Call Our
HELPLINE
1-800-4PD-INFO

Jump to content


E-Newsletter Signup Like us on Facebook Sign Up For Our e-Newsletter
Photo

carbidopa/levodopa 25/100 CR or ER

Can you break them in half?

  • Please log in to reply
3 replies to this topic

#1 Beau's Mom

Beau's Mom

    Advanced Member

  • Members
  • PipPipPip
  • 1,916 posts
  • LocationSeattle, WA

Posted 08 October 2013 - 12:20 AM

A year ago a nurse in a hospital gave me 1/2 of a 50/200 carb/levo which was scored. She said if it was scored, it was safe to break it in half. Now I take 1/2 of a 25/100 carb/levo every morning which is not scored. Does that mean the timed-release element is no longer effective? I have noticed more head bobbing after the 1/2 pill than when I take the other three doses of one whole ER carb/levo during the day. Different pharmacists and nurses have told me different things about this. l I'm hoping you can clear it up once and for all. Thank you.


I am not a human being trying to have a spiritual experience; I am a spiritual being having a (sometimes difficult) human experience.

 

First symptoms: right-hand tremor, constipation and restless arms 1978 (age 25). Depression and anxiety (non-motor symptoms) began in 1989 and worsened through the years. Last inpatient episode June 2013.

Diagnosed December, 2010 by a regular neurologist (age 57). After negative reactions to Requip, Mirapex and selegiline began Sinemet 25/100 3x/day. First MDS visit in Houston in February of 2011 was inconclusive. Second MDS visit at Baylor Fort Worth in May/June 2011 diagnosis changed to Parkinsonism, Sinemet stopped. Third MDS visit in August 2011 in WA State: received a confirmed diagnosis of idiopathic PD which had started on the right side and had now crossed to the left side as well. Restarted on Sinemet 25/100 4x/day. A short trial of Amantadine caused audio hallucinations in September 2011.

 

Current medications at age 62: Sinemet 25/100 ODT every 2.5 hours while awake (7/day). One Sinemet 25/100 CR between midnight and 4 AM. Trazodone 200 mg at bedtime, Fluvoxamine 300 mg at bedtime. Clonazepam 0.5 mg morning and afternoon, 1 mg at bedtime. Vit D3 2x/day, Calcium Carbonate Susp. 5 cc daily, Baclofen 10 mg 3x/day, Flonase two sprays 2x/day, Calcitonin-Salmon nasal spray once daily (for osteoporosis). Gel eye drops as needed throughout the day, Restasis Eye drops 2x/day, Nighttime eye ointment at bedtime. 02 2L per nasal cannula while asleep. Walker, electric wheelchair, moist and soft or pureed foods and 115 caregiver hours/month keep me sane.

 

All of the above subject to change based on progression, stress level, and dyskinesia. Whew! I'm glad I finally wrote that all out.


#2 Dr. Okun

Dr. Okun

    Advanced Member

  • Ask the Doctor Moderators
  • PipPipPip
  • 5,467 posts
  • LocationUniversity of Florida

Posted 10 October 2013 - 08:13 PM

It has long been speculated that by breaking a CR pill in half you lose some but not all of the CR (extended release) properties.  


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 Beau's Mom

Beau's Mom

    Advanced Member

  • Members
  • PipPipPip
  • 1,916 posts
  • LocationSeattle, WA

Posted 10 October 2013 - 10:12 PM

Do you allow your patients to do it or are they limited to the unscored versions of ER or CR by their insurance? If the insurance refuses to pay for proper dosing, can we appeal that?


I am not a human being trying to have a spiritual experience; I am a spiritual being having a (sometimes difficult) human experience.

 

First symptoms: right-hand tremor, constipation and restless arms 1978 (age 25). Depression and anxiety (non-motor symptoms) began in 1989 and worsened through the years. Last inpatient episode June 2013.

Diagnosed December, 2010 by a regular neurologist (age 57). After negative reactions to Requip, Mirapex and selegiline began Sinemet 25/100 3x/day. First MDS visit in Houston in February of 2011 was inconclusive. Second MDS visit at Baylor Fort Worth in May/June 2011 diagnosis changed to Parkinsonism, Sinemet stopped. Third MDS visit in August 2011 in WA State: received a confirmed diagnosis of idiopathic PD which had started on the right side and had now crossed to the left side as well. Restarted on Sinemet 25/100 4x/day. A short trial of Amantadine caused audio hallucinations in September 2011.

 

Current medications at age 62: Sinemet 25/100 ODT every 2.5 hours while awake (7/day). One Sinemet 25/100 CR between midnight and 4 AM. Trazodone 200 mg at bedtime, Fluvoxamine 300 mg at bedtime. Clonazepam 0.5 mg morning and afternoon, 1 mg at bedtime. Vit D3 2x/day, Calcium Carbonate Susp. 5 cc daily, Baclofen 10 mg 3x/day, Flonase two sprays 2x/day, Calcitonin-Salmon nasal spray once daily (for osteoporosis). Gel eye drops as needed throughout the day, Restasis Eye drops 2x/day, Nighttime eye ointment at bedtime. 02 2L per nasal cannula while asleep. Walker, electric wheelchair, moist and soft or pureed foods and 115 caregiver hours/month keep me sane.

 

All of the above subject to change based on progression, stress level, and dyskinesia. Whew! I'm glad I finally wrote that all out.


#4 Dr. Okun

Dr. Okun

    Advanced Member

  • Ask the Doctor Moderators
  • PipPipPip
  • 5,467 posts
  • LocationUniversity of Florida

Posted 11 October 2013 - 06:07 AM

Insurance does not mandate whether a patient splits their pill to my knowledge.  Even if not scored, a patient can split their pill.  I rarely ask a patient to split a CR, but it is possible.


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




0 user(s) are reading this topic

0 members, 0 guests, 0 anonymous users

Homepage | National Parkinson Foundation