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MComes RPH

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Everything posted by MComes RPH

  1. MComes RPH

    Transition to higher dose of CL

    Super, I'm glad it's going great. Since all is going well, you can make the changes after 5 days if you like. That should not be a problem. I hope this helps and please keep me posted.
  2. MComes RPH

    Pharmacy refuses to fill prescribed generic

    Calprof, I have not seen much success with converting the online pharmacies to try a different generic medication. It is true, they buy in such large quantities from the manufacturer that will give them the best price. I usually recommend that you try one of your local pharmacies (Costco, Walmart, Sam's Club, etc..) and use the Good Rx discount card. You can pull this up as an app on your phone and it does give great discounts on thousands of generic medications. I don't know of a retail pharmacy that does not accept it. I hope this helps and please keep me posted.
  3. MComes RPH

    Low dose Zonisamide

    Curious, I had a feeling you were talking about the "PD" initials too. I was trying to stay politically correct, but agree with you 100%. PD has always been synonymous with Parkinson's Disease. As far as the traveling is concerned, I build in the recovery day. I to travel quit a bit and it has become more of an issue since the diagnosis. I now know that I need to recover and build in that time. If I am going for business, I make sure I plan out and do not overextend myself. I plan meetings over days, not hours. I schedule events later in the morning and try to end at a reasonable time, around 6:00pm to 7:00pm. I also try to keep the same bedtime routine on the road that I have at home. I also apply these same rules for leisure travel. If I must drive, I break up the day in half. I leave a little later in the morning, plan a break for lunch, and make a plan how much I CAN drive. Not how much I want to drive. To some this can be more stressful. I rather enjoy it. I take my time and really absorb the adventure. Another trick I have is that I use Melatonin when I travel any great distance. Melatonin helps keep your carcadian rythem in check. It helps my internal clock adapt to where I am. I also, as much as possible, try to keep my medication schedule on my original time zone. This way I do not experience many adverse effects of trying to change my medication to a new time zone, only to change it back in a few days. I leave the hustle and bustle to others. I work on my own schedule andmake plenty of time for breaks. I used to have to my schedule into my travels. Now I work my travels into the schedule. The best part about a trip sometimes is the travel and not the destination. I hope this helps and please keep me posted.
  4. MComes RPH

    Low dose Zonisamide

    So curious, Our body temperature is controlled in the part of the brain called the Hypothalamus. Besides controlling body temperature it also controls hunger, thurst, and hormones. Sweating, or excessive sweating, is unfortunately a part of PD. There is not much we can do about it, but I have attached one article specifically addressing that issue. I have also attached several articles about the effects of the autonomic nervous system as it relates to people with PD. I have seen the commercial talking about Peyronie's Disease. I know it may feel like they are aiming it people with PD, but it also affects people with other issues such as diabetes. For many patients this is difficult to talk about or they may not know it is related to PD. I think it is to raise the awareness of this issue and also sell some new medication or procedure. Yes, that is my inner pharmacist who does not agree with drug companies advertising prescription medication on television. I hope this helps and please keep me posted. Excessive Sweating In Parkinson’s Patients: by Dr. De Leon – defeatparkinsons https://defeatparkinsons.com/2015/01/07/excessive-sweating-in-parkinsons-patients-by-dr-de-leon/ effect parkinson's on autonomic nervous system - Google Scholar https://scholar.google.com/scholar?q=effect+parkinson's+on+autonomic+nervous+system&hl=en&as_sdt=0&as_vis=1&oi=scholart#d=gs_qabs&p=&u=%23p%3DXJEgprAnGq8J effect parkinson's on autonomic nervous system - Google Scholar https://scholar.google.com/scholar?q=effect+parkinson's+on+autonomic+nervous+system&hl=en&as_sdt=0&as_vis=1&oi=scholart#d=gs_qabs&p=&u=%23p%3DxXSq0Cr59eYJ effect parkinson's on autonomic nervous system - Google Scholar https://scholar.google.com/scholar?q=effect+parkinson's+on+autonomic+nervous+system&hl=en&as_sdt=0&as_vis=1&oi=scholart#d=gs_qabs&p=&u=%23p%3DtHDcGgK4F_EJ Autonomic Nervous System Dysfunction in Parkinson's Disease. - PubMed - NCBI https://www.ncbi.nlm.nih.gov/m/pubmed/12628063/ Autonomic nervous system dysfunction in Parkinson's disease: relationships with age, medication, duration, and severity. | Journal of Neurology, Neurosurgery & Psychiatry https://jnnp.bmj.com/content/56/10/1090 Autonomic Issues in Parkinson's Disease https://www.movementdisorders.org/MDS/Scientific-Issues-Committee-Blog/Autonomic-.htm
  5. MComes RPH

    Post - Hidden

    I found your most recent post and am working on it now.
  6. MComes RPH

    Post - Hidden

    I am not sure why it came up as hidden, but this is the only post I have from you. Please try to post again
  7. MComes RPH

    Namzaric

    You are welcome. Anytime
  8. MComes RPH

    Transition to higher dose of CL

    Super, I don't blame you for being cautious about going directly in the higher dosage. I would go with your first suggestion of replacing one dose per week with the higher dose. For example: Week 1 (if you are taking it 4 times a day) 48.75 am 36.25 noon 36.25 afternoon 36.25 evening Week 2 48.75 am 36.25 noon 48.75 afternoon 36.25 evening Week 3 48.75 am 48.75 noon 36.25 afternoon 48.75 evening Week 4 48.75 am 48.75 noon 48.75 afternoon 48.75 evening This staggered dosing will better distribute the medication when you start with the higher dose so you don't have too much medication at any certain time of the day.T This way you are insured that you will not have any side effects from taking too high of dose too quickly. Also, you may not need a higher dose throughout the day. So this might help you see if you only need higher doses at certain times of the day. I hope this helps and please keep me posted.
  9. MComes RPH

    Difference Between Artane Generics?

    Jenny, Any liquid will have a faster onset of action then tablets. The reason for this is because a liquid is already broken down and is ready to be absorbed immediately. A tablet, on the other hand, must be broken down into essentially a liquid form in order to be absorbed. It is the extra step of breaking down that causes the tablet to have a longer onset of action. I hope this helps and please keep me posted.
  10. MComes RPH

    timing of requip xl

    Viriyagita, That is exactly what I had in mind. As for the morning dose, it is different for each patient. If someone is off in the morning and needs faster relief, then I recommend the IR. In the case where a patient if not off in the morning but will be soon, then I recommend the CR. As is with your situation. I hope this helps and please keep me posted.
  11. MComes RPH

    Low dose Zonisamide

    So curious, I do not see a new post from you. If you would like to post it again I will be more than happy to help you. For future reference, below your post you will see button that reads "Notify me of replies." By clicking this you will be alerted of my reply.
  12. MComes RPH

    How to extend dopamine effects

    Cactusflower, I do not usually see Mirapex taken with Sinemet. The reason is two pronged. Both of the medications bring about the same result, therefore you may get increased effect of too much Levodopa. The results would act like you have too much Levodopa causing dyskensia. The side effects of both medications are very similar and when taken together will have an additive effect (1+1=3) Because of this you would have increased stomach upset, a great deal of drowsiness, and severe decrease in blood pressure. The decrease in blood pressure will be most apparent when the patient stands from a seated or laying position. A patient may get light headed at the least or pass out as the most severe. I hope this helps and please keep me posted.
  13. MComes RPH

    Difference Between Artane Generics?

    Jenny, Great question. In the United States, generic medications have to have the same active ingredient (in this case trihexphenidyl) as the brand name medication (Artane). They also have to contain the same amount of the active ingredient. There are 2 things that can differ in the generic medication. (1) The binding agent, which is combined with the active ingredient so it can be made into a tablet and (2) the amount of pressure used make the product into a tablet. These 2 conditions will affect the onset of action. If the tablet is pressed to tightly, it will take longer to break down and delay the absorption. Now if the binder and active ingredient are not pressed tightly, the tablet will be broken down more quickly and have a quicker onset of action. Neither of these scenarios will will diminish the effectiveness, only the onset of action. With that in mind, there is really no generic that is better than another. It may vary from person to person and once you find the one that works the best I recommend that you keep a note of it with your medical files or your medication list. I hope this helps and please keep me posted.
  14. MComes RPH

    is my Madopar working at all?

    Bill, Modopar should help with rigidity, gait, and slow body movements. I like to say it has a "liquid" effect of the body of a person with PD. It will help loosen and relax the rigidity of the body. It should also help you walk smoother and lengthen your stride while walking while also increasing the speed of movements in your arms and legs. The onset of action is usually between 30-60 minutes. If you are seeing little to no help with these symptoms, then you are most likely under dosed. There are specific movements the Dr. will have you do during appointments, walking, finger tapping, arm movements, head movements, and flexibility. These determine if a medication is working. If you see no improvement in these actions, you should have the dosage increased. Modopar is the "gold standard" for PD and should work to improve symptoms across the board. Once the dosage is increased you should see an improvement within the first 30 to 60 minutes after you have taken the medicine. If no improvement is seen, you should wait until the next dose is due and increase that dose above the original dose. Let's say the Dr. increases the dose to 1/2 tablet. If you try this and get no relief, you can increase the next dose by 1/4 tablet ( or total of 3/4 tablet). Increases of 1/4 tablet throughout the day until relief is a very reasonable dosage increase to find the correct dose. If you start to experience dyskensia (sudden jerking movements of the arms, legs, and sometimes head) that means the dose is too high and should be decreased to the level of the previous dose. I hope this helps and please keep me posted.
  15. MComes RPH

    timing of requip xl

    Viriyagita, The best possible scenario to get the best coverage would be to take the XL twice a day (4mg in the morning and 4mg in the evening). This way you are getting a constant flow of medication that will be within therapeutic levels throughout the day. I also recommend that you take the XL about 2 hours after taking the Sinemet CR. The reason for this is because about 2 hours after taking the Sinemet CR it will be starting to decrease in blood level. By taking the XL at this lower period of Sinemet CR you will get more symptom relief . It is optimal to stagger the doses throughout the day to maintain relief of symptoms and give you a better quality of life. Ultimately you want to take the medications so that while one medication is at a lower blood level another medication is at a higher level. Then when the second medication is starting to decrease in blood level, you will take the first medication to cover that period. I know that you mentioned you take the Sinemet IR in the morning, which is a great idea. Since it may take longer for the CR to start working, I recommend taking the IR to kick start your day. If the CR is four times a day, you can start the first dose about 1 & 1/2 to 2 hours after the first IR dose of the day. If you notice that one tablet of the IR is not taking the edge off of the symptoms then you can take another 1/2 to 1 tablet if needed. I hope this helps and please keep me posted.
  16. MComes RPH

    Apokyn

    Noah, I thought you were talking about a pump that did not use Apokyn, I'm sorry. Yes, the ApoPump does use Apokyn. The Apokyn injection is an immediate release that does not go through any metabolisation, which is why it works so quickly. The lozenges do take a little longer to work because they do get metabolised, which is why the side effect may be less. I'm not saying that the shortness of breath won't be a side effect of the lozenges, but it may not be as intense. I was just trying to think of any alternative for you at this point. Hang in there my friend. I'll keep an eye out for any other possibilities. I hope this helps and please keep me posted.
  17. MComes RPH

    Apokyn

    Noah, At this point I think the lozenges would be worth a try. The pump will use a Carbidopa/Levodopa gel. It is in a "cassette" which is placed in the pump and will release the medication throughout the day. Depending on how much medication you need, a cassette can last as long as 16 hours. So the good news is that you can use the pump because it does not contain the Apokyn. I hope this helps and please keep me posted.
  18. MComes RPH

    Apokyn

    Noah, I'm sorry, it was a mistype. I meant to say in this situation it should be fine to use the Apokyn. In a occasional severe "off" period it should be fine to use it. Unfortunately, with the side effects you are having I wouldn't recommend it for daily use. There is also no way to combat the shortness of breath. I know it stinks when you find a product that works and you can't take it because of the side effects. The lozenges may be better for you. I hope this helps and please keep me posted.
  19. I just wanted to let everyone know that I found a pharmacy that will compound generic Apokyn (Apomorphine) in lozenge form. I have attached the information below. Apomorphine Compounded https://www.cfspharmacy.pharmacy/human-medicine/apomorphine-compounded?gclid=EAIaIQobChMIm-_-4_uQ3QIV3LbACh20BQn8EAAYASAAEgJ5-vD_BwE
  20. MComes RPH

    Weaning off arthritis meds

    Super, I am so glad you found something that works. If you would like to decrease either, or both, the Arthrotec and Gabapentin. I will first suggest you decrease the dose one medication then decrease the other. This is called stair step dosing. You decrease one a little bit then the other a little bit and alternate if needed. I will explain it for you. First we will address the Gabapentin. You said you were talking 300mg per day. If you are taking 100mg three times a day (total of 300mg per day), you can decrease it 100mg twice daily (total of 200mg per day). Try this for 3 days and then decrease the Arthrotec. You said you were taking 150mg of Arthrotec twice daily. I am not sure if you are taking 3 of the 50mg of Arthrotec twice daily OR 2 of the 75mg twice daily. At this point I will assume it is 2 of the 75mg twice daily. The best way to do decrease this would be to take 150mg in the morning and 75mg in the evening for 3 days and the decrease it to 75mg in the morning and 75mg in the evening. After 3 days of this regime you should be able to tell if you still have enough relief of your symptoms to maintain your quality of life. At this point if you would like to decrease your medications further let me know. I hope this helps and please keep me posted.
  21. MComes RPH

    Apokyn

    Noah, In a direction situation it should be fine to use the Apokyne. I would also like to let you know I found a pharmacy that can compound Apokyn generic (Apomorphine) lozenges. I think this might be what you are looking for. Here is the information about it and a phone number that you can call to see if they can bill your insurance. This is a mail order product so, you can contact a local compounding pharmacy near you to see if they can do the same thing. Apomorphine Compounded https://www.cfspharmacy.pharmacy/human-medicine/apomorphine-compounded?gclid=EAIaIQobChMIm-_-4_uQ3QIV3LbACh20BQn8EAAYASAAEgJ5-vD_BwE I hope this helps and please keep me posted.
  22. MComes RPH

    Question about moderation

    Cactusflower, I just finished answering your post. Let me know if you have any further questions.
  23. MComes RPH

    Apokyn

    Miracle, I am not sure when it will be available, but I will let you know when I hear something. I hope this helps and please keep me posted.
  24. MComes RPH

    How to extend dopamine effects

    Cactusflower, I will answer these in succession so as to better understand them. First, it is absolutely fine to take the Levothyroxine along with the Sinemet. I recommend doing this because both are better absorbed when taken on an empty stomach. I like that the Doctor is slowly increasing the Sinemet. My theory with Sinemet, as well as other PD medications, is to start low and go slow. This is the best way to avoid side effects while trying to obtain the most effective therapeutic dose. I will also recommend that if a patient is slowly increasing a Sinemet dose that the first dose to increase should be the one where it is needed most. In your case you are having trouble in the morning, so the morning dose is the one you should increase first. When a patient is taking Selegiline and Sinemet (Carbidopa/Levodopa) I will advise to separate them by at least 2 hours. The reason for this is due to the fact that Selegiline can increase the side effects of Sinemet. This can result in uncontrolled movements of the arms, head, and sometimes the legs. This is called dyskensia and can be diminished or even eliminated by separating the two medications by at least 2 hours. I usually recommend that the Sinemet is taken first followed by the Selegiline. The Sinemet has a quicker onset of action than the Selegiline. I believe that once the full regime is reached you will have better control of the symptoms throughout the day. I hope this helps and please keep me posted.
  25. MComes RPH

    Need to switch meds?

    Brenda, If you are taking it for Parkinson's and want to take less of the Regular Sinemet during the day, the usual dose of the ER is usually three times a day. You could try taking it in the morning to see how long the effects last, then talk to the Doctor to let him know. Many times I see the ER used three times a day and the Regular Sinemet used if needed throughout the day. Usually the only reason I have seen Sinemet ER used at bedtime is for Restless Leg Syndrome. Since this is not the case, I would definitely get in touch with the Doctor and express your concern. I hope this helps and please keep me posted.
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