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MComes RPH

Ask the Pharmacist Moderators
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Everything posted by MComes RPH

  1. artane

    Chuck, Depending on the dosage you were taking, it does not have any untoward effects on the body if it is stopped abruptly. You were only on it for a month, so I am guessing that the dosage was not that high. When a person has to slowly step down from a medication is when the dosage is high and/or they have been on the medication for a long period of time. I may not agree with how he did it, but I think he should have let you know that this is a trial run to see how you react. I hope this helps and please keep me posted.
  2. medication schedule

    Sheryl, Please keep me posted. Instead of the times I laid out for you, you could substitute the starting time as the time she wakes up. That would be the starting time for the Sinemet, then you would give the next Sinemet 6 hours from that time, and the last Sinemet 6 hours from the second dose of Sinemet. You would also follow the same timing with the Mirapex. Example: 1) wakes up at 6:00am. Sinemet 6:00am, Mirapex 7:00am, Sinemet 12:00pm, Mirapex 1:00pm, Sinemet 6:00pm, Mirapex 7:00pm. When people are early risers they may experience an off time prior to bed because the medication was started early. If this happens, it is fine to take a Sinemet prior to bedtime if an off period should come about. I hope this helps and please keep me posted.
  3. Restore-gold

    Hiker, The only side effects that I am aware of is some stomach upset and heart burn. I hope this helps and please keep me posted.
  4. medication schedule

    Sheryl, The first thing you should do is call the doctor and see if he wants you to take both medications. It is not uncommon for a patient to take both medications. With this in mind I would not increase or decrease any of the medications until you speak with them. As far as dosing of the medications, if you are in fact supposed to be taking them both, would be as follows. Since the Sinemet is an immediate reacting and the Mirapex is a longer acting medication, it is best to take the Sinemet at a time when the Mirapex maybe wearing off. Below is an example of a schedule you should try is you are experiencing the "off" effects. 8:00am Sinemet 9:00am Mirapex 2:00pm Sinemet 3:00pm Mirapex 8:00pm Sinemet 9:00pm Mirapex Now this is the schedule for the "perfect" patient. It may have to adjusted for each patient, because as we know, no two patients are alike. I usually recommend that a journal be used to track "off" times, Dosing times of medications, food intake, excercise, and sleep times (including naps). You may start to see a trend when you track these over a period of time. It must also be noted that Sinemet should be taken on an empty stomach (30 minutes prior to a meal or 90 minutes after a meal). If the meal contains protein or is extremely fatty, the Sinemet should be taken 1 hours prior to that meal or 2 hours after that meal. I hope this helps and please keep me posted.
  5. deciding about drugs

    Hiker,I am glad to see that you have researched your options for possible medications. There a few different choices when it comes to medications used to help motor symptoms in Parkinson's Disease. Azilect is usually the drug of choice for relieving motor symptoms. When I council patients about Azilect side effects or complications I focus on the most common issues first, which would be some upset stomach, possible joint pain, and insomnia (which is most prevalent in the first few days of therapy). The serious, but RARE, side effect of serotonin syndrome when take with certain anti-depressants. I have discussed this with hundreds of doctors, neurologists, and movement disorder specialists and have been told that they have not seen this reaction in any of their patients. The other issue of concern is the interaction of Azilect and tyramine rich foods (aged cheeses, cured meats, tap beers, and certain wines). This warning has since been removed from the labeling process due to the fact that Azilect has such a great affinity for MAO-B and very little, if any, affinity for MAO-A (which is where the interaction takes place. Amantadine is another medication used to help with motor symptom problems. Amantadine is primarily used as an antiviral, but in further research it has been shown to help with motor symptoms in PD patients, though the actual mechanism is not fully understood. It is usually prescribed as a twice daily dosing but, a long acting amantadine called "Gocovri" has just been brought to market specifically for motor symptoms of PD. Some possible side effects may be lightheadedness and a lowering of blood pressure upon standing. As far as natural products are concerned, I will usually recommend that a person who has just been diagnosed with PD stay with prescription medications to start. This is mainly due to the fact that these products are not regulated by the FDA and have less stringent rules of their production and claims of how they work. I make sure as a Pharmacist I make sure that my patients know what are the main side effects to look for. When a patient sees the entire list of possible side effects, it can become overwhelming. I hope this helps and please keep me posted.
  6. Side Effect Or Wearing Off?

    John, With either medication change there is usually not a transition period. The fact that she is sensitive to medication changes, if they were to change her to the 25/100 the may have her start out with 1 tablet a day for 3 days, then 1 tablet twice daily for 3 days, then 1 tablet 3 times a day from there on out. That is truly a doctors call, but since she has a sensitivity issue, the second option of slowly increasing how many times a day may be the better option. I hope this helps and please keep me posted.
  7. Restore-gold

    Hiker, There are 3 main ingredients that help with Parkinson's symptoms: 1) (NAC) also known as N-acetyl-cysteine. This increases the Dopamine binding. Which means that Dopamine will bind to the receptors to a greater extent allowing for more Dopamine to be used in he brain to relieve symptoms. 2) Green Tea Extract. The chemical in Green Tea Extract, epicatechin gallate, is used to reduce free radicals and inflammation. Free radicals are molecules that get into our system and interfere with the production or longevity of certain substances, in this case it is Dopamine. It is also believed, but has not been proven, That ECG may may have a neuroprotective factor associated with it. This means that it may have the ability to protect certain cells from being broken down. 3) L-tyrosine. This product has shown to increase the levels of Tyrosine in the Cerebral Spinal Fluid, the fluid that runs through the brain and spinal cord, which can increase Dopamine turnover. This means more Dopamine will be available.
  8. Azilect generic price

    Hiker, The assistance program is a great option. Just be aware that it is for brand name only. I hope this helps and please keep me posted.
  9. Side Effect Or Wearing Off?

    John, The larger dose may last bit longer, but may also cause more unwanted effects, such as dyskensia. When I evaluate a persons medication schedule I look at the dose compared to the symptom relief. In this case if the 10/100 is working, but not long enough, that person may be a good candidate for the Sinemet CR 10/100. I took into consideration her sensitivity to medication and decided not to introduce, at this point, another medication. Comtan is a medication that must be used with Sinemet, usually the extended release version, and can extend the benefit of the Sinemet. That is why I chose not to include as an option. The way I handle medication management in a Parkinson's patient, as well as most other medications is to "start low and go slow" with any medication that is introduced to the patient. By following this rule of thumb we avoid adverse reactions that will be more harmful than helpful. I also look at the patient make-up to see if they have any issues about medications, such as medication sensitivity. Comtan is well tolerated, but I believe that there are other options available so we can avoid her medication sensitivity. Lastly, many doctors who treat specific ailments, such as Parkinson's, must be open and listen to their patient's and adjust accordingly, especially with Parkinson's patients. At this point I believe the doctor may go with either the Sinemet 25/100 three time a day or the Sinemet CR 10/100 three times a day. I would like to see the later due to the fact that she is responding well to the Sinemet 10/100 for the relief of her symptoms, all we need is to have it work for a longer period of time. I hope this helps and please keep me posted.
  10. Sinemet absorption with applesauce

    Noah, Since the orange juice is acidic, it is believed that will aid in the breakdown of the medication which, in turn, may speed up digestion. If someone is having trouble with the quickness of which the symptoms are relieved, then I may recommend they take it with orange juice. It is not known how much faster, if any, the absorption is with the use of orange juice. I hope this helps and please keep me posted.
  11. Can Parkinson's be stopped

    hiker, This medication, who's brand name is Bydureon, is available in the United States in an injectable form. Unfortunately, it cannot be used for the relief of Parkinson's symptoms. It is specifically used for Diabetes and any use other than for Diabetes is called "off label" and is against the law. Plus it is still in clinical trials and, until it passes the clinical trial, will only be used for diabetes. I hope this helps and please keep me posted.
  12. Can Parkinson's be stopped

    I thought most of you would be interested in this, so I decided to post this article from The BBC Health and Science section First hints Parkinson's can be stopped By James GallagherHealth and science reporter, BBC News website 4 August 2017 Share this with Facebook Share this with Twitter Share Image copyrightGETTY IMAGES It may be possible to stop the progression of Parkinson's disease with a drug normally used in type 2 diabetes, a clinical trial suggests. Current drugs help manage the symptoms, but do not prevent brain cells dying. The trial on 62 patients, published in the Lancet, hints the medicine halted the progression of the disease. The University College London (UCL) team is "excited", but it urges caution as any long-term benefit is uncertain and the drug needs more testing. "There's absolutely no doubt the most important unmet need in Parkinson's is a drug to slow down disease progression, it's unarguable," Prof Tom Foltynie, one of the researchers, told the BBC. In Parkinson's, the brain is progressively damaged and the cells that produce the hormone dopamine are lost. It leads to a tremor, difficulty moving and eventually memory problems. Therapies help manage symptoms by boosting dopamine levels, but the death of the brain continues and the disease gets worse. No drug stops that happening. 'First' In the trial, half of patients were given the diabetes drug exenatide and the rest were given a placebo (dummy treatment). All the patients stayed on their usual medication. As expected, those on just their usual medication declined over 48 weeks of treatment. But those given exenatide were stable. And three months after the experimental treatment stopped, those who had been taking exenatide were still better off. Prof Foltynie told the BBC News website: "This is the first clinical trial in actual patients with Parkinson's where there has been anything like this size of effect. "It gives us confidence exenatide is not just masking symptoms, it's doing something to the underlying disease. "We have to be excited and encouraged, but also cautious as we need to replicate these findings." Parkinson's disease 'may start in gut' Century-old Parkinson's question answered Experts excited by brain 'wonder-drug' Early days They also need to trial the drug for much longer periods of time. An effective drug would need to hold back the disease for years in order to make a significant difference to patients. Parkinson's progresses slowly and the difference in this 60-week trial was definitely there, but was "trivial" in terms of the impact on day-to-day life, say the researchers. The drug helps control blood sugar levels in diabetes by acting on a hormone sensor called GLP-1. Those sensors are found in brain cells too. It is thought the drug makes those cells work more efficiently or helps them to survive. It is why the drug is being tested in other neurodegenerative diseases including Alzheimer's. David Dexter, the deputy director of research at Parkinson's UK, said: "The findings offer hope that drugs like exenatide can slow the course of Parkinson's -  something no current treatment can do. "Because Parkinson's can progress quite gradually, this study was probably too small and short to tell us whether exenatide can halt the progression of the condition, but it's certainly encouraging and warrants further investigation." Dr Brian Fiske, from the The Michael J Fox Foundation for Parkinson's Research, said: "The results from the exenatide studies justify continued testing, but clinicians and patients are urged not to add exenatide to their regimens until more is known about their safety and impact on Parkinson's." Follow James on Twitter
  13. Parkinson's with dementia pill reminders

    Cat, I have recommended a few smart phone app's in the past, MediSafe Reminder and Medication Reminder & Pill Tracker, for those people who want that type of program. I do understand the frustration of it nor being able to be modified from day to day. I created a program that has worked well for patients, care givers, and even physicians (who have recommended it to there patients). If you look under my forum, Ask the Pharmacist, you will find the heading "Medication Schedule." The main aspect of this is that you must have Microsoft Excel to run it. With this program, you can do the following: -Either print out the daily medication list and fill it in by hand OR fill it out on the computer and save it. - You can put in the date, exact times, medications, strengths, frequency of use (once a day, twice a day, etc...), and also intake of food and times. -There is also a portion of the sheet dedicated to actions of the day. You can input when naps were taken, any exercise, off times, and possibly side effects or adverse effects. - The main reason I made this was to save time in the office. The majority is time spent with the Dr. is telling them what happened since the last appointment. With this program, you can either email the daily sheets or fax the daily sheets to the Dr.'s office a few days in advance of the appointment. That way the Dr. can read them ahead of time so that time is not wasted on giving them an oral history of the goings on since the last appointment. Trying to remember everything is difficult, so this program will help the Dr. possibly see trends in the medication schedule notes to help fine tune the medication regime. This is also a program that can be done on a home computer or smart phone, as long as it has the Microsoft Excel. I hope this helps and please keep me posted.
  14. Side Effect Or Wearing Off?

    The dosing of every 3 hours is difficult to arrange with eating. Sinemet should be taken 1 hour prior to eating or be taken about 90 minutes after a meal. If she were to switch to the long acting, she could take the morning, afternoon, and evening doses an hour before breakfast, lunch, and dinner. The empty stomach issue is important, but not as important as eating. If someone eats and takes Sinemet, the amount of Sinemet will be decreased. The main proponent to avoid is protein with Sinemet. Protein taken with Sinemet will completely negate the effects of Sinemet due to protein binding the liver enzymes so the Sinemet cannot be metabolized to it's active ingredient. I hope I can give clarity on how sleep helps PD patients. When we sleep this is the only time when our Dopamine cells can rejuvenate themselves. This is because we don't move much in our sleep which allows our muscles to rest and not use much Dopamine. That is why she is doing so well in the morning after a good night of sleep. I hope this helps and please keep me posted.
  15. Question about Link between dopamine and testosterone

    Super, That could very well be the issue. It is very hard to tell when the dead Dopamine cells reached the magic number of about 80%. The closer you get to that number the more prevalent the symptoms become. In my case, for example, I was diagnosed at the age of 29. Thinking back to the time before the diagnosis I can remember instances of symptoms occurring, though they were very minimal at the time. Now I can usually see someone who has PD just by how they walk. I hope this helps and please keep me.
  16. Azilect generic price

    It is highly unlikely that the price will drop significantly in a few years. Sinemet, for example, was first produced in the early 70's so it has taken about 48 years to be at the low price that it is today. You can expect the price to decrease slowly the more years it is on the market. I hope this helps and please keep me posted.
  17. Mylan C/L On Back Order?

    Thanks for the information. I will just reiterate for others who are curious about medications being out of stock or back ordered. Every pharmacy usually has two wholesalers. Their primary wholesaler is usually from their own company warehouse, and a secondary wholesaler which is usually McKesson or Cardinal. That is why I recommend to call other pharmacies in your area if your usual pharmacy is out of stock on your medication. Also, as Waywrd pointed out, you may have better luck at finding your medication at a bulk store (Costco or Sam's Club) because they order in bulk. Another lesser know facts is that if you go to a chain pharmacy (Wal-Mart, Walgreens, CVS, Rite Aid, Meijer, Kroger) is that most of them can check other pharmacies in the chain to see if they have your medication in stock. So if you normally go to Rite Aid on Main Street and they are out of stock on your medication, that store can look up the other Rite Aid stores on their computer to see if any other Rite Aid stores have your medication in stock. I hope this helps and please keep me posted.
  18. Sinemet absorption with applesauce

    Yes, chewing or dissolving the tablet under the tongue will have a very quick onset of action. The only issue may be is that the full dose might not be absorbed. Also when I stated that she could take 1 tablet every 3 hours, I believe you asked how could food be consumed with such tight time restraints. As long as Sinemet is taken anywhere from 30 to 60 minutes prior to a meal OR 90 minutes after a meal she should be fine. Many PD patients on such a schedule usually eat many small meals, or snacks, throughout the day. The recipe I usually recommend is with orange juice. This is how the Mark's Liquid Sinemet is made. 1- Count the total tablets of regular 25/100 she is taking daily. I believe you said it was 3. 2- Take the number of tablets and multiply by 100 ml's. (So you would need 3 x 100 ml's= 300 ml's) 3- For every 100 ml's of liquid you need 200 mg's of Vitamin C. Orange juice usually does not have enough Vitamin C to help the levodopa work so, we add Vitamin C tablets. The amount of Vitamin C needed will be 150 mg. 4- Now crush the 4 tablets of Sinemet. You can either use a pill crusher that you can purchase at most pharmacy or you can place the tablets in a tablespoon and use the bottom side of a teaspoon to crush them. You want to get as fine of a powder as possible. 5- Crush the 150 mg. of Vitamin C. Since Vitamin C comes in strengths of 250 mg., 500 mg., and 1,000 mg., it may be difficult to get exactly 150 mg. So what you could use 1/2 tabs of Vitamin C 250 mg. which is 125 mg. The 25 mg. difference will not affect the efficacy of the final product. **Note: Use plain Vitamin C tablets. Do not use coated tablets, extended release tablets, or Vitamin C with Rose Hips. 6- Place the crushed Sinemt tablets and the crushed Vitamin C into the 300 ml's of Orange juice. The entire bottle now contains 1 day's worth of Sinemet. 7- It can be consumed in two different ways: a) it can be sipped throughout the day just as long as the entire contents. are consumed before bedtime. the mixture can also be. consumed by drinking 100 ml's. 3 times a day. 8- The mixture can be refrigerated to make it more palatable. 9- ALWAYS shake well every time. before drinking. I hope this helps and please keep me posted.
  19. There is a prescription drug discount card called GoodRx. I first would like to state that I am, in now way, affiliated with this program nor do I benefit in any way from promoting this program. The GoodRx program is just a discount program available to everyone and cannot be used in conjunction with any insurance program. If you copy and paste this: https://m.goodrx.com/?gclid=CjwKCAiAm7LSBRBBEiwAvL1-L-oULYoUUorUy-5LMuclp6SYVcxMBzgIGtRw4v93NeozWhpG0h3vbRoCygIQAvD_BwE into your search engine (Google, Bing, etc...) It will pull up the GoodRx site. From here you can check the price of a medication at their discounted price along with a list of nearby pharmacies with their prices and you can even search what medications are used by disease state (Example: Parkinson's Disease). This is great if you take several medications for PD. The most important aspext of this site is when you tap on the Menu button, in the upper left corner, then select to print your card. You will have to put in your name and address, then your card will be sent to you. At this point you can also View your card so you can print one off for immediate use. Here is an example of how much you can save: Walgreen's cash price for Generic Azilect (Rasagiline) 1mg. for 30 tablets is $524.39. The discounted price with the GoodRx price is $244.48. That is a savings of $279.91. Better yet, that is not the lowest price I found. The best price I found was at Walmart which had a price of $230.56. After you have printed your card, you can download the pricing app from the Apple Store for iPhone's or from the Play Store for Android Phones (Galaxy). Like I said, with this app you can look for a specific medication or you can look up medications by disease state. Consider this a belated Christmas present. I hope it will help you.
  20. Azilect generic price

    Waruna, I was just getting ready to post this, then I saw your question. I have known about this for a while, but it just struck me that I should post this for everyone to see and take advantage this. There is a prescription drug discount card called GoodRx. I first would like to state that I am, in now way, affiliated with this program nor do I benefit in any way from promoting this program. The GoodRx program is just a discount program available to everyone and cannot be used in conjunction with any insurance program. If you copy and paste this: https://m.goodrx.com/?gclid=CjwKCAiAm7LSBRBBEiwAvL1-L-oULYoUUorUy-5LMuclp6SYVcxMBzgIGtRw4v93NeozWhpG0h3vbRoCygIQAvD_BwE into your search engine (Google, Bing, etc...) It will pull up the GoodRx site. From here you can check the price of a medication at their discounted price along with a list of nearby pharmacies with their prices and you can even search what medications are used by disease state (Example: Parkinson's Disease). This is great if you take several medications for PD. The most important aspext of this site is when you tap on the Menu button, in the upper left corner, then select to print your card. You will have to put in your name and address, then your card will be sent to you. At this point you can also View your card so you can print one off for immediate use. Here is an example of how much you can save: Walgreen's cash price for Generic Azilect (Rasagiline) 1mg. for 30 tablets is $524.39. The discounted price with the GoodRx price is $244.48. That is a savings of $279.91. Better yet, that is not the lowest price I found. The best price I found was at Walmart which had a price of $230.56. After you have printed your card, you can download the pricing app from the Apple Store for iPhone's or from the Play Store for Android Phones (Galaxy). Like I said, with this app you can look for a specific medication or you can look up medications by disease state. I hope this helps.
  21. Sinemet absorption with applesauce

    The first thing we have to remember is that Sinemet is broken down in the stomach and is absorbed in the small intestine. So medication that is in a liquid form does not need to be broken down in the stomach, therefore it will be absorbed the fastest. A controlled release tablet has a coating that will slowly be broken down in the stomach, thus it will be absorbed in small amounts over a longer period by the intestines. Taking Sinemet with any type of food, even apple sauce, can decrease the absorption of the medication. The less solid the food, the better the absorption. If absorption of Sinemet can be greatly reduced, or even nullified, if it is taken with protein. This is due to the fact that the protein will be metabolized in the liver before the Sinemet will. Now onto the amount of water you drink and Sinemet absorption. If you drink a large amount of water, greater than 6-8 oz's, with each dose of Sinemet then it may take longer to get into the system. Taking Sinemet with 4-6 oz's of water should give the best results. There is a recipe to make your Sinemet into a drink formula, but this is only for patients who may need to maintain a constant level in order to control their symptoms. If you would like that recipe, please let me know. I hope this helps and please keep me posted.
  22. Side Effect Or Wearing Off?

    John, I am glad that you found this site and also that you have found it so helpful. That is what we strive for. The symptoms that she is experiencing, walking on the toes, bent legs, and leaning forward, are key symptoms to Parkinson's Disease (PD). This, in turn, causes most PD patients to fall forward. Most other disease states or conditions usually cause the patient to fall backward. You also did a great job of recognizing that Sinemet should be taken on an empty stomach, which can make a huge difference as you saw. The anxiety feeling when she is going "off" can be caused by a few different reasons. (1) When a patient goes off (which means their medication is wearing off) can usually be felt internally before the external symptoms become visible to others. I think the best way to describe it to people who do not have PD is what I call the "volcano effect." When a volcano is ready to erupt, internally the ground is moving and shaking. This is how it feels for someone who has PD. They can feel it internally before symptoms are visible. When the volcano finally erupts, it is then that people can see the ground shaking, smoke, and lava. This eruption in PD is when the symptoms become visible to others. (2) The anxiety can also be due to the fact that the patient knows that the time to take their medication is getting close and the anxiety takes place because they are worried that others may see the symptoms or that the symptoms may be more severe than what they are used to. Therefore causing anxiety. Now to the Sinemet dosing. There are 2 possible ways to help increase her quality of life. One would be to increase the frequency to coincide withe her off times. If the strength appears to almost rid her of symptoms, then you know the dosage should be correct. Instead of 3 times daily, you may want to discuss with the Dr. to change it to every 3 hours. The only downfall to this is that she may experience dyskensia, which can be caused by too high of a dose of Sinemet. Dyskensia is uncontrolled, involuntary muscle movements. Whereas PD tremors are small uncontrolled shaking or movement in the hands, dyskensia is usually greater movements of larger muscles and can result in movements that look like jerking of the whole arm and possibly the neck. The second way to possibly increase her quality is to talk with the Dr. about possibly using a long acting Sinemet, called Sinemet CR. It comes in two different strengths, CR 25/100 and CR 50/200. This long acting form is slowly released usually over an 8 hour period and is usually dosed at 3 times daily, or in some instances less. I hope this helps and please keep me posted.
  23. Question about Link between dopamine and testosterone

    S, Since Azilect is in a class of medications called MAO-B Inhibitors, they will boost the effectiveness of the Dopamine we already produce. It will not create more Dopamine. It is my medical mind that says it appears that it is the volume, not the effectiveness, of dopamine that will affect prolactin production. Eventually almost everyone who has PD will be on Levodopa therapy, which can coincide with Azilect therapy. At that point more Levodopa will cause an increase in Dopamine. What we also have to look at is the total amount of Dopamine we have at any particular moment. We do not see symptoms until about 80% of the Dopamine cells are dead or non functional. What we need to find out is at what % Dopamine Cells remaining affects the production of prolactin, and thusly, Testosterone. At this point I have not seen any in for to tell us that. I hope this helps and please keep me posted.
  24. Sinment

    Trisha, The Sinemet 25/100 is actually a medication that if you do not see improvement within 3 days it can be increased. The dose that he is taking is usually a good starting dose, but I am surprised that the Dr. did not give you instructions to call him if you see no improvement after being on the initial dose. I would definitely call the Dr. and let them know you have seen no improvement and would like to be instructed on what to do at this point. I hope this helps and please keep me posted.
  25. 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.
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