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Is novicaine contrindicated with sinemet?


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#1 Dick T

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Posted 11 April 2013 - 11:09 AM

I had two injections of novicaine by the dentist while he was working on my teeth. The result was I had difficulty with balance and felt doped up for the rest of the day. Is the use of thse two medications compatible?

#2 MComes RPH

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Posted 12 April 2013 - 12:22 AM

I have had this question before and oddly enough there is a reaction that can happen with local aesthetics and (1) people with PD and (2) people taking sinemet.
Let's start off with 2 facts: (1) sinemet can cause orthostatic hypertension (OH)- which is a sudden drop in blood pressure when getting up (possibly too quick) from a seated or laying position. (2) PD can also cause OH. So together you get a 1+1 effect.
Now when you go to the dentist they usually give you novocain (for pain) added with another medication (like epinephrine-which is a vasoconstrictor used to imitate amount of blooded saliva produced during the procedure). It is usually the extra ingredient, epinephrine, which is the culprate, because it also cause OH.
Little do people know that regular aesthetics and local aesthetics can stay in your system for a few days. That is why you probably get the way you did.
Hope that helps. Be careful when getting up from unsealed or laying position. Because the faster you get up, the quicker you could passo (or at the least get dizzy and light headed)
Hope that helped.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#3 esther51

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Posted 12 April 2013 - 04:53 AM

How about novacaine with azilect - Is this safe?

#4 miracleseeker

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Posted 12 April 2013 - 08:00 AM

My mom is gettting major dental surgery on Tuesday. She will be under sedation of a combo of Versed and Fentanyl for 3 hours. What should I do to prepare?
I hear horror stories of people with PD with dementia that goes downhill from there. True?

#5 MComes RPH

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Posted 15 April 2013 - 08:02 AM

No interaction between novacaine and Azilect.n
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#6 MComes RPH

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Posted 15 April 2013 - 08:14 AM

The only interaction betweenPD meds (sinemet) and versad and fentyl is some added drowsiness and dizziness.
As far as the dementia , it may take the patient longer to "come back" to normal . This is because the anesthetic stays in the system for a long time, especially in the elderly. So it appears to be the dementia taking over but really it is the anesthetic just acting longer than ot normally would.
Hope this keeps you at ease and keep me posted.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#7 miracleseeker

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Posted 25 April 2013 - 08:06 AM

My mom was out for 20 hours after her surgery. She could not open her eyes and was in a very deep sleep all that time. It's been a week now and she still has trouble walking. She has to go back to the dentist next week to get some permanent crowns and can have just regular novacaine for that. I hopefully she won't fall asleep again.

She's now basically teethless because he removed a major portion of what she had in her mouth due to decay and only solution are dentures. The dentist said no way to implants for her seeing how she reacted to the sedation last week. I don't know if dentures will be right for her since she barely opens her mouth for me to brush her teeth so imagine having a set of invaders in her mouth at all times.

He prescribed some kind of mouthwash for her to use as toothpaste to remove gingervitis but from what I read about it from others I will skip it. It supposedly changes the taste bud and I need her to eat more than anything to regain her strength. I don't understand how the FDA can approve all these drugs that give off so many side effects yet won't approve other drugs that clearly will work but just not on everyone so why not let the ones that can benefit.... benefit? Case in point are a lot of the PD and dementia drugs that did not make the cut. What difference does it make since a lot of drugs get recalled anyways years from now when people have already been taking them for years.

#8 MComes RPH

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Posted 28 April 2013 - 11:11 AM

As a pharmacist, before and after I was diagnosed with Parkinson's Disease, I believed the same as you bit with some restrictions. Now that I have PD, I know that if I was told that tree bark would help my PD, I would try it.
The sad part is, this is the new "fast track" system that has been put in place. The system is in place to get medications for more serious diseases to market quicker to benefit the patient.
The tough part is, we as American's, seem to want everything RIGHT NOW not RIGHT. I am saying this about you, but rather people in general. When I was working behind the counter as a pharmacist and I would tell people it would take 20 minutes to get their prescription done, they would scream and holler, "20 minutes, all you have to do is put the pills from a big bottle into a small bottle and give it to me!" I would reply very kindly, " I understand it appears a monkey can do what I do, but a monkey does not know if this med interacts with you're other meds, what side effects may occur, what disease states may be exacerbated by this med, what food or drinks may increase or decrease the effectiveness of the med, is the Dr wrote for a dose that may be too low and may not be effective, or that another Dr may have written a medication for her that is the same but goes by a different name. So, I guess the 6 years of pharmacy school and the State Board has granted me the obligation to make sure you get the right medication, with no time frame. So, with that in mind, I feel more comfortable taking the extra 5 minutes to make sure you get the right medication, not the wrong medication NOW."
So, I can see it from both sides. I can also empathize with you. Unfortunately, in the world we live in, there is no med that has no side effects. Truth be told, if aspirin were to be attempted to be put on the market today, it would never make it. Due to the fact that who would believe a med could take care of a headache and a take care of a pain the toe, take care swelling anywhere in the body, and also thin out the blood. No person, let alone a drug agency, allow this med be approved stating it can do all the things it CAN actually do.
I do understand where you are coming from. What I think we need is a "meet-in-the-middle" program. The issue with that is when you get politics involved in anything, it seems there is no "meeting-in-the-middle" let alone a "meeting of the minds."
Good luck and I am on your side. I guess we may be able to win the battles, but I think it will be tough to win the war. Sorry to say.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#9 miracleseeker

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Posted 28 April 2013 - 04:28 PM

Doing it right is your reason for the delay but I do believe laziness and entitlement is mostly the reason a lot of phamacies take their sweet time. I say this because lots of people go on weekends where doctor's office are closed so there would be no one to call to verify anything and even better is when it's a refill. The patient is alive and well and is getting more of the drug prescribed by the doctor because he or she feels it's working so what's the hold up?

I'm bias cause my mom's pharmacist is super quick and I'm in and out in 10 minutes tops. Maybe he has a limited supply of meds he gives out so he knows them by heart or he's just an exception. Let's just say I hope he won't retire anytime soon.

Back to sedation drugs. I wonder if they had interefered with the PD meds cause the last time my mom was in this coma state was when she spit out most of her morning dosage and by the afternoon she was out for a very long time.

#10 MComes RPH

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Posted 03 May 2013 - 11:48 AM

As far as the pharmacist thing, I see that lot. I came from a blue collar town where you work hard to ear your pay. All of my customers are not customers, they are friends. I know them all by name, would drop off meds on my way home if the patient needs them, and had all the dr's home or cell phone numbers. I got my work ethic from my parents. My dad worked at a paper mill 12 hours a day then , depending on the year, would either referee basketball, umpire baseball, or be at one of my brothers games. My mom worked retail and immaculate care of a house with 3 guys in it, plus PTA, fundraising, volunteered at school, and was at every event we had. You are correct. It depends on the pharmacist. I am seeing as time goes on, some only care about the cash.
As far as the sedation, I think you are right on. When everything else is gone, that is the only thing left. Then after that wears off, back to herself, but very fatigued. A great care giver is hard to find.
I always say that many times it is easier to have PD than to take care of some one with PD.
Thanks for the update and keep me posted if you notice anything else.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#11 miracleseeker

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Posted 03 May 2013 - 05:20 PM

Crowns were put in yesterday with no novacaine thank god. She also was able to get impressions made for the partial dentures. However when I fed her dinner last night she was grinding like crazy with each bite of food. It sounded like she was chewing glass. I called the dentist this morning and she said she was positive the crowns were the right fit so I should wait and let her get adjust to them. Once the dentures are received and she would by then have a full set of teeth then everything will be aligned. I don't know how long I can wait for that to happen.

I have slowly increased her Stalevo dose back up from 125mg 3 times a day to 150mg morning and afternoon while leaving 125mg at night. She was doing better as far as her balance and ability to get up by herself again with very little grinding until yesterday. Yes, my mom is the one who grinds her teeth from excess PD meds. What I did do differently this time is eliminate the 2am Sinemet dose and I think as a whole she was just on too many mg of PD meds while I kept concentrating on just how much she was taking from Stalevo even though they are crushed and absorbed too quickly. She still moans and groans but at least no grinding afterwards until.... yesterday.

Yes a good pharmacist is hard to find and your town is lucky to have you. So are we with your valuable info. Thanks a lot!

#12 MComes RPH

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Posted 07 May 2013 - 11:27 AM

Thank you. Any time. Sometimes we want to control too much, so we think more med will do it. When actually, less is really more.
Keep me posted.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org




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