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MComes RPH

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MComes RPH last won the day on August 22 2016

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About MComes RPH

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    Board Certified Pharmacist, Medical Board Member, & Consult
  • Birthday 05/24/1968

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  1. Namenda

    Seeker, There is not much difference between the 28mg and 21mg. Also, just because he has not seen it used at that dose does not mean it does not happen. The maximum dose of Namenda XR is 28mg per day. I'm not sure where he receives his information. The half-life (the amount of time it takes for 50% of the medication to be eliminated from the body) is 60 to 80 hours. When it is 2.5 to 3.3 days. when it is taken every 24 hours there is always a constant level in the system. There is nothing wrong with this half-life, in fact it is somewhat normal for an extended release medication. Since she has been on it a while she would have to tapper off of it, but she could go from 28mg to 21mg immediately with no problem. Due to the length of time it is in the system, the effects and side effects can linger. Most common side effects are drowsiness, headache, constipation, dry mouth, and possible confusion. As a hypothetical, if someone were to go cold turkey from 28mg XR once a day, it would take about a week to completely rid the system. I hope this helps and please keep me posted.
  2. Sinemet absorption with applesauce

    dmCwolfe, Great idea. Since swallowing/choking is one of the primary issues with PD, this is a great alternative. I hope this helps and please keep me posted.
  3. deciding about drugs

    dmCwolfe, You have the right attitude and commitment. We are always here to help you along the way. I hope we can help you when you need it and please keep me posted.
  4. deciding about drugs

    Capcodmomma, you are correct. the more we keep moving the better everyone's health will be. With or without PD. Also, sleep is so important to PD patients. It is the time when we use our muscles very little, which allows us to "store" Dopamine from our existing Dopamine cells. I hope this helps and please keep me posted.
  5. Side Effect Or Wearing Off?

    Absolutely. A good medication regime, any type of movement, keeping on a schedule, and sleep, sleep, sleep. So important for PD patients. I hope this helps and please keep me posted.
  6. Hallucinations

    Yes, an increase in the Seroquel can help with the sleep. Helping the sleep can do wonders over all. Sleeping, napping, resting is so important for PD patients. It is when our bodies are at rest that we use very few muscles. Since we use very few muscles, this is the time when our remaining Dopamine cells can conserve Dopamine for later use. I hope this helps and please keep me posted.
  7. JrFordy, As you know there is not a one size fits all medication regime. It sounds like you are on the right path, unfortunately we don't know how long the path is. The only thing that I can see that may help you is a product called Apokyne. It is a quick release injection, the mechanism is very much like a clicky pen, and it help reverse off periods within a matter of a few minutes. This can really increase the quality of life in many patients. Lastly there is DBS. I have seen it work wonders in late stage patients. That may be an option you may want to discuss with your Dr. Godspeed my friend, you are not alone. We are here for you. I hope this helps and please keep me posted.
  8. nite meds?

    Inge, In very rare cases will Parkinson patients have to get up at night to take medication. When we sleep our body has very little movement. This means that little Dopamine is used at night to move your muscles. This results in a conservation of Dopamine. While sleeping, napping, or at rest is the only time our remaining dopamine cells can rejuvenate themselves. The short answer is, rarely. Great question, thanks. I hope this helps and please keep me posted.
  9. medication question

    Inge, If you were to take 2 of the Rytary, mathematically you would be at 47.5/190mg. Now this is very close to the Rytary 48.75/195mg capsules, but there is an issue. When yo take 1 capsule it will be broken down and absorbed at one rate. If you were to take 2 capsules, they will break down and absorb at different rates and not give you a consistant level of medication in your system, which is very important with this medication. I hope this helps and please keep me posted.
  10. Withdrawal severity scale

    Boeing, Thanks for the questions and hopefully I can clarify this for you. The DAWS is primarily used for Dopamine Agonist medications. So, Right away we are left with one, which is Cabergoline. Now this was just approved for use in Parkinson's in the UK, but has been used worldwide for many years to control prolactin relief. From my experience, it has not beed used in the treatment of Parkinson's disease due to it's high affinity for he d2 receptor, which has little affect on the relief of Parkinson's patients. Most, if not all, of the Dopamine Agonist medications used for Parkinson's have a high affinity for the d3 receptor, which is the primary receptor for Parkinson's disease. It is for this reason that the Dopamine agonist medications are used in the DAWS system, not Cabergoline. Since the withdraw issue is primarily used for Dopamine agonists that have the high affinity for d3. In saying that, the theory of "start low and go slow" is primarily talking about Dopamine Agonists, but I also use it for any Parkinson medication. Start at the lowest possible dose and increase the strength or frequency slowly to avoid any possible adverse affects. Amantadine is classified as an antiviral medication and would not fall into the DAWS. It is usually prescribed at 100mg one to two times daily with a max dose of 200mg daily. A new long acting amantadine has come to market called Gocovri. It is a once a day, controlled release formula of amantadine. Lastly Selegiline, which also does not fall into the DAWS category. Selegiline is a very old medication, that was used for Parkinson's, but has basically been replaced by a product called Rasagiline (brand name Azilect.) Selegiline dosing schedule was very difficult, the interaction with food products was/is real and can be dangerous, and one of the by products is an amphetamine like product. The dosing was difficult due to the amphetamine like metabolite. It could not be dosed any later than 6:00pm due to the metabolite causing patients to stay awake. The foods to avoid were those that contained Tyramine, such as aged or cured meats, aged cheese, different wines, draft beer, sauerkraut, soy beans, soy sauce, tofu, and a few others. The reaction can a severe spike in blood pressure and result in an emergency room trip.The new product, Azilect (Rasagiline), is what we call a very distant cousin to selegiline. Newer products are developed from older medication to either decrease the amount of medication needed to relieve the symptoms, to decrease the strength of the medication, or to eliminate some of the major side effects. The warnings on Rasagaline hint that there may be a food interaction, but there has not been one documented. In my more than 25 years of experience, thousands of patients I have spoken with, and hundreds of doctors I have consulted with, none of them have had the tyramine reaction with Rasagiline. I hope this helps and please keep me posted.
  11. sinemet reactions

    Chuck, First, I am sorry for the delay. I had to have emergency surgery about a week ago. One of the leads to my stimulator, that controls dystonia, pulled away from the muscle in the thoracic region in my back. I was unable to use my right arm, until this morning, when I got the okay from my Dr. I still have to use a sling, but at least I can type. When a person has an increase in Sinemet or is just given Sinemet for the first time, the may experience dyskinesia. Dyskinesia is sudden involuntary movements or jerking of the muscles. It can happen in the arms, head, neck, shoulders, and even the hand. We do not see symptoms of PD until 80% of our dopamine cells are dead. So, let's say someone has 20% left. The amount of Sinemet to take care of their symptoms may be much less than for that of a person who has 13% left. This can be confused with an increase in Parkinson symptoms, such as tremor or diffculity when using fine motor skills (eating, drinking, buttoning shirts, etc...) Another possibility could be that the Sinemet, over time, could be affecting other parts of the brain. Keep in mind this is not seen too often. it is believed that Sinemet can effect other parts of the brain over time, thus causing increase tremor, rigidity, and muscle movement. I am not a true believer in this theory because first and foremost Dopamine is the major controller of muscle movement. There would be no other part of the brain or chemical that would affect the muscles to the extent to cause tremors. It was a theory that I wanted to throw out there. I like to give patients the whole scope when I can. I believe there is a simple and reasonable resolution to this issue. I use the saying, "Start low and go slow," when it comes to dosing Parkinson's medication. This means that it should be started at a low dose and increased over time. If you are taking 25/100 three times a day and having this reaction, one of two things can be done. Either decrease the strength or decrease how many times a day it is taken. Since it appears you are very sensitive to Sinemet, I would try the the second option. Make sure you keep a journal and try the following. Take one Sinemet in the morning and wait until you feel an "off" period coming. At that point, write down the time the "off" time started and also note the time you took the Sinemet. Now id the Sinemet gave you very little relief, then it would be reasonable to the the strength. The process above would be started again. I should also state that you need to check with your Dr. before making any changes to your medication regime. I always recommend that all people with Parkinson's keep a journal. If you have Microsoft Excel, you can go the the main page of my Forum "Ask the Pharmacist" and you will see an entry titled "Medication Schedule." I tried to make the most comprehensive Medication Scheduling tool aimed at Parkinson's patients. It is literally all encompassing as far as medication, strength, dosage, off times, possible side effects, etc... I believe the best part about this is that it can be saved on the computer and keep your work there or you can print it off and fill it in by hand. This way you can either email it or print it off and fax it to your Dr. a few days before your appointment. This can save so much time because I know we spend most of our time at a Dr. appointment telling them everything that has happened since the last appointment. This way the Dr. has it ahead of time and can go over it BEFORE you are in the office. I hope this helps and please keep me posted.
  12. Side Effect of Lorazepam?

    Thanks for the great advice. Let's all keep that with our "Maintain our bodies" promise.
  13. Sinemet and Baclofenn

    You are welcome. May all of you have safe and blessed travels. ~Your Pharmacist
  14. Sinemet and Baclofenn

    In this case I would ask you to consult with his Dr. about a possible sedative for the flight. If the medication is only lasting 4 to 5 hours, then don't wait 6 hours to dose it. Stay ahead of it, possibly try to keep a journal of exact off times. Maybe dose Sinemet at 3 & 1/2 to 4 hours and the Baclofen about an hour after that. I hope this helps and please keep me posted.
  15. Sinemet and Baclofenn

    I would recommend giving the Sinemet first thing in the morning and then wait about an hour and give the Baclofen. I would follow this schedule throughout the day. an example would be: Sinemet at 9:00am, 3:00pm, and 9:00pm Baclofen at 10:00am, 4:00pm. and at 10:00pm. This can be adjusted for his sleep times. I believe the most important part to remember is to give the Sinemet first thing in the morning on an empty stomach with some Orange Juice. Wait 1 hour before eating. Then one hour later take the Baclofen, with or without food. Then follow the same schedule in about 6 hours and then again in about 12 hours from first dose. I hope this helps and please keep me posted.
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