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Timing and dosage of PD meds


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#1 miracleseeker

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Posted 13 November 2013 - 02:07 PM

Dr Okun,

 

Why do people need to take a PD medication at night when they will just be sleeping and not required to have any movements?  If the drug is eliminated for the night and let's say becomes 2 times a day instead of 3 will this affect a person's mobility in the daytime?   How about decreasing the drug at nightime? Again will that make it worse for the person in the daytime?



#2 Dr. Okun

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Posted 13 November 2013 - 03:35 PM

This need varies patient to patient.  Almost no one can get away with only 2 doses a day because of the short half lives of PD drugs.  Many patients will get re-emregence of symptoms and have poor sleep without PD drugs at bedtime.  Some will also wake up stiff.  PD is not one size fits all so I would suggest you work with your doc and discover the strategy that works best 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


#3 miracleseeker

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Posted 13 November 2013 - 04:05 PM

What you are saying is the over all dosage affects the whole day and not specifically for that period of time.  Like... less at night does not only affect the nighttime.

 



#4 Dr. Okun

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Posted 14 November 2013 - 12:31 PM

What I was trying to articulate is that the per dose is more important than the total dose during the day.  If your per dose is too high for example you may get dyskinesia or hallucinations for example.


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 14 November 2013 - 01:30 PM

Too little for one dose will only affect that period of time and not how you feel the whole day? 



#6 miracleseeker

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Posted 14 November 2013 - 07:23 PM

I decreased her Stalevo dosage from 150mg to 125mg for the nighttime dose only and then would give her just half a 25/100 sinemet around 3am.  Essentially it's like giving her 150mg total but spread out.  Within 20 minutes of that tiny bit of Sinemet she starts to grind her teeth.  I don't get it?  When she takes 150mg 3 times a day of Stalevo she's fine.  I was trying to follow your suggestion to take less but more often.

 

 



#7 Dr. Okun

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Posted 15 November 2013 - 07:21 AM

The key is more art than science.  You should work with your doctor to slightly increase or decrease doses and adjust to optimal intervals.  In many people Comtan (Entacapone) causes dyskinesia (in your case maybe teeth grinding); and in these cases many people will switch back to regular 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


#8 miracleseeker

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Posted 15 November 2013 - 03:22 PM

Apparently Sinemet is causing the teeth grinding and not Stalevo.  I didn't want to give her say 50mg Stalevo instead because of the extra dose of entacapone she would be taking. Last night I put her back on 150mg at night and she was fine.   So much for less is more.



#9 Dr. Okun

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Posted 17 November 2013 - 09:25 AM

Parkinson's disease is art of medicine as the brain is changing and so the medications often need tweaking.  Stalevo has sinemet and comtan as the two active ingredients.

 

Glad you solved the issue.


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


#10 miracleseeker

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Posted 17 November 2013 - 10:04 AM

My theory is that even though she was taking less Stalevo which was 125 instead of 150 there is no way to know how much is left in her system at 2 or 3 am when I gave her the half tablet of Sinemet so it was just too much.  I suspect the grinding would occur if I gave her 50mg Stalevo in place of the Sinemet.  Like you said Stalevo has Sinemet too so that would make no sense that the grinding only occurs with Sinemet and not Stalevo.

 

I have tried decreasing the Mirapex to decrease the sleep attacks but she still sleeps.  What can be done to make her stay alert?



#11 Dr. Okun

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Posted 17 November 2013 - 11:20 AM

Not sure, best to consult directly with your doc and see what can be tried.


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


#12 miracleseeker

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Posted 21 November 2013 - 12:42 AM

Her doctor did not have an answer.  Medication for narcolpsy was out of the question as was Ritalin. Do you not have patients with the same problem with drowsiness?

 



#13 Dr. Okun

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Posted 23 November 2013 - 08:03 AM

Lots of PD patients have drowsiness.  We examine meds and particularly agonists and higher dose levodopa; we look at non-PD meds; and we get sleep studies liberally.  This can be hard to pinpoint and treat and it usually is a complex and long-term plan that needs to be worked out over several appointments with your doctor.


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


#14 miracleseeker

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Posted 23 November 2013 - 06:07 PM

What do you think of red bull or no dose or 5 hour energy? 



#15 Dr. Okun

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Posted 24 November 2013 - 05:51 AM

I have not had many patients take these types of energy drinks with Parkinson's disease, but in the cases I am aware of, they have not been very effective.  I would welcome other comments.


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


#16 Luthersfaith

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Posted 24 November 2013 - 08:16 AM

I currently take 25/100 Sinemet, 1.5 pills 4 times a day, and Amantadine 3 times a day. (Just weaned myself off of the Neuropatch 4 mg)

 

I have used all of the energy drinks. Monster's made me sick.  The 8.4 ounce Red Bull was helpful in giving me a boost of energy for a few hours, but over time I would "crash" afterwards, so thee down side was not worth the up side.  5 Hour energy was the best.  But over time I seemed to become immune to it and it made me feel weird… like having the jitters.

 

I think the key is not to use them all the time.


"I have told you these things, so that in Me you may have [perfect] peace and confidence. In the world you have tribulation and trials and distress and frustration; but be of good cheer [take courage; be confident, certain, undaunted]! For I have overcome the world." - Jesus (John 16:33)

#17 Dr. Okun

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Posted 24 November 2013 - 01:59 PM

Thank you for the post.  Your comments remind me that I have also heard of Parkinson's disease patients "crashing" from the Monster drinks, red bull, and energy drinks.


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


#18 miracleseeker

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Posted 24 November 2013 - 04:31 PM

That would happen to anyone though right?  This is still a stimulant and once it wears off you will nose dive.

 



#19 Dr. Okun

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Posted 24 November 2013 - 04:53 PM

Not necessarily.  Not all stimulants when monitored by your doctor will cause a nose dive.  Drugs like provigil and ritalin can be used safely without "nose-diving" rebound.


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 miracleseeker

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Posted 24 November 2013 - 05:00 PM

I asked her doctor about Ritalin and he said no because it is not safe for the elderly in her condition.   B-12 shots?  Would that be helpful?   or even extra Vitamin C?

I'm trying....

 






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