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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. Restore-gold

    I have heard this product works well in early stage parkinson's (stages 1-3). It has shown little success in stages 4 & 5. For the first few weeks on it your symptoms usually worsen as your body becomes used to the product. After that, the symptoms usually get better. I have only seen a few studies on it and they do seem positive. It may be worth a try. I hope that helps and please keep me posted.
  2. COMT inhibitors and freezing

    Xaxa, It is good to hear from you and what a great question. My first thought was that It does not seem on the surface that these two medications would do this, so I focused in in the medication they have in common. In this case it is Entacapone. Some of the more common side effects are hyperactivity, twitching, and twisting. The I remembered that Entacapone can cause a decrease or absence of body movement. This, by itself, may appear as to be a freezing episode.v This is the only idea that came to mind. I hope this helps and keep me posted.
  3. Side Effect of Lorazepam?

    Musician, Thanks for adding to this topic, I did forget to add it. Besides benzodiazepines, like Xanax and Ativan, this effect can also happen with pain medications like codeine, oxycodone, oxycontin, hydrocodone, morphine, hydromorphone, oxymorphone. Certain muscle relaxers like Some ans Zanaflex can also fall into having the same issue. The scariest part is when I see someone on all 3 classes of medications together. Thanks again musician. I hope this helped and please keep me posted.
  4. Anesthesia and C/L

    Waywrd, Thank for the info. I just answered another question on a post about, "if your pharmacy is out of your meds," that you may want to read. Once again, thank you
  5. Mylan C/L On Back Order?

    Most every pharmacy has it's own warehouse to get medications from, this is their main source of medication. Then, almost all pharmacies, except independent pharmacies, have a secondary wholesaler, which is usually McKesson or Cardnial. Oddly enough, while I was writing this I received a phone call from my pharmacy telling me my generic Sinemet CR 50/200 by Mylan, with a 3 month supply (quantity of #270) was ready to pick up. I asked him to order another 6 bottles of 100 tablets (6 extra months for me) of the Mylan brand, and he was able to. I talked with a friend of mine at Walgreens last night and he told me it was on backorder. Both of them use McKesson as their secondary wholesaler. This usually means that it is on a "first come, first serve basis. Since this appears to be the case, ask your pharmacist to check every morning, and night if they are willing to, to see if the generic you need is in stock Make friends with your pharmacist, it can go a long way. To me, all of my customers were my friends. I hope this helps and please keep me posted.
  6. question on c/l manufacturers

    Johnny Good to hear from you again. There has not been much is the subcontracting anymore. What seems to be the big, and I mean big, issue is that so many companies that make c/l are buying up other companies that make c/l. Some companies that have never produced it in the past are buying up companies that make c/l. This is causing many issues of back ordering and out of stock issues of certain brand of generic. As you know, once you find a company that works you want to stay with that company. So that is the main headache now. I think the out sourcing to smaller companies seems to be a thing of the past. As always, I hope that helps and please keep me posted. Don't be a stranger.
  7. Mylan C/L On Back Order?

    This is a problem all over the country. When I spoke with pharmacist and the company's I get the same answer that it's on back order. I wlways recommend that patients get their refills as early as possible, which is usually when about 80-85% of the medication is gone. This will then allow you to be able to save up extra in case of an emergency. I hope this helps a little and please keep me posted.
  8. Side Effect of Lorazepam?

    Jill, Sleep is so important for everyone, but especially for people with PD. Sleep is the only time the dopamine cells we have are able to replenish themselves. This is because we don't move much, therefore our muscles don't use up as much dopamine. I'm glad I could help and please keep me posted.
  9. Namenda

    I'm so glad to hear that. Please keep me posted.
  10. Anesthesia and C/L

    Waywrd, It was like I was telling you that one follows the other and then when the levels get to a certain point, the reaction occurs. I thought I put the dye being an issue in the first one, along with carbidopa. I think I got so deep into the kinetics that I may have forgotten to mention it. So, I believe it is either the dye or carbidopa. I know it's hard to remember what we did yesterday let alone 3 to 4 months ago, but if you could remember the generic brand than we can actually look up the color color. It makes it tough because they don't use a purple dye, they use blue #4, red #7, blah ba blah. But if you know the manufacturer we should be able to work backwards to the color. I'll throw my 2 cents in, I have never had a patient allergic to the fillers. They are stuff like starch, lactose, calcium salts. You will also find them on the label as "inactive ingredients. " I hope this helps and please keep me posted.
  11. Mylan C/L On Back Order?

    LllWaywrd, I filled my 50/200 CR by Mylan Brand filled 2 weeks ago at Kmart for #270. I also filled my Mylan Brand 25/100 for #720 at Kmart. I did call 2 different Rite Aid stores. One had Activis CR, Mylan 25/100, and Mylan 10/100. I will try and find out some more tomorrow. I hope this helps and please keep me posted
  12. Gradual transition to Rytary/expired samples

    Marketfocus, There are many ways in which the Rytary can be added to a medication regime. I have seen Rytary in the morning and Sinemet in the afternoon and night time for 1 week. Rytary morning and afternoon the next week. Then Rytary 3 times a day with no Rytary. Then you have to go through fine tuning the Rytary. I am not saying it is a bad medication, because it isn't. It has been a savior to people in my family, my friends, and patients. But, it was not for me. My true belief is that if a person is going to try Rytary, then the should start it all in one day, by itself, and keep a journal (which I believe everybody with Parkinson's should do). This journal (which should contain medication, strength, time of day, time of when and what you eat, the time you wake up and the time you go to bed) can show trends when off and on times occur and this will help you adjust your medication. I have also noticed that the exchange chart just works on total Sinemet used and not the Sinemet CR, but you should just add the dosage. What I have heard from patients and Dr's alike is that the exchange rate seems to give a Rytary dose that appears a little high, thus giving the patients dyskensia, headache, vomiting, and if long term it can cause obsessive disorders. This could possibly be not taking into consideration of the CR, but many Dr's are looking at the conversation table and dosing it down one notch. Also, c/l is carbidopa/ levodopa. So if the chart states (Situation A) you should start at 3 capsules of Rytary (each cap if 48.75/195) three times a day, some Dr's are choosing (Situation 4 capsules of Rytary (each capsule is 36.25/145) three times a day. The total levodopa difference between situation A and Situation B is 15mg of levodopa DAILY. But we all know how much a a different 15mg can make. I hope this help and please keep me posted.
  13. Side Effect of Lorazepam?

    Jill, This untoward effect could fall under muscle and/ or joint pain. I would also consider it an untoward effect of Lorazepam. I am not a fan of Lorazepam because the half-life is between 6.3 and and to all metabolites (even lorazepam) would take 18 to 24 hours. To me, this is a very long time to stay in the system and possibly have many medication and system issues. Also, this class of medications are called benzodiazepines and all have different half-lives. I prefer Xanax over Lorazepam because it's half-life is 6.3 to 26.9 hours. At first glance it may appear in line with Lorazepam. What you have to consider that the 26.9 hours. The actual Xanax active ingredient is out betwee 8.9 and 11.3 hours. As far as the face pain could be due to a variety things. A friend of mine who is a dentist said that MOST people bring their teeth, but will tell you they don't. He said that i did, so i put him to the test. He wanted me to only chew sugar free gum, and only when I'm working, working around the house (my wife and i are renovating oir "Florida" room (which in Michigan is called a walk in freezer) exercising, riding my bike, driving, and driving. Let me remind you that 6 months ago he took impressions, he took impressions that day, and would take them in 6 months. That 6 months ended last Wednesday November 6th and I went in for the re-check. I was blown away at the results. My grinding was, for the most gone. Most of it happened at night (so i bought a moth guard for use at night times). He also told me that driving and shopping were the 2 worst causes of grinding because (1) we can't yell at people in the store, and (2) you grit your teeth when you are driving because you know you NEED that car and are very possessive, and grind our teeth instead of road raging. In closing, your Dr. May want to try some sort of antidepressant, which can help, but I would rather see a low strength Xanax (probable 0.25mg) and have your Dr. can adjust it if needed. I hope this helps and please keep me posted.
  14. Namenda

    I am glad to hear that and I am also glad I could help. I'm glad I could you and please keep me posted
  15. Anesthesia and C/L

    Waywrd, This is a real issue that happens and is confirmed in the Allergy and Immunology for Clinicians. they have a great description of it, so I will quote it. Basically it states that exposure to allergens induces Mast cell degeneration. In this process chemical mediators are released and v attract inflammatory cells that infiltrate the airway wall. This causes bronchospasm, Mucosal edema, hyperactivity of the airway, and mucus secretion. The neglected component is vascular permeability, which is the hallmark of mast cell degranulation. Like muscle spasms, mucosal permeabolity happens rather quickly with the best antidote being an antihistamine. I hope this makes sense. This happens in severe allergic reactions and is quick to onset. I truthfully have not heard it happening with Carbidopa/levodopa. Since levodopa is naturally produced in the body, this could lead us to determine that the reaction is taking place because of a reaction to carbidopa, which is not naturally occuring in the body. I hope this helps and please keep me posted.
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