• Announcements

    • ForumAdmin

      Frequently Asked Questions - Step by step guides

      Do you need assistance registering, logging in, posting, etc? Please visit the all new Frequently Asked Question Forum for step-by-step guides. Click the link below to access these helpful guides. Frequently Asked Questions
    • ForumAdmin

      Recursos Nuevos en Español    
    • ForumAdmin

      Línea de Ayuda 1-800-473-4636

      Línea de Ayuda 1-800-473-4636   ¿Qué es la línea de ayuda 1-800-4PD-INFO (473-4636) de la Fundación Nacional de Parkinson? Es un número de teléfono gratuito que ayuda a las personas con la enfermedad de Parkinson, sus familiares, amigos y profesionales de salud, a solucionar diferentes inquietudes.   La línea de ayuda ofrece: Información actualizada Apoyo emocional Referidos a profesionales de salud Recursos comunitarios Amplia variedad de publicaciones gratis    

MComes RPH

Ask the Pharmacist Moderators
  • Content count

  • Joined

  • Last visited

  • Days Won


MComes RPH last won the day on August 22 2016

MComes RPH had the most liked content!

Community Reputation

174 Excellent


About MComes RPH

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

Profile Information

  • Gender
  1. Marc, No problem. I'm glad I could put some things in perspective. I'm glad I could help but please keep me posted.
  2. I guess it needs to be treated just like any other medication. "Start low and go slow." It sounds like a trial and error issue, but it sounds like you are on your way. I'm glad i could help and please keep me posted.
  3. Marc, You are more than welcome. Anytime.
  4. C, As of yet it is not available in the United States, but when it does become available I will certainly let you know. I hope this helps and please keep me posted.
  5. Waywrd, As always, thanks for the update because you know I am your Pharmacist. By chance did the check your QT Wave in your heart? I have been trying to piece together some information about a possible link between prolonged QT wave and Parkinson's Patients, which can cause them to faint. as always, I hope this helps and please keep me posted.
  6. Loveya, This is a very low dose of medication and is a very normal starting position. I know that when we first start taking medication for Parkinson's Disease it can be scary. The main point I tell Physician's and Patients alike is that most Parkinson's medications should be used by a method I call, "Start low and go slow." this means that you start at one of the lowest doses of a medication, which you Dr. has, and increase it in small increments o v er time. The main thing that I would recommend at this time is that you start a journal. If you look on the main page of mt Forum "Ask the Pharmacist" you will see a topic entitled Medication Schedule. This is a great tool to help you and your Dr. help control the dosing of the medication. On this form which you can download if you have Microsoft Excel, should be filled out daily. On the form you can input the date, medication name, the medication strength, number of tablets you take at there specific times, and any symptoms (such as "off" times) you may experience throughout the day. This can then be saved and the emailed or faxed to your Dr before your appointment so the two of you do not have to waste precious time talking about what happened since your last appointment. It will be there right in front of you. Here is a little about this medication: Mirapex (Pramipexole) It is classified as a Dopamamine Agonist that works by helping restore the balance of Dopamine in a certain part of the brain called the Substantia Nigra. It can help relieve such symptoms as tremors, muscle control, stiffness, and muscle spasms. It has also been shown to be effective in Restless Leg Syndrome. This medication is usually prescribed to be taken three times a day and can be taken with or without food. It is recommended that it be taken with at least 4 oz. of water and should be separated from over-the-counter products like vitamines, supplements, herbs, laxatives, and anti-diarrheals. If you do need to take any of those products it is recommended that you take Pramipexole at least one hour before these products or two hours after taking the Pramipexole. Some common side effects may be drowsiness, dry mouth, dizziness, and lightheadedness. If you experience passing out, hallucinations, suddenly falling asleep, or muscle pain, please contact your physician because these are very rare (less than 1%) but serious side effects Some people may experience relief of symptoms quicker than others. A normal range of when you may feel symptom relief may take up to 4 to 6 weeks. Please do not discouraged by this because, as I said, It is better to start low and go slow than to start at a high dose or increase the dose by a great deal to quickly which will definitely result in side effects. If you have any other questions please do not hesitate to ask. I hope this helps and please keep me posted.
  7. Marc, I do understand your frustration. Many of the good Neurologists and Movement Disorder Specialists usually ask very pointed questions to determine if you should start on medication. Since they are not in your body and do not see you 24 hours a day, They may ask you for your input. The main criteria that would separate whether or not a Dr would start a new young onset patient on medication is, "how much are your symptoms affecting your quality of life?" If the patient states that the symptoms are having very little affect on their quality of life, then medications probably will not be prescribed. If the symptoms are affecting the patients quality of life, the Dr will ask a series of questions to figure out what medication to start with based on the symptoms. Like I said, that is what good Physicians do. If you are not satisfied with their answers, then you may want to look into a second opinion. I am now 49 years old and was diagnosed at the age of 30. I have probably tried every possible medication regime available. It was a second opinion that I sought out who confirmed the diagnosis. The first Dr actually said to me, "You are too young to have Parkinson's Disease and I believe you have essential tremors." I guess that me being a pharmacist and knowing the difference between the 2 ailments lead me to seek a second opinion. Even after that second opinion and started doing public speaking, I still asked Neurologists and Movement Disorder Specialists what they thought of my situation. All, yes all, agreed that it was Parkinson's disease. Once the diagnosis is confirmed, the patient is truly in the driver's seat as far as there medication therapy is concerned. By this I mean that you have to be completely transparent with the physician. This can start with keeping a good journal. Even if you are not on any medication and have been diagnosed with PD, you should always keep a journal. This journal should be done daily and consist of any symptoms you may have, what time of day they happen, what time you eat, what you eat, any situations that may surround when the symptoms occur, is there anything that may decrease or increase the severity of the symptoms, and are the symptoms progressing. These are just to name a few. When this is done on a daily basis you may see a trend as to when symptoms seem to be occurring. This is also a great tool for your physician to decide if to start medication, what medication to start with, and at what dose the medication should be started at. This is where I say you are in the drivers seat. At this point keeping a journal is imperative. In this journal journal you will have the medication name, the strength, the time you take it, any "off" times you may experience in relation to the medication, and symptom relief. If it does come down to you having to start medication therapy, if you look on the main page of my Forum "Ask the Pharmacist" there is a medication schedule that you can download and fill it out on a daily basis. This is great information for the Dr. when you have your appointment. I do understand the frustration you feel and anyone who has Parkinson's who says they don't would be lying to you. It is a very frustrating disease, but with the right Physician and the right tools it could possibly make it easier for you to handle. I hope this helps and please keep me posted.
  8. Waruna, After a little research, here is what I have found as far as the cash price (no Insurance) for Generic Azilect 1mg #30 in order of least to most expensive. Costco: $288.00. You do not have to be a member to fill your prescriptions there, but is you are a member the price would be $278.00 Sam's Club: $296.00. You do not have to be a member to fill your prescription there, but if you are a member a discount ranging from 8%-40% would be applied Walmart: $316.00. Rite Aid: $595.00 CVS: $649.00. Walgreen's: $750.00. As you can see the prices vary a great deal. Now these prices are from my area, which is in Michigan. The prices may vary depending where you live, but more than likely you will find the pharmacies in your area will probably look very similar to the ones posted above. I hope this helps and please keep me posted.
  9. Discovery, The only 2 interactions that could possibly occur are extra drowsiness and possible respiratory depression (difficulty breathing). If the Azilect or the CBD Oil causes drowsiness, the combines effect could be excess drowsiness. The second interaction, respiratory depression, has the same additive effect. If one or both of the products causes you difficulty breathing, using them together could cause the additive effective. I call the the "1+1=3" scenario. If both of the products causes either drowsiness or breathing trouble, then taking them together will cause the issue to be more severe. This can occur at low doses and does increase in severity if the doses are increased. I hope this helps and please keep me posted.
  10. Marc, There is only one interaction and it is minor. The interaction is between Ropinirole and Rasagaline. If neither of them cause you drowsiness, then there should be nothing to worry about. If one or both causes drowsiness, then the drowsiness could have an additive effect on your body. I call it the 1+1=3 sscenerio. Besides that, there are no other interactions. I hope this helps and please keep me posted.
  11. Otto, There is really no sure fire way to choose an antidepressant specific for are Parkinson's patients. Most Dr's work off past experience as to what may work best for a particular patient. The problem that may exist sometimes is that the depression can be organic (already within the person's mind) or brought on by PD. I usually see Dr's trying the newer antidepressants first due to the less incidence of side effects and that smaller doses are showing to be more effective than larger doses of older medications. As far as choices of antidepressants used in people with Parkinson's that have depression and anxiety are usually: (1) SSRI's (Selective Serotonin Reuptake Inhibitors): Celexa (Citalopream) Lexapro (Escitalopram) Paxil (Paroxitine) Prozac (Fluoxitine) Zoloft (Sertraline) (2) SNRI's (Serotonin Norepinephrine Reuptake Inhibitors): Cymbalta (Dulaxitine) Effexor & Effexor ER (Vanlafaxine & Vanlafaxine ER) Pristiq (Desvenlafaxine) (3) Atypical (Because their Mechanism of action does not fir into any other group) Desyrel (Trazadone) Remeron (Mirtazapine) Wellbutrin & Wellbutrin SR (Buproprion & Buproprion SR) This is usually the order in which they are tried in most patients and also based on the Dr's previous experience with the medications. All of these antidepressants work on both depression and anxiety. Their are certain circumstances where the anxiety is too much to be controlled by a certain antidepressant. At this point it will be at the Dr's discretion as to choose to add a Benzodiazipine, such as Ativan (Lorazepam), Klonipin (Clonazepam), Librium (Chlordiazepoxide), Valium (Diazepam), or Xanax (Alprazolam). Depending on the situation the Dr may add an antianxiety medication with the antidepressant or decide to withdraw the antidepressant and solely use the antianxiety medication. I many patients I will use a scenario of relieving headache pain. To make it simple, I will say that there are basically 3 options: Tylenol (Acetaminophen), Motrin or Advil (Ibuprofen), and Bayer (Aspirin). People who have Liver issues will want to stay away from Tylenol (Acetaminophen) due to the fact it is broken down by the liver. If a person has stomach issues such as ulcers or sensitive stomachs, they will want to sty away from Motrin or Advil (Ibuprofen) because it is very tough on the stomach. Lastly, if a person has an issue with blood thinners or sensitive stomachs, they will want to stay away from Aspirin. As yo can see many issues are involved in choosing just a pain medication, the choice of an antidepressant that helps with anxiety could choose to be an even tougher decision. I hope this help and please keep me posted.
  12. cbern, I copied your questions and will answer them in order for you. Is this something that you would do? Do you think that I am under dosing/overdosing? Am I being too impatient and need to stay on one of these doses for a specific period and what could that be? ANSWER: This does look like a reasonable dosing schedule. As far as over/under dosing, that can only be determined by you. As you know that everybody has a different tolerance to medication, if you feel Dystonia or Dyskensia coming on, it may be too much. If you feel little to no symptom relief, then there may be too little. As far as being impatient, when it comes to PD medications we all are. Almost all PD medications should go by the code of "start low and go slow." This is definitely hard to deal with, but in the long run it will help find the optimal dose for the maximum relief of symptoms for us to increase our quality of life. I am now trying to start low and go slow, supplementing IR as needed. I am very leery about overdosing and dyskenesing since I also watch my 2 sons after school and actually coach them in their sports. ANSWER; Once againg, if you start low, let's say one-half tablet, then you should be fine. I may also recommend that you try to stay ahead of the off time by trying to take the IR before the off times occur. I take my IR about one hour prior to my next long acting dose. This really seems to help. Once again, I used my medication schedule to help with this. You can do this by making a journal of medication, strength, time, and off periods. Or, if you look on my main forum page of "Ask the Pharmacist" you will see a medication schedule that you can download and use. This can only be done if you have Microsoft Excel. How long does it take for the body to readjust when you alter your medicine "cocktail"? Am I going to have dyskenesias until I am more stable over a period of maintaining the dose? ANSWER: The adjustment period can take anywhere from 4-6 weeks to get a stable regime. As always, some people it may take longer and some it may be shorter. It truly depends on how much of the regime was altered and how long you are tapering up. Once you believe you have reached the best dose available, I usually recommend at that point the next 3 months should only be used to "fine tune" the dosing. After eating, should I not jump the gun and supplement with Sinemet and wait it out to see if the Rytary kicks back in? Could supplementing and jumping the gun kick the dyskenesias? ANSWER: For optimal results with Sinemet, it should be taken on an empty stomach. wich means take the Sinemet 30 to 60 minutes prior to eating or wait and take the Sinemet 2 hours after eating, Any food taken with Sinemet or within those time frames can alter the absorbtion time of the Sinemet which will then delay the onset of action of the medication. I hope this helps and please keep me posted.
  13. John, The depression you are feeling is normal. Feeling down because you can no longer do the things you used to be able to do is a normal reaction. you may want to discuss with your Dr the possibility of adding an antidepressant to your drug regime. Parkinson's can also bring on depression, so you add that to the feelings you have about not being able to do certain things you were once able to do can really have an additive effect. One thing I have realized is that I needed to remember that there are certain things that I can not control, and one of those is the quickness of progression of the disease. Some people have the same symptoms for years and never progress. Others have long periods of time with no change then all of a sudden have a rapid decline for 6 months or so, then level off. Every person is different which means every disease progression is different. I have found it health to talk to a therapist about this issue. The decreased sex drive could be the effects of depression and your ability not not be able to perform tasks that you once were able to. That depression, anxiety, and (for lack of a better term) self loathing could all be additive effects that could cause a decrease in libido. I think that you see once you have found a good medication regime this could change this issue quickly. I hate to say this, but you are early in the game. It has taken some people years to even come close to a regime that works. You are doing the right things by staying active, which is the one thing every Dr will recommend that will help you stave off some of the progression of Parkinson's. As for the subject of who to tell and when to tell them is an age old question. I felt like the quicker I told someone the understanding they were of your situation. This, in turn, allowed me to be more social. I have found that if I see someone looking at me weird or if they say something to me that this was my opportunity to educate them. When I travel to do public speaking is when I received the most most looks and questions. This was a great opportunity to educate those people. I will tell you that I am 49 years old and was diagnosed when I was 30 years old. My worst experience happened when I brought my 8 year old daughter to Starbuck's . I was having an off day and was shaking, dyskenetic, and slurring my speech a bit. After we put in our order, my daughter went to get our favorite seats so we could work on her spelling test she had that day. As she left the line a man behind me said, "You are disgusting, just look at yourself." I replied with, "Excuse me." He continued with, "You should be ashamed of yourself. You are obviously coming down off of something like booze or drugs and you are out there driving and bringing your daughter in here. You put people's lives in danger by driving and are a complete disgrace to what a parent is. You should be ashamed of yourself!" We have gone to this Starbuck's every school day morning and everybody there knew me and knew I had Parkinson's. The knew me so well that they always gave me a straw with my coffee so I would not spill it when i tried to drink it. The other's in line did not know how to react because they were not sure if the man was correct, but everyone working there knew my circumstance. I proceeded to give this man a 10 minute dissertation on every aspect of Parkinson's Disease. No one in line moved or said a word, they just stood there with their mouths wide open. I finished with, "The next time you accuse someone of something you better have all the facts and have your ducks in a row, because the next person might not be as nice as me." I handed him a card that explained what Parkinson's Disease was and walked away. He did not say a word. When it became his time to order he just gave them his order and stood there. The girl at the register, Jessica, told him that they would not fill his order and that he was not allowed to visit that location again. At that point the people in line cheered and the man walked out with his head hung low. I believe that when you open up to people about your disease you will find very understanding and have a lot of questions for you. Take that time to educate. I believe that thhis will also give you the confidence to want to go out more. This is most important with your family. If you withdraw from them, they may believe they did something to upset you. You don't want that, so the best way is to be honest with them about it. I have also used my Parkinson's as a punchline to many jokes, which helps people feel more at ease about discussing it with you. Parkinson's is a very aggravating disease.for 2 main reasons. (1) We do not know the path of progression. (2) Most of the medication used for Parkinson's is a "start low and go slow" regime. We need to make sure we start at a low dose to make sure we do not experience any side effects. The "go slow" means that we have to slowly increase the dose over time to get a dose that is close enough, without going over, to take care of our symptoms but not too much as to cause side effects. I hope this helps and please keep me posted. Now on to your questions. Questions I currently run about 20-25 miles per week and I am outdoors regularly working on rental properties I own ANSWER: John, this is awesome. It has been proven that the more active you are the better the chances of the disease progressing will be less. Any non-prescription medications I can take to help combat the depression? ANSWER: There are many natural products or over-the-counter products that claim to help with depression. Since these products are not mandated by the FDA, I believe the best way to proceed is to talk with your Dr about initiating an antidepressant into your medication regime. You will find that many of the antidepressants will also help with anxiety as well. So this could help with 2 of the issues you mentioned above. Any diet that could help? ANSWER: There is really no specific Parkinson's diet. As usual lot's of fruits and vegetables. As far as meat goes, many people are under the belief that if you take Sinemet that you cannot eat protein. The answer is you can eat protein but make sure that you take your Sinemet at one hour prior to eating protein or take your Sinemet at least 2 hours after consuming protein.
  14. Noah, No one is better than the other, it is patient and Dr specific. What you are using it for you should get the same effect. I hope this helps and keep me posted.
  15. John, I have copied your questions and will answer them accordingly. Questions I would like to try to increase my Carbidopa/Levodopa pills to 6 pills per day to address the problems in my left arm. I am looking for any suggestions that might help me deal with the severe nausea. ANSWER: There is a medication known as Lydosyn which just contains Carbidopa. Carbidopa is basically added with Levodopa to combat the side effect of nausea that Levodopa can cause. How quickly should I increase my dosage from 3 pills per day to 6 pills per day? ANSWER: As a rule of thumb I usually recommend a patient increase the dose about every three days by at least 1/2 tablet per dose. This, as well with most Parkinson Medications, should follow the "Start low and go slow" mantra. This way you will avoid possible side effects of the medication. If the medication dose or strength of the medication is raised to quickly, the result could be serious side effects. Should I take my medication at the same time each day? What time? ANSWER: I usually recommend that you follow the Dr's orders when you first start taking the medication. For example if the Dr writes for three time daily, then it is usually recommended that the person take it at 9:00am, 3:00pm, and 9:00pm. When it comes to Parkinson's patients this schedule may change due to when your symptoms arise. I usually recommend keeping a journal containing the Medication, Strength, Time, Off times, and Side Effects that may happen. If you go to the main page of my forum "Ask the Pharmacist" you will find a medication schedule/journal that you can download (only if you have Microsoft Excel). There you can put in the pertinent information and you will end up seeing trends as to when you should take your medication. The other nice part about this is that you can either email or fax it to your DR a few days prior to your appointment so you do not have to waste time explaining to the Dr what has happened since your lasy appointment. It will already be there for them to read. Is nausea from an increased dosage typical? How long does it typically take for body to adjust to increased dosage (i.e. to not feel nauseated)? ANSWER: Nausea is very typical of an increased dosage. It all depends on the person but, some people may have it go away in a week or so while others may have some nausea throughout their whole medication regime. Any OTC suggestions for helping the nausea? Should the pills be taken before meals, with meals, or after meals? Any suggested foods? Foods to avoid? ANSWER: This type of medication should be taken on an empty stomach which means it needs to be taken at least 30 minutes to prior to a meal or 2 hours after a meal. The main food product you should avoid taking too close to this medication is Protein. If you follow the guidelines I gave you then you should be fine. If you take the medication too close to protein the the protein will bind up the liver enzymes needed to break down the medication which could result in a delay in onset of the medication. I hope this helps and please keep me posted.