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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. On Vacation

    Hello everyone, I will be on vacation moving my daughter to college. I will be able to start answering questions on Wednesday August 24tg. Thank you for understanding, Mark
  2. Possible Sinemet side effect?

    Lolita, It sounds more like a side effect of Sinemet than an infection. A sore throat is an uncommon, not serious, side effect of Sinemet. You may also have a dry, hacky cough to go along with it. In some cases it may appear to be an upper respiratory infection, but a simple throat or sputum culture by the Dr could have been done to determine if it is an upper respiratory infection. I would give your neurologist a call and let them know your circumstance and let home decide what to do. A possible lowering of the dose may help, or he may decide to change medications all together. I hope this helps and please keep me posted.
  3. nativ

    Noah, There are very few people that do this basically because it is mainly done for people in a state of what is called "brittle" Parkinson's disease. This means that there off times have become so bad that they have to have constant input of Sinemet. Like I said, I do travel quit a bit and I do use this method to help keep my levels in control. There is now a product called Duopa which is and intestinal infusion of levodopa keeping constant levels of Dopamine for approximately 16 hours per day. If anybody if using the liquid Sinemet drink, please feel free to post it here for Noah. I hope this helps and please keep me posted.
  4. Meds not working

    Merc, There are side effects of unknown cause of Sinemet which are pain in joints and swelling of the hands, feet, and ankles. The Gabapentin was probably used because the Dr thought it might be nerve damage causing the pain. The reason the pain is usually worse at night is because the person has been up and around all day, which will cause the swelling to get worse and the pain to be worse. Once the person is able to relax the body is trying to bring the body back to a normal state. At this point os the night the swelling and pain are usually at their worst from being up and around all day. It does sound like a Sinemet issue, which I would discuss with the Dr. The Dr may recommend some physical therapy, which could help. Since all the Ortho exams came back negative, it sounds more like a side effect than an permanent problem. I would recommend talking to the Dr about the Sinemet dosage. The Dr may want to switch medications. In the meantime I would make sure to keep the leg(s) elevated whenever possible and keep cold compresses on them. Also, I would recommend taking Ibuprofen (Motrin or Advil) to help with some of the pain. The dose that can be prescribed by a Dr is up to 800 mg three times a day. One thing to keep an eye on is if the swelling goes down as the pain subsides. The reason for this is that when there is an issue of a pulled or torn muscle or ligament, it can cause swelling. This will be able to tell you if the swelling is due to an injury or if they are separate issues. From what you have told me, it sounds like separate issues. I hope this helps and please keep me posted.
  5. Anesthesia and C/L

    Waywrd, I have had many procedures where I have had to be placed under anesthesia, not once has the dose of anesthesia had to be adjusted. I know this because I asked the same question. People with Parkinson's are in a special group of people that are told to continue their medication therapy right up to the hour that anesthesia is needed. This is due to the fact that the repercussions of a patient with Parkinson's not taken their medication greatly outweighs the incidence of any issue with the medication in the system. Now I am talking specific PD medications. The Dr may have you stop taking fringe medications such as antianxiety, pain, other types of medication of this type. I hope this helps and please keep me posted.
  6. Sinemet CR spacing

    Buzbyc, I do see your reasoning of adding an extra dose in the day to make sure your Dopamine levels stay constant. But I would have to agree with your Dr because you are able to pin point a specific time of day when your symptoms are becoming worse. This is exactly why I recommend that PWP keep a journal. It will show a pattern of when you have off times so the dosage can be adjusted at that time. If you were having off times throughout the day, I would agree to possible add the extra dose or even a low dose regular release Sinemet. But, if an extra dose were added to the day the likelihhood of side side effects occurring from the increased dosage far outweighs the possible benefit of the increased dosage. If you are interested in a making a journal, you can go to the main page of my "Ask the Pharmacist" Forum where you will find an entry near the top that reads, "Medication Schedule." you must have Microsoft Excel in order to use this, but it is very helpful. It allows you to add medications, strengths, number of tablets taken at certain times a day, what you ate and when, and a place for Adverse Reactions. This can be done daily and be saved or you can print it out and fill it out daily. Either way, the nice part is that you can email it or fax it to your Dr a few days before your appointment. This way half of your appointment is not spent trying to recall to thr Dr what has happened since your last appointment. This, by far, is the most time consuming part of the appointment. I hope this helps and please keep me posted.
  7. nativ

    Noah, Liquid Sinemet can definitely reduce dyskensia because it is made into a liquid form that is sipped throughout the day as if you were getting a continual supply of levodopa. Somewhat like an infusion. It is primarily used in later stage patients who, when take tablets, have too many issues with off times and side effects. I use it from time to time when I am traveling because it gives me better and more precise control of my symptoms. There are several ways to make it, but the one I make is for convenience because it is not necessary to refrigerate but can be to make it more palatable. Here is the formula: Liquid Sinemet made with Orange Juice: 1) Count the number of Sinemet 25/100 tablets you take in one day. (for use in this example let's say you take 4 tablets per day) 2) Take the number of tablets and multiply it by 100 ml's. (so in this case you would need 4 X 100 ml= 400 ml's) 3) For every 1000 ml's of liquid, in this case orange juice, you will need 2000 mg's of Vitamin C. Orange juice does not have enough Vitamin C to help the ingredients work, but in a pinch if you do not have Vitamin C it is fine not to add it. You will see maximum effects if you do have the Vitamin C to add to the mixture. The amount of Vitamin C needed for this Mixture would be 800 mg's. If you require less than 1000 ml's, all you have to do is to multiple the amount of Orange Juice needed by 2. So, in this case we take 400 ml's and multiply by 2 to come up with 800 mg's of Vitamin C. 4) Crush the 4 tablets of Sinemet. Pharmacies do sell pill pulverizers where you put the tablets in a little cup and then screw on the cap. The cap is cone shaped and will crush the tablets. Make sure it is ground into a fine powder. Make sure you clean the pulverizer after each use. 5) Now you need to add 800 mg's of Vitamin C. You can probably find powdered Vitamin C at a specialty vitamin store (ie. Vitamin Shoppe or GNC), but if there is not one near you your local pharmacy will carry Vitamin C tablets. The best ones to use are the chewable Vitamin C because they are easily crushed. If you cannot find the chewable tablets, make sure you use a regular Vitamin C tablet, not an enteric coated or a delayed release tablet. If you must use the tablets you will find that they come in increments of 250 mg (ie. 250 mg, 500, mg, and then 1000 mg). I recommend that you crush 750 mg (or 1 and 1/2 tablets of the 500 mg) which is close to 800 mg. 6) Place the Sinemet powder and the Vitamin C powder in the 400 ml's of orange juice. This bottle will then contain a 1 day supply of Sinemet. It can either be sipped throughout the day or you can drink 100 ml's four times a day. 7) This solution must be SHAKEN WELL before consuming it. 8 )The convenience of my mixture is that it does not have to be refrigerated but can be is it tastes better to you. 9) Once mixed, this solution is good for up to 48 hours. I hope this helps and please keep me posted.
  8. nativ

    Otolorin, Any time, it is my pleasure.
  9. Too much or too little Stalevo?

    Seeker, By the sounds of what you are describing it sounds like stiffness and reduced dexterity. This is a sign of PD which would coincide with the lack of Dopamine. Without actually seeing her it is hard to be completely correct, it is an educated guess. I say that because when a symptom occurs in a PD patient it usually happens most on the side affected by the PD. Since this is in both legs, unless she has severe PD, it would be odd that it happened in both legs. It may also be dystonia (which is basically a severe muscle spasm) which originates from the same part of the brain that PD does, which is the basal ganglia. Dystonia can happen secondary to PD and usually comes about from taking Levodopa, and ingredient in Stalevo. This can happen on both sides of the body and can also include the upper and lower back. The odd thing about dystonia is that it can happen in two different scenarios: 1) On-Period dystonia: This dystonia happens when the medication is working to alleviate all the other symptoms, then dystonia happens. 2) Off-Period Dystonia: This Dystonia happens when the effects of the Levodopa are wearing off and the symptoms of PD are also apparent.. This can somewhat narrow down what type of dystonia it is and therefore can also lead one to determine which track to take, either adding levodopa or decreasing levodopa. This is also the reason I always recommend that you keep a journal of medication, time of dosage, times of eating, and the time any effects may happen. When you look back over the journal, many times you can see a pattern of some sort. If you look on my main page of this forum you will see a topic entitled, Medication Schedule." You must have Microsoft Excel in order to use this, but the nice part is that the journal can be kept on line and updated daily or printed out and fill it out. This can then be emailed or faxed to the Dr. a few days prior to the appointment so the majority of the appointment time is not spent on "What has happened since your last appointment?" The PD Dr's, and all Dr's I have encountered, love this idea because it saves them time and also saves you time. During the appointment a plan of action can be made and several other avenues can be made if the first choice does not pan out. The best way to be 100% sure would be to take her to her Dr. or a Movement Disorder Specialist, but knowing the above information can greatly help the Dr in their decision making. As always, I hope this helps and please keep me posted.
  10. nativ

    Nataliya, I try to stay away from some YouTube videos and certain information on the internet. I grew up on lake Michigan and I saw a search where you can go whale watching on Lake Michigan. LOL. What ever you need, feel free to contact me anytime and I hope I will be able to help you. Please keep me posted
  11. nativ

    Otolorin, I am not saying that it cannot happen that somebody can replace prescription medication with natural L-Dopa. It can be possible but it depends on what stage the person is in with Parkinson's. The amino acids may help with the passage of mucuna through the BBB, but we really don't know how much. There are several ways to diminish dyskensia while on carb/levo theraby: Reducing the dose or taking smaller doses throughout the day. Possibly changing to liquid sinemet, which is taken in small amounts throughout the day. Adding Amantadine will sometimes help with the dyskensia. The last option, if the dyskensia is severe enough, is DBS or a Duodopa Pump. I hope this helps and please keep me posted.
  12. trazadone

    Noah, No problem, I am here when you need me.
  13. A shortage of Carbadopa/Levadopa CR????

    I am not sure where the products come from, but today I decided to make a call to the FDA. They assured me there was no shortage issue, only a back order issue. This means that the companies are building up enough supply to get out to everyone . In the meantime, the companies are shipping out small quantities to pharmacies across the country. Ihope this helps and please keep me posted.
  14. trazadone

    Noah, I think there may be 2 things that can be done. First, I would try taking the Valerian about 45 minutes prior to bed, the Melatonin about 25 minutes prior to bed, and the Trazadone about 10 minutes prior to bed (but make sure you are in bed when you take the Trazadone). I believe this small change could allow all of the medications to be active in the system at the same time. As you know every person has a different metabolization time. It sounds like you may be a slower metabolizer, so taking the meds earlier may help. Secondly, I think an increase in strength may be needed. With a medication like Trazadone, it is reasonable to increase the strength after being on the medication for about 7 days. The max dose of Trazadone is 150mg per day. I hope this helps and please keep me posted.
  15. nativ

    Atremorine is a natural product that contains L-Dopa. It comes in a powder form and, since it it is not a medical medication, it is not regulated by the FDA. 1) The starting dose is 5 grams per day. The dose can be increased slowly if needed to a max of 20 grams per day. Since this is a natural product, the amount that reaches the brain is unknown. It can be taken with other Parkinson medications, including Levo/carb and Entapacone. 2) If and when you decide to try Atremorine make sure you inform your Dr. The Dr will be the one who can tell you how to tapper off of your other medications. It is always best to decrease the doseage of the medication in small increments over a long period of time. I would recommend that you decrease only one medication at a time. This way, if some type reaction were to happen, you do not have to guess which medication could have caused it. 3) From my experience of natural L-Dopa products, I have not seen or heard of a patient who has been able to replace their Parkinson medications with natural L-Dopa products. The main reason is due to the fact of how much of the natural product can reach the brain. There is a part of the body known as the blood-brain-barrier. It can be thought of as a sieve or filter. Only molecules that are small enough are able to pass through this barrier and work in the brain. Prior to even getting to the blood-brain-barrier the product must first be broken down in the stomach, absorbed through the small intestines, metabolized in the liver into it's active form, and then pass the blood-brain-barrier in order to work. Since natural products do not have to go through the same research and development process as prescription medications, it is not known how much of this product is available at the end of this process. I hope this helps and please keep me posted.
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