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azilect and sinemet cr


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#1 esther51

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Posted 21 March 2013 - 04:31 PM

I have been on sinemet cr for several years. I started azilect about 3 weeks ago. I was diagnosed with predominant tremor Parkinson's. I can hardly even type this question to you because my shaking is much worse. Could the azilect cause this? I've never had problems typing or writing before It's as if the sinemet is not working. Please help. My neurologist said it could be psychological

#2 greentree

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Posted 29 March 2013 - 05:19 PM

My feeling is that whenever there is a change in medication, it is wise to be on the alert for side effects. I was on Sinemet also when Azilect was added and I began to have dyskinesias, so my neurologist said it was probalbly the Azilect which enhances the Sinemet. I went off the Azilect and the dyskinesias got better. This was a couple of years ago. Now that I am needing a little more Sinemet I am getting dyskinesias again. When I drop back on the Sinemet, even just a little bit, the dyskinisias get some better. Psychological? I doubt it very much. I would ask him/her if you could take less Sinemet or go off the Azilect. I cannot say if the change in your tremor is caused by the Azilect but maybe it is because the enhanced Sinemet is somehow making the tremor worse. (Just a guess.) Was your question directed to the pharmacist forum? I would ask them.

#3 MComes RPH

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Posted 29 March 2013 - 05:21 PM

Did you switch from sinemet to Azilect, or did you add Azilect to the sinemet?
The reason I ask is because there can be different answers.
1- if you stopped the sinemet and started taking sinemet: if this was done, there has to be a taper down time with sinemet AND a taper up time with Azilect (usually 0.5 mg daily for 1 week then 1 mg daily thereafter). If sinemet was just stopped and Azilect took it's place, then you are going to experience PD symptoms until your body gets to the effective amount of Azilect. In some people it can take a month, but most Dr's (and myself included) usually recommend staying on the Azilect for at least 3 months. This way you have given the Azilect enough time to reach the effective blood levels to work. As with all PD meds, I tell people to "start low and go slow," this way you lessen the possibility of side effects or adverse effects of the medication. Another reason for waiting the 3 months and to start low and go slow with the dose is because when you first start any medication, your body looks at it as a "foreign" substance and tries to repeat it from your system. So if it is given at full dose, your body will react very harshly to the med. When it is given at lower doses to start and the dose is increase slowly, your body will not notice it that much. After the dose gets increased, your body now looks at it as being part of it's own make-up, and very few side effects should occur.
2- if you added Azilect along with the sinemet. It is not uncommon for the first few weeks, even up to a month, for your symptoms to get worse instead of better. It is just one of those things that cannot be explained. What I will usually recommend that the patient give the Dr a call and explain what is going on. Many times the Dr will write a prescription for a low dose regular acting sinemet (maybe a 10/100 or a 25/100) for the patient to take wen the "off" times are very severe.
The real issues with either method (1 or 2 above) that you give it time to work. The majority of time why people give up on a certain medication is that they do not give it enough time to work. With the Azilect, as I stated earlier, it may take as little as a month, but more likely 2 to 3 months for its full effectiveness to be noticeable. I know this seems like a long time, but in the long run it may be worth it. As I also said, many dr's are more than willing to give a low dose sinemet to get you through the tough times, as long as you do not become more dependant in the sinemet than the Azilect. If you just remember that the sinemet is there for the tough times, I think you will see over time that you will use less regular sinemet as time goes on. It takes time, but I think if you give it that time, you will be surprised at how well it may work for you.
Hope this helps and keep me posted.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#4 greentree

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Posted 29 March 2013 - 05:22 PM

Sinemet CR is also harder to regulate than Immediate release Sinemet. The level might not be as even throughout the day as it should be.

#5 MComes RPH

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Posted 29 March 2013 - 05:25 PM

Thanks for the info. PD meds are not a "one size fits all." So in here, we are a family and are willing to share our experiences, which at times, is more important than any info I could ever give.
Thanks for the input, it is much appreciated.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#6 esther51

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Posted 30 March 2013 - 05:49 AM

In answer to your question, I added azilect to sinemet cr. But, my doctor knew I was only taking 1/2 of a .5 azilect and I think that was the problem. When I started taking the whole .5 I seem to be doing better so I'll try to hang in there for a few months and see what happens. Thank you all SO MUCH for your help.

#7 MComes RPH

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Posted 04 April 2013 - 11:45 AM

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

#8 esther51

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Posted 14 April 2013 - 08:20 PM

Mark: I need some encouragement to stay on this azilect. I am on day 20 now and the side effects are terrible. I feel like just crying today. I have an all around sick feeling. My neck and shoulders hurt. I have joint pain. I have a lump in my throat. I am very tired. I was determined to stay on it, but I don't know if I can. Is this a normal reaction? It's worse than I expected. I just don't know what to do anymore.

#9 MComes RPH

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Posted 15 April 2013 - 07:57 AM

Like I say the optimal effects can take anywhere from one to three months. If it is at a point where you just can't handle it and the "right now" you feel you need a break. It would be ok to give the Dr a call and explain what is going on. He may 1- take you off of it or 2+:yell you to take a short break from it and still get the benefits if you start up later.
Get his advise first, you won't be a loser, it will be a minivacation
Keep me updated.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#10 Hope

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Posted 16 April 2013 - 08:29 PM

My psychiatrist and my neurologist are in disagreement about whether I can stay on my current anti-depressant regime,
40 mg Paxil and 20 mg Celexa, and start Azilect.
The depression is almost as debilitating as the still mild PD symptoms, and I have only had a couple months to get used
to the diagnosis, so I am wary of Azilect.
Neuro says I must get off the Paxil first. Psychiatrist says Welbutrin is anti depressant of choice for PD, but I don't feel
in good enough shape to make any changes right now. Last time I tried Welbutrin it really raised anxiety.
Any ideas?

#11 MComes RPH

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Posted 23 April 2013 - 09:16 AM

Ok, I see this a lot. I do not believe the patient should be caught in the middle of 2 dr's choices. I believe the patient should have input, such as your cover that the last time you were on wellbutrin you had a lot of anxiety. Those 2 dr's need to take that into consideration and THEY SHOULD DISCUSS IT.
Now, you have my opinion thrown in the mix, and you have brain salad. Just kidding, but seriously it is very confusing for the patient. What I will give you is my opinion when I had to go through this. My circumstance was very similar to yours.
The last time you were on wellbutrin, were you on another other meds? I was not. I was like you. I was on paxil and THEY wanted to put me on azilect. Well, there is a serious reaction between Azilect and Paxil, so I knew we had to change. My neuroologist said lexapro and my psychiatrist at the time said wellbutrin. Keep in mind, I had both of them sitting in the same room as me, and since I am a pharmacist, they wanted my input also. Both of them knew I had been on wellbutrin before and had some anxiety issues. But we all agreed that when wellbutrin was given with Azilect that the anxiety seemed to go away and also that the wellbutrin seemed to help with some of the parkinson symptoms. At that point, we all agreed that I would give wellbutrin a try for 3 months. In case I did not mention it,my wife was also there. I always recommend you bring along a spouse, caregiver, friend, or someone who has your best interest at heart. The reason for this is that they see things that we do not. Trust me on this. It is true .
So knowing what we know, I tried wellbutrin for 3 months. The first month, no change. The second month, I felt a little better mentally, physically, and husbandly. Then came the third month, when I felt worse than ever. Anxiety came back like before. But my mood was one where I was very edgy and no one knew which "me" was going to wake up that day.
Now, all the studies said that wellbutrin should have helped with mood and PD. In my case it did not. So we all gathered together and brought our notesbof what occurred over those 3 months. So we decided to slowly taper off the wellbutrin and slowly start the lexapro.
That was 5 years ago and I am still on lexapro.
This just goes to show how everyone is different. Probably about 70-75% of the people I talk to are taking the wellbutrin along with Azilect and are doing fantastic.
I think this is the same approach you need to take. As you know, with PD and anxiety, there is no "one drug fits all."
I will give you some advice. 1- never change 2 medications at the same time. If they want to do Azilect and wellbutrin. You need to be off the pail for 14 days before starting Azilect. So, taper off the pail and slowly start the wellbutrin. This should be about 14 days. At this point you can start the Azilect. They will usually start you at 0.5mg for 7 days, and then increase it to 1 mg daily after that.
Remember, what worked for me may not work for you. But the one thing I ask is that you give the mens at least a 3 month chance. Unless you are tearing the house apart, then you may want to get hold of your dr NOW!
Please keep me posted and let me know what is going on. Best of luck to you my friend.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#12 Hope

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Posted 26 April 2013 - 12:53 AM

Thank you so much for this answer. I am sorry I didn't see it before I posted a new topic. It is extremely helpful-- thanks so much!
I'm a single mom with three kids, so if I can just get to September, I will have the empty nest (or as empty as it ever gets with employment rates as they are for ppl in their 20s). Haven't told the kids yet, and some of my friends are turning out to be running for cover after a doctor or test appt. So I was tempted to go alone this time.
I'm scared about going off the paxil. This is what is so confusing. Anxiety is the worst part of this--now that I am in OT and PT it is kind of fascinating and hugely relieving in a weird way to learn of all the things going wrong that I was in denial about. I was very nervous on the welbutrin. Maybe I can just stick with the Lexapro and I take one Klonipin .5 a day. And do a slooooowww taper on the Paxil?

#13 MComes RPH

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Posted 28 April 2013 - 11:39 AM

That would be an option. I know how it is to be afraid to go off a med that has worked so well. I have run into this many times, being 44 years old and being diagnosed for 10 years with symptoms going farther back than that. Many times I have had to go off a med that I thought was working great and that I could not go without. The first time the stress and anxiety of changing meds was worse than the anxiety I already had. The toughest part is that I am a pharmacist and sometimes too much knowledge is dangerous. The change in med worked, and at that point I realized I was the patient, not the Dr.
I will be honest and tell you that you may go through many changes in meds, some work out and some did not. I think the best information I can give you is to start a "Medication Log."
It can be done on any computer. You just make a blank calendar, you put on there the time you took the medication, then add any events(good or bad) that happened (also note the time on that as well). Make sure you do this daily. Then when you see your Dr you need to bring that with you. That info is priceless to the Dr. The more info you can bring the Dr that they don't have, like personal info (because they don't live with you) the better they can be with prescribing the correct medication.
Best of luck and keep me updated.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#14 Island Woman

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Posted 28 April 2013 - 12:17 PM

Mark, had to stop the sinemet cr and go back to regular...it brought back internal tremor again but could also be I was over stressed at the time...may give it another try.

Patricia

#15 MComes RPH

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Posted 28 April 2013 - 01:37 PM

Pat,
Thanks for the update. It is so tough to tell sometimes because stress and anxiety can bring out our PD symptoms or make them worse.
Hang in there and give me a shout if I can help. You know where to find me.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org




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