Jump to content
helplinedonate

MComes RPH

Ask the Pharmacist Moderators
  • Content count

    2,361
  • Joined

  • Last visited

  • Days Won

    17

Everything posted by MComes RPH

  1. MComes RPH

    ER vs 3x/day

    There are a couple of reasons. Usually a doctor will start someone on the regular release and increase accordingly strength or how many times a day. This will also give a patient better control of when their symptoms come up, they can just take a regular strength. If someone does well on the regular and you pretty much know when the off times might come about, then one could change to the ER. If you take the Regular Release 3 times a day, you may be able to get away with take 2 of the ER a day. The main outcome you are looking for is to decrease the amount of tablets a day. If 3 a day of the regular release works well and off periods are in control, I wouldn't change something that's not broken. I hope this helps and please keep me posted.
  2. MComes RPH

    Generic Azilect price

    No new update. Looks like it has stayed the same. Sorry
  3. MComes RPH

    medication and exercise

    What I was referring to was the fact that many PD patients have a difficult time with balance, gait, and shuffling and that walking is one of the best low impact "exercises" to do. Here is a snippet from an NBC article I have attached. From nbcnews.com https://www.nbcnews.com/better/health/why-walking-most-underrated-form-exercise-ncna797271 The Physical Benefits of Walking “There are many reasons to walk for exercise,” says Ann Green, M.S., past heptathlon world athlete, yoga teacher and fitness studio owner. “Walking improves fitness, cardiac health, alleviates depression and fatigue, improves mood, creates less stress on joints and reduces pain, can prevent weight gain, reduce risk for cancer and chronic disease, improve endurance, circulation, and posture, and the list goes on…” These are just some of the physical attributes of walking. Also mentioned are mental issues it can improve. "The act of walking is also a proven mood booster. One studyfound that just 12 minutes of walking resulted in an increase in joviality, vigor, attentiveness and self-confidence versus the same time spent sitting. Walking in nature, specifically, was found to reduce ruminating over negative experiences, which increases activity in the brain associated with negative emotions and raises risk of depression." The damage of related related exercise compared to walking. Other comparable exercise (running) can damage the cartilage in the joints, can cause osteoarthritis, excessive stress on the heart which can damage the heart, and cause extra stress on the immune system. Which you can see in this article: From mnn.com https://www.mnn.com/health/fitness-well-being/stories/5-ways-walking-is-better-than-running. I hope this helps and please keep me posted.
  4. MComes RPH

    Question about Link between dopamine and testosterone

    S, I am glad to hear that and will also be interested in hearing the results. Like we discussed throughout this post, it appears we were on the right trail. I'm glad you found a Doctor who was open minded and willing to listen. To me, that is gold. I'm glad this helped and please keep me posted.
  5. MComes RPH

    medication and exercise

    Sharon, Great question. The main reason is that people with PD usually have issues with walking, balance, leg strength, and then eventually they give up and live a stagnant life. We all need to stay active, but mainly people with PD. Even just very low impact like stretching and yoga. You will find a great amount of information on line about why people with PD should exercise, but also specific types of exercise to do. It has also been proven that walking is one of the best "exercises" anyone can do to help to maintain quality of life. I will tell people that exercise is as small as one more step than you did yesterday. Literally, if you can only took 10 steps yesterday, then 11 steps today is progress. Also, like I stated, you should "exercise" AFTER you take your medicine. IF, by chance, you forgot to take your medication, then you should take it ASAP. I hope I clarified things for everyone and thank you for your input.
  6. MComes RPH

    Loss of Consciousness

    Jeff, Without knowing her full medical history is dose sound like like Sudden Sleep Syndrome (SSS) which does happen with many Dopamine Agonists. I know of a person who took Mirapex and fell asleep at the wheel and drove through a corn field. I am not pointing out Mirapex, but it does and can happen with all Dopamine Agonists. It has happened to people while driving, at work, while eating, or just sitting down. It rarely happens when the person is actively doing something. So, the short answer is yes there is a history with Dopamine Agonists and SSS. Now with an older medication like Sinemet, it can happen, but not suddenly. In fact, I have been on Sinemet for years and have never had an SSS yet. Sometimes I may feel a little groggy or foggy, but it is enough time for me to stop what I am doing (driving a car) and pull over until it passes. Just to be on the safe side, some Doctors may even prescribe a low dose of Ritalin or Adderall to combat the the issue. It does work, and works well. At this point you need to get her to the Doctor and let them know. They may submit a report to the drug company concerning the issue. It is when the drug companies get many of these reports that may cause them to, at the extreme, pay for certain damages that may occur while someone is on the medication and an episode happens. There has been a warning that has been put on the Dopamine Agonists that explains about SSS and addictive behavior because doctors have reported. For now, get her into the doctor ASAP and explain the very serious. He will probably stay clear of prescribing any Agonists for her. Sinemet is a good option. What ever the case, please let me know the outcome and I will help you along the way. I am glad she is ok and that she was not exposed to any seriously damaginging situations. I hope this helps and please keep me posted.
  7. MComes RPH

    liquid sinemet

    Noah, Once it is made in the morning it should be good all day. You are keeping it in the refrigerator, which is the correct thing to do. The only thing that may be an issue is that you have to vigorously shake it before each and every use. Also, different refrigerator's have different temperature zones within the cabinet. I notice that when I put something in the back on the top shelf it has a tendency to freeze up. If you keep it in the door it has a tendency to be affected by the door being opened and closed several times a days, so you don't really get a perfect temp. I usually recommend to keep it toward the frond of the shelf, preferably on the top shelf. But I believe when you use the lower shelves you should probably keep it toward the middle of the shelf. I hope this helps and please keep me posted.
  8. MComes RPH

    medication and exercise

    Thank you, and I appreciate all of you.
  9. MComes RPH

    medication and exercise

    Oh, you did not at all. But thank you. It is so awesome that there has been so much activity on this forum, but it has been rapid fire. Truthfully, anyone who knows me, will tell you that I love and thrive in this atmosphere. Mostly because I get to help so many people, which in reality, is very therapeutic for me. I can't thank you enough.
  10. MComes RPH

    medication and exercise

    Diana, I know it seemed like I got the two jumbled up, but I have been talking with Noah at least once a week. So I am sorry for the confusion. The posts literally came in back-to-back. Thanks again.
  11. MComes RPH

    Increasing Rytary dose

    You are welcome.
  12. MComes RPH

    medication and exercise

    Noah, With Ropinirole, you may have to take it about an hour prior to working out. You usually don't need extra, because I tell people to work out after they take their routine. But, if someone is off schedule, they may need up to one tablet of a Regular Release tablet to right the ship. I hope this helps and please keep me posted.
  13. MComes RPH

    medication and exercise

    Noah, The best way to remember is to use an old bottle and put some Sinemet in it. Then you place it where you start to work out. I actually put mine by my water bottle. Works every time
  14. MComes RPH

    medication and exercise

    Cereus, No problem. Anytime
  15. MComes RPH

    Decreasing Diphasic Dyskinesia

    camt68,, I think you need to start journal about PD. The journal should contain the medication, strength, time you take it, and any untoward effects (ie, Dyskensia.) I will tell you that when you first start changing My first recommendation would be to take a short acting (immediate release) as soon as you wake up. Mark that time in your journal. That way it can be absorbed and kick in to start working. Now, when you start to feel off, take the CR and mark it in the journal. Now when you feel like you are going off, take a Regular Release Sinmet and mark it in your journal, wait about 30 minutes, then take an Amantadine and mark it in your journal. The next time you feel off, take a Regular Release Sinemet, and mark it in your journal Then the next time yo feel off, take a Sinemet CR and mark it in your journal. Then the next time you feel off, take a Sinemet Regular Release and mark it in your journal. Then the next time you feel off, take a Sinemet Regular Release and mark it in your journal, then wait 30 minutes the take an Amantadine, then mark it in your journal. From there, if you feel off again, you should take a Sinemet Regular Release and mark it in your journal. The example journal should look like this: Medication Strength Time Taken Result Sinemet Regular 25/100 7:00am Off at 8:30am Sinemet CR 8:30am Off at noon Sinemet 25/100 12:00pm Amantadine 100mg 12:30pm Off at 2:30pm And so on. as you noticed I have you make sure that you write in the journal the time you went off. This is so that when you take the medication tomorrow, you should take it about 30 minutes before the time you did yesterday so you can avoid the off times. If you keep up with this journal, after about a week, your medication regime should be so effective that you may not even have any dyskensia, or many fewer. How may keep changing the times so that eventually the regime will be perfect, or close to it. I hope this helps and please keep me posted.
  16. MComes RPH

    Madopar vs Madopar HBS

    Cldm, The headache is very common and does usually go away over time, usually about a month. If after that time frame your headache does not go away, I would probably switch back to the Madopar 50/12.5 5 to 7 tablets per day. I have had some people find relief of the headaches by taking Excedrin. Don't take is you take blood thinners because Excedrin does contain Aspirin, as well as Acetaminophen (Tylenol), and caffeine. It appears like this combination really woks well. If the headaches do continue after about a week, you can take the Excedrin with the Madopar. I hope this helps and please keep me posted. I hope th
  17. MComes RPH

    medication and exercise

    Noah, It absolutely makes sense. Dopamine is the main chemical which makes muscle move. When we lack Dopamine, we lack the muscle motor skills, and we then have PD. When we work out, exercise, or do anything strenuous our body requires us to use more muscle strength, which requires more Dopamine. That is why if you have PD and do not take your medication before you do some sort of work out, you will definitely be off afterwards. I always recommend that PD patients do any exercise son after they take their PD medication. That way they will not be off ahterwards. Great topic. I hope this helps and please keep me posted.
  18. MComes RPH

    Increasing Rytary dose

    If they are increasing in frequency throughout the day, then I think the reasonable move would be to first try the added extra low dose during the day. You should see a change within about 3 days. If you do not see improvement, then try the higher dose but keep it at 3 times a day. If the issues are just getting worse, but are at the same time during the day, then I would try the higher dose but stay at 3 times a day. With this, you should also see a difference with about 3 days. If you do not, then after the 3 days I would try the lower dose but increase it to 4 times a day. I know these sound like the same thing, but there is a difference between frequency and overall strength of symptoms. Many times it is easy to tell them apart and sometimes it is easier. the ways that I have provided for you will help in either situation. I hope this helps and please keep me posted.
  19. MComes RPH

    Low dose Zonisamide

    Deb, I am going to break this down piece by piece to stream line it for us. 1) All of the over-the-counter products (turmeric, Omega red, calcium and Magnesium) should not be taken with the prescription medication. this is mainly due to them causing a decreased absorption of the prescription and not all of the interactions of the over-the-counter products are known because they are mandated by the FDA and not the DEA. You can take them all together, but I would recommend taking them with food, which would avoid them from interacting with the PD medication because most of that should be taken on an empty stomach. 2) I am concerned about the Pharmacist changing the Rasagiline. What strength and when did you take it before the change AND now what strength and how many times a day do you take it? Is it just 5mg at 7:00am? 3) There are some interactions that I will go over with you now: (a) Zonisamide and Benztropine: When these are taken together it can cause, mostly in younger patients, but the patient cannot produce sweat when these are taken together and can cause electrolyte imbalances. I don't think it should be an issue, but to avoid it those 2 medications should be separated as far apart as possible. Also, contact the physician if you notice the patient is not sweating. (b) Zonisamide and Xanax: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect. (c) Zonisamide and Tizanidine: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect. (d) Benztropine and Xanax: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect. (e) Benztropine and Rasagiline: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect. (f) Zonisamide and Rasagiline: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect. (g) Rasagiline and Xanax: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect. (h) Xanax and Entacapone: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect. (i) Xanax and Tizanidine: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect. (j) Benztropine and Tizanidine: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect. (i) Levodopa and Tizanidine: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect. (j) Tizanidine and Entacapone: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect. (k) Entacapone and Zonisamide: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect. (l) Benztropine and Entacapone: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect. To a lesser extent than above ** As you can see all of the medications listed under (3) can cause the same similar issue, which would cause the daytime drowsiness you have been experiences. (4) Benztropine and Levodopa: Benztropine can decrease the absorption of Levodopa. Which will decrease the amount of Levodopa there is to be used by your body. (5) Xanax and Levodopa: Xanax can decrease the effects of Levodopa. (6) Levodopa and Rasagiline: Rasagaline can increase the side effects of Levodopa and can worsen already present dyskensia. From your list of medications and the many overlapping side effects that have to do with the CNS, such as drowsiness and respiratory depression, I am very surprised that you are not experiencing more drowsiness. From the list of medications and side effects I would not add alcohol because it will case all of the drowsiness, breathing, and possible "zoning out" sleeping to become much worse. In my opinion, I think you may want to speak with your doctor about these overlapping issues and try to correct them, or possibly seek a second opinion. Not a second opinion about the Parkinson's Disease but rather about a whole new medication regime. As you can see from the side effects alone, there are many overlapping meds causing the same issues. Depending on how much Xanax you use during the day could also make this issue worse. Here are some of my concerns: 1- The paralytic sleep you speak you experience is because of the Rasagiline, Tizanidine, C/L/E, Benztropine, and maybe Xanax that you take first thing in the morning. All of these interact with each other to have the 1+1=3 EFFECT, but to a greater effect because you have around 7 different ingredients that have the same side effects. 2- I think that either a C/L/E should be used possibly at the 100 strength less times a day OR possibly make a change to Sinemet and Sinemet CR. This way you do not have the Entacapone there to interact with the other medications. 3- I am wondering why Tizanidine is only being used twice a day, in the early morning and early afternoon. Maybe a change to a lower strength more times a day could give better relief throughout the day and possibly help with the sleep issue. 4- If you are looking for something to help you sleep, a medication like Trazadone or certain antidepressants may help with that issue. I think if some of the other issues I mentianed were looked at then maybe your sleeping issue might be a little more stable. 5- I see why the Zonisamide is being used, but some of those symptoms that the doctor prescribed Zonisamide for could be side effects from the interaction of Levodopa and Rasagiline. One such interaction symptoms is hypotension, which can be caused by alcohol, Parkinson's Disease, low body weight, and being dehydrated (which can be caused by the interaction of Zonisamide and Benztropine). Some symptoms of Hypotension are anxiety, dizziness, lightheadedness,vision changes, and balance changes. So, I may look at aking that away and looking at changing times or dosages of Rasagiline. I hope this helps and please keep me posted.
  20. MComes RPH

    DESPERATE FOR SCHEDULING HELP

    You are welcome.
  21. MComes RPH

    DESPERATE FOR SCHEDULING HELP

    Linmuia, The Levothyroxine should be taken first thing in the morning on an empty stomach. It can be taken with some food about 30 minutes after taking it, but these food should be avoided because they can decrease the absorption of T4 (Levothyroxine). Those foods are calcium in all forms ( vitamins, calcium added to juices, etc...), walnuts, soybean flour, cotton seed meal, and dietary fiber (powder, tablets, or waffers). As far as when to take the Sinemet, it is important to take without food. The best absorption is when the Sinemet is taken 1 hour prior to a meal or two hours a meal. Most people have the best success with taking it one hour prior to meals because it is easier than waiting two hours to eat. If someone needs a small snack within the time constraints of one our before or two hours after a meal, that is fine. The main product to completely stay away from is protein. When protein is taken taken too close to Sinemet, the protein will almost always be metabolized before the Sinemet in the liver due to the greater affinity the liver enzymes have for the protein. As far as to when to take the amantadine, it will all depend on when the dyskensia usually happens throughout the day. The best way to figure this out is to make a journal that will look somewhat like this: Medication Strength Time Given Symptom time start/stop Levothyroxine 75mcg 7:00am none Sinemet ? (1/2) 8:00am none Sinemet ? (1/2) 11:00am Dyskensia at 12:00 Noon Amantadine 100mg 12 Noon Dyskensia stop at 12:45pm once you have this information for the first day, you will then be able to adjust for the next day. The first day may be the toughest because you will have to wait until the dyskensia starts and the give the Amantadine. So, in the example above the Dyskensia started at Noon. Which means to avoid it the next day, you should probably try to give it around 11:30am. When yo keep this type of journal it will be easier to manage when to give the medications. As time goes on you should a very precise medication regime. There will be days that may go again st the normal, but that will happen and you will just have to adjust to it on those days. The last point I can give you is that you may feel that have to adjust more than one medication at a time. The main thing to do is to get the timing of the Sinemet timing correct, or as close to correct as possible. From there, you will see what time the dyskensia occurs, Just an FYI, Dyskensia will usually occur when the Sinemet levels are even just a little too high. So, you may see it happening after possibly the second and fourth doses of the day. They may also occur at different times because no two patients are the same. This is why you use the journal to have a specific medication regime for that patient. I hope this helps and please keep me posted.
  22. MComes RPH

    Splitting Tablets

    Gene, i don't see a problemat all with that. Good luck. I hopethis helps and please keep me posted.
  23. MComes RPH

    ropinirole

    Hiker, The average dose varies dependingon theperson, maybe 3 to 5 mg three times a day of immediaterelease. I do see dizziness as an issue when someone first starts on the medicationand when the get up from a sitting or laying down position. Ihopethishelps and please keep me posted.
  24. MComes RPH

    Mucuna Pruiens

    Marle, Any time. Thank you.
  25. MComes RPH

    Parkinson's Meds Info

    I tried a copy and paste of the link you provided and it did not lead me anywhere, only a blank screen. I wish I could hep you. I'm sorry.
×