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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. John, Unfortunately I have had the same experience with the DEA and trying to get the exacts on if the companies are manufacturing, rebranding, or just selling out of the aquired product so then they can produce there own. as far as the NDC # goes, here is an explanation of what it represents: An example of an NDC # is: 11111-2222-33. - The first 5 digits of the NDC # represent the manufacturer (ie. TEVA, Mylan, etc...) - The next 4 digits of the NDC # represents the product (ie. Azilect 1 mg., Sinemet 25/100, etc...) - The last 2 digits of the NDC represent the original package size the medication came from (ie. 02 can represent a bottle size of 100) Here are some Manufacturer Codes (the first 5 digits) that I retrieved from that may help you: 00228 Actavis 16729 Accord Healthcare 68084 Amerisource Health Services 60505 Apotex Corporation 57664 Caraco Pharmaceutical Company 60951 Endo Pharmaceuticals 58177 Ethex Corporation 00115 Global Pharmaceuticals 60429 Golden State Medical Supply (Repackager) 51862 Libertas Pharma 00904 Major Pharmaceuticals 63739 McKesson Service (Repackager) 00378 Mylan Pharmaceuticals 54868 Physicians Total Care Inc. (Repacackager) 62756 Sun Pharmaceuticals 47335 Sun Pharma Global FZE 00093 TEVA Pharmaceuticals 51079 UDL Laboratories 64679 Wockhardt Limited This number should be printed on the prescription label that is placed on the bottle. It can also be found on the Patient information sheet. I hope this helps and please keep me posted if you need anything else.
  2. This is a great question. Sinemet can cause a side effect of weight loss. Parkinson's Disease itself can also cause weight loss. As far as increasing or decreasing medication due to weight loss and dosing medication due to weight are a different story when it comes to PD medication. Parkinson medication is dosed based on symptoms and not weight. Many other medication, such as antibiotics, diabetic medications, cholesterol medications, etc.., are dosed based on weight and not symptoms. I guess one would have to weigh out the results of decreasing medication in order to gain weight back. If you decrease your PD medication in order to gain weight back, you have a situation of symptoms increasing with the possibility of gaining weight. I would rather have a few extra pounds and have control of my symptoms. Knowing that even if you decrease your Sinemet may help you gain some weight back, there is also the issue of the disease itself paying a role in weight loss also. My recommendation is to take the medications at strengths that are needed to control your symptoms and help you keep a quality of life. I would also recommend asking your Neurologist or Movemet Disorder Specialist what hospital they are affiliated with. I say this because every hospital has a Nutritional Expert on staff and will be able to provide you with a good diet regime for a person with Parkinson's. Many times a person with Parkinson's who takes Sinemet may lose extra weight is due to the interaction between Sinemet and protein. It is recommended that Sinemet be taken at least 1 hour prior to eating a meal (especially protein) or 2 hours after consumption of a meal. Protein is a major building block for muscle development. The hospital will probably have a physical therapy program who could recommend some time of exercise to keep your muscles toned and in their best functioning ability. I usually recommend walking with good arm movement at the very least to help keep a good quality of life. I hope this helps and please keep me posted.
  3. Noah, I have seen this in other patients, including myself, when I tried to switch to Rytary from Sinemet CR and Sinemet combination. What I have learned is that it is not necessarily the contents of the product themselves, but rather the combination and timing of the medications. Some people do well on the switch to Rytary while others do not. I usually recommend that if a person wants to try Rytary that they do it 100%. To solely take Rytary and not mix it with Sinmet CR. When two medications are taken together it is very hard to differentiate which medication is the culprit of the side effects or is it a combination of the two. With this in mind, I usually recommend that a person choose between Rytary or Simenet CR (+) Sinemet. In order to be able to help manage a medication regime that that may help you in your situation I will need your daily medication regime. I will need Medication, Strength, Extended Release or Immediate, and the Times that you take these medications throughout the day. This way I can get a better look at Dosage and Timing of each medication and make suggestions of any changes that may need to occur. Thank you and I look forward to helping you.
  4. If the Doctor recommended that you take Prilosec, then you are safe to think that he intended for you to take it consistantly and not the 14 days as stated on the Prilosec information. I would continue taking the Prilosec as it seems to work best for you, as you stated. As far as taking Prilosec and Sinemet together, as I stated this is not a good idea. The suggestion you made of taking the Sinemet about 2 hours before taking Prilosec is the same advice I would give. The 2 hour time frame allows the Sinemet to be broken down, absorbed, and metabolized in the liver before the Prilosec has a chance to interfere with this process. Any product that alters the stomach acid, accelerates the intestinal movement (ie. laxatives), or slow down the intestinal movement (ie. antidiarrheals, codeine based products) may interfere with the absorption of any medications in the body. I hope this helps and please keep me posted.
  5. As far as I am aware there is no pharmaceutical company producing Levodopa anymore. After a quick search the only products I could find were via Amazon in the form of Pure Levodopa Mucuna Pruriens available through a variety manufactures. Since this is not considered a prescription is does not have to go through the rigorous testing of prescription medications. Also, the amount of this product needed to obtain the end result of relief of symptoms is umknown and will vary from person to person. It is also unknown if any, or all, of this product is able to cross the Blood-Brain-Barrier and work on the Dopamine stores in the Substantia Nigra portion of the brain. I hope this helps and please keep me posted.
  6. I truly appreciate this information. As technology improves I believe we will find similar evidence that improved testing technology will show that current testing may not have the capability of showing such information. With the improvement of technology in imaging and screening I am sure we will be able to find out more information about PD, and many other diseases, in the future. I almost liken it to the technology of cell phones. I am sure that if anyone had told us 15 years ago that we would be able to carry around a devise in the palm of our hand that could process information faster, hold more memory, communicate with others immediately and in multiple languages, retaining information in a few seconds, , buy and sell products without a store, pay bills without using a check or money order, buy tickets to an event (concert, ball game, etc...) without standing in line or using the phone, find old classmates or friends without using a book, send photo's around the world, find a date or mate without leaving home, give a person the ability to solve a complicated math problem by taking a picture of it and running it through an app., have a whole library at our finger tips, find out all there is on any given subject in a matter of seconds, and being able to connect with a "Virtual Doctor" to help you with an ailment. Knowing that that is a short list of things a "cell" phone can do, we would have said, "You are crazy." I know that scientific imagining and screening are much more involved than that of a cell phone, I am very excited where this technology is taking us. I appears that the sky is the limit and the only limiting factor is the minds of those involved. Thank you for the information. I hope my input was helpful, and please keep me posted.
  7. I have read about this recently and am interested in this novel approach. I do understand the reasoning behind it and how it would be beneficial for the PD patient. Since the inception of this disease, which was discovered 200 years ago this year, we have not been able to find a cure even tough we believe we know exactly where the issue stemmed from and the process that effects it. There have been great strides in medication therapy over the years to help control the symptoms and the introduction of DBS has greatly improved the quality of life of so many people afflicted with this neurodegenerative disease. In a superficial way this concept is already being achieved through medication management. I know this is a simplistic form of what the article is referring to, so I am not sure if the procedure spoken about in this article could cover the the amount of "symptoms" Parkinson's Disease is attributed to. The are two questions I have after reading this article: (1) how many procedures have to be done to "correct" the multitude of symptoms or issues that result from having PD, and (2) how will they be able to differentiate between PD related issues and the organic issues (ie. depression) that would have become present even if the person did not have PD. When we talk about possible issues of PD, the list is long and contains the obvious and not so obvious: Tremor, muscle stiffness, dystonia, problems with coordination, gait issues, balance, fatigue, restless sleep, daytime drowsiness, possible dementia, forgetfulness, anxiety, mental confusion, depression, speech impairment, inability to communicate, loss of smell, urinary problems, weight loss, constipation, difficulty swallowing, drooling, facial masking, and issues with writing. This by no means is a complete list and was just a list I compliled off the top of my head. The other issue of concern is that some of the symptoms can exacerbate other symptoms of PD. An example of this would be how anxiety can exacerbate tremors, restlessness, and possible confusion. I believe that any research that focuses on PD is good research. I appreciate researchers who are thinking out of the box and looking at this disease from different angels. I have always stood by the phrase, "Find the cause, find the cure." I am hopeful that this may lead to possibly helping limit or eliminate the main symptoms a person may be experiencing as a result of having PD. In this same spirit I also hope that stem cell research can lead further into the possibility of eradicating PD at the most or limiting the disease progression at the least. I hope this helps and please keep me posted.
  8. This correct. In the scenario I was using for the individual, I was trying to make it as simple as possible. Thank you. I am sure this will help many people.
  9. The breakdown and absorption of oral forms of medication is normally this: Tablet- slowest (Break down complete range 30-45 minutes, full absorption range 45-60 minutes) Gel Tablet Gel Capsule Capsule- (Break down complete range 15-30 minutes/ full absorption range 30-45 minutes) Liquid- Fastest (No break down and ready for immediate absorption One thing to keep in mind that the above scenario is on a perfectly healthy body with no Stomach, GI, Liver, Bladder, or Kidney issues. Basically a perfect atmosphere. Once again this is a range and will be different for every individual. I hope this helps.
  10. Noah, If you red my response to Market above that should hopefully answer your question. A quick answer is that is that "yes" the are both MAO-B inhibitors, but Xadago has an extra Mechanism of Action. Azilect Can be used alone or in combination with other PD medications to releive a variety of symptoms. Xadago is not used as monotherapy, and must be used in conjunction with Carbidopa/Levodopa therapy. It is only, as of today, to be used to help decrease the "off" time in individual's with PD. I hope this helps.
  11. Market, Unfortunately the Mechanism of Action (MOA) of Topamax on migraines is not fully understood and was basically noticed when studied on seizure activity. It is known that Topamax stabilizes electrical nerve acticity by modulating two neurotransmitters. In seizure activity it is seen that the neurotransmitter GABA (which is a calming neurotransmitter) is decreased and Dopamine and Glutamate (which are excitatory neurotransmitters) where low. Topamx stabilizes this situation by mudulating the GABA, Dopamine, and Gluamate back to the "normal" levels. It is theorized that this Glutamate antagonistic (blocking) activity may the reason Topamax works on migraines. When it comes to the difference between Azilect and Xadago it is a very in depth and somewhat difficult to explain, but I will attempt to. I will show their individual effects and actions in quick bullet point form so you can see the difference instead of me trying to explain it. Azilect: Monotherapy: Can be used alone or with other PD medications. Selective MAO-B Inhibitor (Monoamine Oxidase B Inhibitor)- Monoamine Oxidase Enzyme breaks down Dopamine. *IRREVERSIBLE MAO-B Inhibitor. Mechanism of action primarily to increase Dopamine in the nervous system of the brain. Indicated uses: Reduce PD symptoms of stiffness, poor muscle control, tremors, and spasms. May have Neuroprotective properties. Xadago (Safinamide): Adjunct Therapy: At this point should ONLY be used in conjunction with Carbidopa/Levodopa therapy. Selective MAO-B Inhibitor (Monoamine Oxidase B Inhibitor)- Monoamine Oxiidase breaks down Dopamine. *REVERSIBLE MAO-B Inhibitor. Duel mechanism of action to increase Dopamine AND stimulate Glutamate release. Indicated uses: Reduction of "off" times in patients with PD. May have Neuroprotective properties. As you can see above the two major differences are (1) Reversability and (2) Glutamate release. I will do my best to describe the differences here. Irreversible .vs. Reversible: Irreversible: MAO Inhibitors such as Azilect (rsagaline) connect to the Monoamine Oxidase Enzyme with a bond that is not able to be broken. This means that the combined product (Azilect + Enzyme) is irreversvible and is not able to do anything. This non-functioning product (and enzyme) activity is blocked until another enzyme is produced. Reversible: MAO Inhibitors such as Xadago (safinamide) connect to the Monoamine Oxidase Enzyme with a bond that is able to be broken. This means that the combined product (Xadago + Enzyme) is reversible and able to be separated so that the enzyme can break the product into their individual pieces and the enzyme can breakdown the individual active piece (in this case Xadago) so it may continue it's activity. Glutamate Release: As stated above, Xadago has the added mechanism of Glutamate release. Some Dopamine receptors aid in Glutimate release while others decrease it. This all depends on where in the brain theses receptors. In the Substancia Nigra, where the Dopamine issue is in PD, Glutamate stimulis coming from other parts of the brain trigger a dopamine response. The Sunstancia Nigra is in the Basal Ganglia and the stimulus of this release is directly responsible for muscle tone and muscle movement. This Glutamate released in this area will then help with maintaining muscle tone and movement without the use of Dopamine. I guess to answer your question that "if you had a reaction to Azilect will you have one to Xadago," is it is mare than likely that you will have the same reaction. Since I have not seen all the available data on the case studies, that is my best educated guess. People say,"A picture is worth a thousand words." Some people prefer the picture. I, on the other hand, prefer the thousand words. I hope this helps and keep and keep me posted.
  12. Carruthers, This medication was just approved by the FDA and is not on the market in the United States. It have been available in several parts of Europe and the U.K. for the past several years. It is known by it's generic name "Safinamide." This medication can be beneficial for Parkinson's patients who have or whom have not had DBS surgery and are on a carbidopa/levodopa therapy, which is required at this point for the use of Xadago. If at this point your husband is currently taking a carbidopa/levodopa therapy and having issues with "off" time and lack of "on" times, this may be a possible additive to his medication regime when it becomes available. I hope this helps and keep me posted.
  13. Here is what else I know about Xadago (Safinamide). It is: 1- A Monoamine Oxidase type B Inhibitor (better known as an MAO-B Inhibitor). 2- The Mechanism of Action, Side Effects, Adverse Effects, and Drug Interactions resemble another MAOI-B specific Inhibitor, Azilect (Rasagiline) 3- At this point, only to be used in conjunction with Levodopa/Carbidopa therapy and has not shown to effective for single use therapy. 4- Being marketed for people with PD who are having issues with "off" periods. 5- To be taken only once a day at approximately the same time every day 6- Can be taken with or with out food. There is no food contraindication (ie. Tyramine reaction) as there is with Rasagiline or Selegiline. There is arning about consuming foods "high" in Tyramine which could result in Severe hypertension (blood pressure). 7- Comes in two strengths: 50mg and 100mg. A patient will start on the 50mg dose and is able to increase, if need, to 100mg after 2 weeks of being on the 50mg. 8- Side effects from Most common to Least common: ( uncontrolled muscle movements (ie.Dyskensia), nausea, tiredness, increase in blood pressure, unusual urges. 9- Drug Interactions: Antidepressants listed as SNRI's, Tricyclic, or Tetracyclic, muscle relaxer Cyclobenzaprine, Amphetamine, Methylphenidate, Metoclopramide, cough suppressant Dextromethorphan, and St. John's Wort. *Some of this information was retrieved from the Xadago website. I hope this helps and please keep me posted.
  14. I know that the price seems a bit outrageous compared to other countries. Much of it has to to with the regulations set fourth by the FDA in the United States. The FDA has rigorous standards that must be upheld and practiced before a medication can be released to the public. This accounts for a great deal of money to be put on research and developement. Many other countries do not have the same standards. There is also the patent issue. In the United States as soon as the molecule is discovered it needs to be patented and at this point the clock starts ticking. The drug company has 7 years to do their research and development, drug trials, and advertising to bring this to the public. This process could take years. Let's just say this process takes 4 years. That leaves 3 years for the company to to make up for the millions they have already spent plus time to make a profit. After the seven years has expired the patent should expire also which would allow generic companies the ability to produce the medication. This is where a grey area happens. Some times the Brand Name company may contact a specific generic company and tell them they they will have the sole rights to produce the medication only if they allow the Brand Name company to produce the Brand name for a few more years. This is why you will see that a patent is supposed to expire on a certain date (let's say March of 2017), but the generic may not come to the public until months later (let's say January of 2018). The FDA truly does have the highest standards when it comes to the safety of medication being produced. I know it can be aggravating but I don't know if anyone can put a price on safety. I also know that most of us with PD would try almost anything if it had the possibility of helping us because, as of today, there is no cure. I hope this helps and please keep me posted.
  15. Yes, I believe that Stalevo is white inside as natural levodopa is a white powder. The only color allergy to be concerned with is that of the coating. They use a red iron oxide in the coating which may, but rarely, cause an allergic reaction if someone can not tolerate the red dye. Also, the coating contains a greater amount of sucrose than "normal" tablets usually do. Patients who have a history of absorption problems with fructose or glucose should let their doctors know this before taking Stalevo. I hope this helps and please keep me posted