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MComes RPH

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MComes RPH last won the day on August 1

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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. MComes RPH

    Sinemet & Supplements in the morning

    Greg, I am glad to hear that. Sometimes it is difficult to find all the interactions when it comes to natural products. Once you find something that works it is worth it's weight in gold. I'm glad this helped and please keep me posted.
  2. MComes RPH


    Ozziejean, The interaction the Doctor is concerned with between Azilect and Zoloft is called Serotonin Syndrome. The effects of Serotonin Syndrome can range from what is called Serotonin side effects which includes headaches, jitteriness, stomach upset, and difficulty sleeping, to Severe Serotonin Syndrome which includes a temperature up to 110°, unconsciousness, and death. The incidence of Severe Serotonin Syndrome is very small. Zoloft can be used with A silent as long as it is "start low and go slow." By this I mean that Zoloft should be started at a low dose (25mg) and increased slowly over a matter of days or weeks. This approach has been successful in many patients. In your particular situation with Parkinson's Disease, the effects of the interaction will probably be less than the symptoms of the disease itself. I hope this helps and please keep me posted.
  3. MComes RPH


    Abernard, There is a non-severe drug interaction between Namzaric and Seroquel. Namzaric is made up of two different ingredients, Donepezil and Memantine. Seroquel can reruce the effectiveness of Donepezil. This interaction may also cause lethergy, confusion, and drowsiness. Seroquel can also interact with the other ingredient in Namzaric, Memantine. The resulting interaction can range from dry skin, mouth and eyes, to memory loss, confusion, hyperactivity, hallucinations, and twitching or jerking. This is usually more prominent and severe in elderly patients. This best way to avoid this interaction is to separate taking the medications by at least 2 hours. It does not matter the order in which they are taken, but the separation of 2 hours will allow one medication to be absorbed and metabolised before the other medication is taken. I hope this helps and please keep me posted.
  4. MComes RPH

    Sinemet & Supplements in the morning

    Greg, I don't see an issue with the medication regime. Interactions between prescription medication and supplements are very difficult to predict. I did check them all and I do not see a problem. If therer is a delay in symptom relief, I would recommend taking the supplements about 2 hours after taking the Carbidopa/Levodopa. I hope this helps and please keep me posted.
  5. MComes RPH

    Rytary Shortage or bad pharmacy

    Dealtsea, I am not aware of any shortage of Rytary. By the sounds of the text message it appears that the pharmacy is ordering the medication through it's warehouse which usually takes about a week to arrive. I don't want to say it is a bad pharmacy, but I would make sure to talk to them and have them assure me that this issue will not happen again. Many pharmacies have an electronic ordering system which usually takes a month or two to catch up with the number of people on a certain medication. I usually recommend that after you have a conversation with the pharmacy that they are given one more chance to rectify the situation and gain my trust. If they fail to do this there are many other choices out available. I hope this helps and please keep me posted.
  6. MComes RPH

    Siminet and amilodopine

    AB, Yes, both of these medications can cause a decrease in blood pressure but when taken together they can have an additive effect (1+1=3). The patient may experience lightheadedness, dizziness, headache, fainting, and possible changes in heart rate or pulse. This usually happens when a patient first begins therapy, there is a dosage increase in one or both medications, or if one or both of the medications is reintroduced into a drug regime. If the medications are separated by at least 2 hours, the incidence and severity is decreased. If the blood pressure and/or the symptoms of the lowered blood pressure continue after the medications are separated by at least 2 hours, a change in medication may be warranted. This should be brought to the attention of the doctor. I hope this helps and please keep me posted.
  7. MComes RPH

    Mouth trouble

    JG, What you are experiencing is called "burning mouth syndrome." It is a side effect of Carbidopa/Levodopa (Sinemet) therapy and the reason is unknown. It can effect up to approximately 25% of the patients taking it and, at this point, there is no cure for this issue. Discontinuation of Carbidopa/Levodopa (Sinemet) results in the issue going away. Patients who experience "burning mouth syndrome" need to be changed to another PD medication, usually a dopamine agonist (Mirapex, Requip, etc...) The fuzzy feeling can be the cause of the Clonazepam alone or in conjunction with the Escitalopram. Clonazepam, and to a lesser extent Escitalopram, can cause dizziness, drowsiness, concentration, and some confusion. When taken together these side effetcts can have a multiplying effect (1+1=3). This effect can last for several hours after the medications are taken together. The half-life of Clonazapam is 19-60 hours with and average of 34 hours.The half-life of a medication is the time it takes for half of the medication to be eliminated from the body. Because of this, the side effects from one dose may last up to 3 days or greater from a single dose. You may want to discuss with your Doctor a possible change from Clonazepam to Alprazolam. Alprazolam is in the same medication class as Clonazapam and has a half-life of 6-27 hours with an average of 11 hours. In some patients this change in medication has continued to give them symptom relief yet decrease the side effects. If the side effects of this class of medication are being used for anxiety and continue to affect your quality of life, a change in medication class is advised. Prozac, Buspar, and Vistaril are alternative medications that can also be used for anxiety. I hope this helps and please keep me posted.
  8. MComes RPH

    nite meds?

    Karl, I am glad to hear it is helping. I think that the starting dosages of Trazadone and Melatonin are reasonable. I usually don't like to add or change 2 medications at the same time due to the fact that if there is a problem is it more difficult to narrow down which medication is at fault. If, for some reason, you do run into an issue with sleep again, you may want to adjust the Sinemet to possibly correct the issue. A small increase in Sinemet will have much less side effects than an increase in Trazadone, as you already know. I hope this helps and please keep me posted.
  9. MComes RPH

    liquid sinemet

    Noah, The SOB usually has to do with an ellergic reaction to the medication, which would come with more severe side effects like swelling of the tongue, lips, mouth and face, difficulty swallowing, congestion, and a localized rash. I hope this helps and please keep me posted.
  10. MComes RPH

    Rytary and Nausea

    Super, I'm sorry I forgot to include possible side effects. The side effects are not common, but when they do occur they may be dizziness, headache, dry mouth, change in taste, loss of hunger, and strange or odd dreams. The side effects may be dose related, which means with increased dose the greater the side effects. I hope this helps and please keep me posted.
  11. MComes RPH

    rytary and quetiapine

    Gene, Please keep me posted if you have any other concerns
  12. MComes RPH

    nite meds?

    Karl, Sorry for the delay and I understand your concern. You're issue is unique because it begs the question, "If you could sleep would you have the tremors?" It is known that when we sleep, this is the time when our brains, specifically our Dompamine Cells, produce natural Dopamine. The is due to the fact that when we sleep, or rest soundly, we move very little. Dopamine is the main compound that is used when we have any type of muscle movement. When there is little or no muscle movement, our brain will be able to conserve Dopamine so it can be used hen needed. In your case it appears that the Dopamine levels are falling off during the night requiring you to get up and take Carbidopa/Levodopa. I would suggest taking a Carbidopa/Levodopa before you go to bed. This may keep you from getting up at night to take take it. This may last for a part or the entirety of your sleep, depending on how much you need. If you need a longer supply of Carbidopa/Levodopa, it may be suggested that you try a low dose Controlled Release Carbidopa/Levodopa (Sinemet CR). This is something you may want to discuss with your Doctor. I hope this helps and please keep me posted
  13. MComes RPH

    Rytary and Nausea

    Super, Sorry for the delay in answering your post. yes, Carbidopa is still the best advice for combating nausea due to Carbidopa/Levodopa therapy. The Initial is usually 25mg. of Carbidopa with the first dose of Carbidopa/Levodopa each day. An additional dose of 12.5mg to 25mg may be given with each additional dose, with a max dose of 200mg per day of additional Carbidopa. I hope this helps and please keep me posted.
  14. MComes RPH

    Drug Interaction warnings

    Doc, With any medication, GABA is usually only an issue at higher doses. The higher doses may cause respiratory depression, mental confusion, and lethergy. When we try medications for the first time er may experience the side effects of the medication rather that the usual effects. This is very common and, in most cases is reversible with discontinued use of the medication. I hope this helps and please keep me posted.
  15. MComes RPH

    liquid sinemet

    Hartcreek, The absorption is usually not effected by the amount of liquid used unless the liquid is of such a great amount that the body cannot absorb it. In this case, the amount of medication is consistant throughout the mixture and the liquid mixture is quickly absorbed in the intestinal tract. Liquids are absorbed to the greatest extent due to the fact that they do not need to be broken down in order to be absorbed. Since the liquid does not have to be broken down, it will mostly go directly to the intestines with little effect by the stomach acids. This will allow it to be used as an effective way to help with almost immediate relief of the symptoms of the off period. The earlier one takes the mixture the better it is at resolving the issue, but some patients do not have that advanced notice. I hope this helps and please keep me posted.