per dose. Hope that help, but would not focus on dose,

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


#3 Ljubica Lojan

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Posted 25 February 2013 - 08:25 PM

I did not mention that my husband is also on 3mg of Mirapex a day. Since he is very sleepy we thought we would ask PD specialist to discontinue Mirapex all together. As a result we thought, perhaps, Sinemet should be increased if we are to discontinue Mirapex.We appreciate your reply.

#4 Dr. Okun

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Posted 26 February 2013 - 07:57 PM

When discontinuing agonists (which can make you sleepy- dopamine agonist side effect), we usually do it slowly over many many weeks to avoid a withdrawal symptom. In many cases we have to move doses of sinemet closer and sometimes even increase the dose.

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 27 February 2013 - 08:01 AM

It seems to be a common side effect for everyone that Mirapex causes sleepiness. Please tell me why this drug was approved by FDA when people cannot function while on it? My mom has sleep attacks all day long for the past 15 years that she's been on this drug. I have tried many times to get her off by slowly decreasing it but all it did was make her shake uncontrollably. What's in the drug that's causing the drowsiness and why can't the makers take that ingredient out?

#6 Dr. Okun

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Posted 27 February 2013 - 06:28 PM

Thanks and sorry about your mom.

Not everyone gets sleepy and I am not sure what about agonists causes the drowsiness; and also not sure why not everyone experiences it.

We wean the drug very slowly over many weeks under a docs supervision and we slowly replace at the same time with sinemet.

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 28 February 2013 - 06:00 AM

We've tried that route and since she takes Stalevo with Mirapex and wanting to decrease Mirapex then we would have to increase Stalevo to = to the strength of both drugs. Stalevo causes teeth grinding in large doses for my mom. This is where the vicious circle continues. Sinemet was not strong enough and higher doses makes her mute.

#8 Dr. Okun

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Posted 01 March 2013 - 11:00 AM

I will post and see if other people have comments for you.

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 Optomist

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Posted 10 March 2013 - 05:00 PM

My first time. Never thought I will be blogging on a forum on medical needs, but here I am.
My wife had young onslaught of PD at the age of 39. Since then she has gone to 4 Neuros. She is taking car/lev 6 times a day ER 50/200, ropinrole/requip (4mg) 3 times a day, Azilect 1 mg once a day, Amantadine twice a day (5am, 11am). She also takes car/lev 25/100 non ER as a kick start 3-4 times a day. That’s a lot of carbidopa/Levodopa. She also takes with 50/200 car/lev 6 tablets of comtan 200. Dr. did not go fot Stalevo as the car/lev in Stalevo is not ER.
She does take an anti-depressant Lexapro once a day (limited due to Azilect). She complains of lots and lots of pain mainly on back and shoulder region. She takes 100mg Lyrica twice a day and lots of OTC pain killers like Advil and Tylenol. She has Vid D deficiency and no other issues then PD related issues. She takes a centrum, high does of Vit D, 1200mg of CoQ10 also.
She does not have trembling but has freezing and rigidity issue, big time. She has some dyskinesia but not always and not much unless she is in stressfull or lengthy conversations.
Her condition gets really really worse at night. She crawls to restroom, asks for help every 30 mins or less, wakes up the whole house, has hallucinations and cries a lot and complains of too much pain. At times, now, we are all getting frustrated with her situation at nights as we have work and school (situation has worsened in last 1 year and she is also not a co operating patient). She recently gotQuetiapine/Seroquel and has taken only couple of doses with no help. The night situation is getting to hurt everyone at home and she is getting more vocal in those situations and also others are not showing any patience either as she will tire herself with un necessary stuff through the day, not sleep on time and not exercise at all beside just taking meds. She hallucinates a lot and makes up things a lot. During day, she will drive, shop, work at home and all, but night comes and she is a different person. At times she is not well during days but it is worse (almost 75% more, no gauge though) at night with non stop crying, moaning and calling for help.
She feels she is completely paralyzed and need help even to move her hand from one position to other. She takes all meds including small car/lev but nothing helps. Around 7-8Am she is much better.
I don't know if she will want to take seroquel for long or not and will it help or not, but all in all she is taking too much meds, but Doctor knows?

Can anyone shed light and has anyone encounter this situation? We all love her very very much, really care for her, help her a LOT all day but also get very annoyed during nights. I think the meds she is taking are too many but the Uni Prof she sees knows it all and wants her to go for DBS for which we are sure she will fail the psychological profile miserably and she does not want to get bald.
I still believe there is much that can be done and her NIGHT SITUATION is very weird. We have been on vacations in last 1 year anb she has behaved very well.

Thank you.

#10 Dr. Okun

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Posted 10 March 2013 - 09:28 PM

A few ideas.

DBS and intestinal duodopa could be solutions.

Taking extra rescue doses of sinemet at night could be useful along with clozaril or seroquel to block hallucinations.

Also dopamine agonists and amantadine, especially late in the day can drive hallucinations. There may be some medication adjustments that can help.

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 Optomist

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Posted 11 March 2013 - 04:35 PM

Thanks Dr. Okun. I really appreciate your responding.
She is not keen on surgery yet and frankly psychological she is not a great candidate. She just took herself off Seroquel after two dosages as she was not sleepy but sleepy enough to not know whats is going on and fell once.



Here is how she takes her dosages or this is how we plan it. In between or with some ER dosages she takes 25/100 rescue dosages 3-4 times.
I think it is too much carbidopa or some drug interaction. Lyrica and Lexapro are close at night

5AM-6AM: one Amantadine, one ER 50/200 generic sinemet, one 200 Comtan, 1 4mg ropinrole

8AM-9AM: one ER 50/200 generic sinemet, one 200 Comtan, one 100 Lyrica

10AM; one Azilect (only once a day)

11AM-12NOON: one Amantadine (last dose), one ER 50/200 generic sinemet, one 200 Comtan, 1 4mg ropinrole

2PM - 3PM: one ER 50/200 generic sinemet, one 200 Comtan,

5PM-6PM: one ER 50/200 generic sinemet, one 200 Comtan,

8PM - 12 MIDNIGHT: one ER 50/200 generic sinemet, one 200 Comtan, 1 4mg ropinrole, 1 LEXAPRO (only once a day), one 100 Lyrica

Her day yesterday was pretty OK, night was also little better after some pep talk during day time. She did need some help but not like past 3 nights where she was completely paralyzed and very depressed.

Best Regards,
OPTOMIST

#12 Dr. Okun

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Posted 12 March 2013 - 08:56 PM

You could talk to your doc about specific intervals (maybe 2 hours and exact times and not general windows).

Some people will in this case consider not using sinemet CR and also simplifying to just using sinemet 25/100 tablets and titrating to the nearest 1/2 tablet the exact dose needed. Sometimes all other meds can be titrated slowly off and you can actually find the magic dose and interval of plain sine met. This is something to at least ask your doc about.

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


#13 Optomist

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Posted 15 March 2013 - 01:29 AM

Thank You Dr. Okum.

For past 3 nights she is better. increased her 25/100 and took off couple 50/200..lets see.

#14 Dr. Okun

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Posted 15 March 2013 - 06:24 AM

Good luck and what a blessing to hear she improved.

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


#15 iamsparky

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Posted 15 March 2013 - 12:56 PM

I am currently taking 25/100 sinemet. For a couple of years, I took I took 1 pill 3x a day. When my "off" periods increased, I moved to one tablet 3x a day plus 1/2 tablet or, on active days, up to 4x a day. My neurologist has suggested that I consider increasing each dose to 1.25 - 1.5 tablets to increase my "on" time. He also offered to add entacapone to my regiment to extend my "on" periods. My question is this - would it be better to increase my dosage of sinemet or to maintain my current dosage and add entacapone to my regiment. I am hesitant to increase my dose of sinemet due to the increased risk of dykinesia it would pose. However, doing adding entacapone pose the same degree of risk? In short, are the risks of each approach the same?

My neurologist's approach is first to optimize the sinemet dose to see if it can increase the amount of "on" time without causing dyskinesia, and minimize the number of medications.

#16 Dr. Okun

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Posted 16 March 2013 - 12:57 PM

If the issue is wearing off and you want to avoid dyskinesia the simplest solution is moving dosages closer together (closer intervals) and not adjusting dose. Adding Comtan could work but will increase the risk of dyskinesia. The reason to increase sinemet dose is if when you are on, you are not completely on; or alternatively you are not turning on.

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


#17 Optomist

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Posted 18 March 2013 - 05:40 PM

Yes...thanks..

So her Dad had a stroke while in skilled nursing home after quadruple by pass. He is in hospital but she did remarkably well and stayed long hrs at the hospital. Dad is better, no major damage so far, frontal lobe stroke (thanks God!) considering.

But I am more glad to see her not in pain and going about things with meds pretty normally. This is what is mind boggling, highly stressful situation, she did well. We went for weddings last summer out of state, she did reasonably great. In between she goes haywire?

#18 Optomist

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Posted 18 March 2013 - 06:01 PM

Beside Carbidopa/Levodopa, though we know little bit but can we get one liner what are effects of certain medications and why are they taken alongwith C/L. Which one can cause what side effects and which are the meds that can be tapered down (not completely) safely? Thanks.

Comtan:
Requip/Ropinrole:
Amantadine:
Azillect:

#19 Dr. Okun

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Posted 19 March 2013 - 08:10 AM

Comtan extends the life of levodopa but can cause dyskinesia and confusion, and we generally simplify and taper off if there is confusion.
Requip is a dopamine agonist, and again it helps with PD symptoms, but this is one that we often taper off if confusion or dementia. Can cause nausea, confusion, dizziness, and impulse control disorders to name a few-- also psychosis.
Amantadine has mild ani-PD effects, but most people use it only for dyskinesia. We typically taper off if psychosis or dementia.
Azilect is a very weak symptomatic drug called a MAO-B inhibitor.

In cases of confusion many experts use only sine met (or Madopar) and sometimes if psychosis will also use clozaril or seroquel.

That is a really short summary as you requested, but this is a complex question and you should use an expert in person opinion before you wean anything.

Good luck.

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


#20 Optomist

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Posted 31 March 2013 - 12:59 AM

Checking in again after couple of weeks. Major issue is freezing but there is lots of pain also. She takes Lyrica 100mg twice a day and 6-8 advil every day.
She was on skelexin and meloxicam (went to pain management at UTSW three times) but not much help. When she has these bouts nothing seem to help ad as ight progresses she is not well..and at AM she is in much better shape? Perplexed?

What should we do? What is not working or needs adjustment. The Dr. tells us do what works?????? A professor..

Dosage again as under : (insert more 25/100 upto 4 times now)

5AM-6AM: one Amantadine, one ER 50/200 generic sinemet, one 200 Comtan, 1 4mg ropinrole

8AM-9AM: one ER 50/200 generic sinemet, one 200 Comtan, one 100 Lyrica

10AM; one Azilect (only once a day)

11AM-12NOON: one Amantadine (last dose), one ER 50/200 generic sinemet, one 200 Comtan, 1 4mg ropinrole

2PM - 3PM: one ER 50/200 generic sinemet, one 200 Comtan,

5PM-6PM: one ER 50/200 generic sinemet, one 200 Comtan,

8PM - 12 MIDNIGHT: one ER 50/200 generic sinemet, one 200 Comtan, 1 4mg ropinrole, 1 LEXAPRO (only once a day), one 100 Lyric

She also does takes Vit D, CoQ10 and multivitamin.




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