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MComes RPH

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Everything posted by MComes RPH

  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. About Xadago (safinamide) Safinamide is a new chemical entity with a unique mode of action, including selective and reversible MAO-B-inhibition and blocking of voltage dependent sodium channels, which leads to modulation of abnormal glutamate release. Clinical trials have established its efficacy in controlling motor symptoms and motor complications in the short term, maintaining this effect over 2 years. Results from 24 month double-blind controlled studies suggest that safinamide shows statistically significant effects on motor fluctuations (ON/OFF time) without increasing the risk of developing troublesome dyskinesia. This effect may be related to its dual mechanism acting on both the dopaminergic and the glutamatergic pathways. Safinamide is a once-daily dose and has no diet restrictions due to its high MAO-B/MAO-A selectivity. Zambon has the rights to develop and commercialize Xadago® globally, excluding Japan and other key territories where Meiji Seika has the rights to develop and commercialize the compound. The rights to develop and commercialize Xadago® in the USA have been granted to US WorldMeds, by Zambon *Information provided by the FDA Website
  12. 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.
  13. 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.
  14. 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.
  15. FDA Approves Xadago FDA Approves Xadago (safinamide) as an Add-On Treatment for Patients with Parkinson’s Disease March 21, 2017 -- The U.S. Food and Drug Administration today approved Xadago (safinamide) tablets as an add-on treatment for patients with Parkinson’s disease who are currently taking levodopa/carbidopa and experiencing “off” episodes. An “off” episode is a time when a patient’s medications are not working well, causing an increase in Parkinson’s symptoms, such as tremor and difficulty walking. “Parkinson’s is a relentless disease without a cure,” said Eric Bastings, M.D., deputy director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research. “We are committed to helping make additional treatments for Parkinson’s disease available to patients.” An estimated 50,000 Americans are diagnosed with Parkinson’s disease each year, according to the National Institutes of Health, and about one million Americans have the condition. The neurological disorder typically occurs in people over age 60, though it can occur earlier, when cells in the brain that produce a chemical called dopamine become impaired or die. Dopamine helps transmit signals between the areas of the brain that produce smooth, purposeful movement – such as eating, writing, and shaving. Early symptoms of the disease are subtle and occur gradually. In some people, Parkinson’s disease progresses more quickly than in others. The efficacy of Xadago in treating Parkinson’s disease was shown in a clinical trial of 645 participants who were also taking levodopa and were experiencing “off” time. Those receiving Xadago experienced more beneficial “on” time, a time when Parkinson’s symptoms are reduced, without troublesome uncontrolled involuntary movement (dyskinesia), compared to those receiving a placebo. The increase in “on” time was accompanied by a reduction in “off” time and better scores on a measure of motor function assessed during “on” time than before treatment. In another clinical trial of 549 participants, the participants adding Xadago to their levodopa treatment had more “on” time without troublesome uncontrolled involuntary movement compared to those taking a placebo, and also had better scores on a measure of motor function assessed during “on” time than before treatment. Certain patients should not take Xadago. These include patients who have severe liver problems, or who take a medicine used to treat a cough or cold called dextromethorphan. It also should not be taken by patients who take another medicine called a monoamine oxidase inhibitor (MAOI) because it may cause a sudden severe increase in blood pressure, or by those who take an opioid drug, St. John’s wort, certain antidepressants (such as serotonin-norepinephrine reuptake inhibitors, tricyclics, tetracyclics, and triazolopyridines), or cyclobenzaprine, because it may cause a life-threatening reaction called serotonin syndrome. The most common adverse reactions observed in patients taking Xadago were uncontrolled involuntary movement, falls, nausea, and trouble sleeping or falling asleep (insomnia). Serious, but less common, risks include the following: exacerbated high blood pressure (hypertension); serotonin syndrome when used with MAOIs, antidepressants, or opioid drugs; falling asleep during activities of daily living; hallucinations and psychotic behavior; problems with impulse control/compulsive behaviors; withdrawal-emergent hyperpyrexia (fever) and confusion; and retinal pathology. The FDA granted approval of Xadago to Newron Pharmaceuticals. Source: FDA Posted: March 2017
  16. 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.
  17. Hello everyone, I have had many questions about when generic Azilect is coming out. I guess the best way to put it, now as we speak, is that just because a patent expires does not mean it will automatically go to generic. There are patent laws involved, as much as we may not like them, they are there for the brand name company to squeeze every dollar they can get. I found 2 terms that may make this a little easier to understand. I have posted them below, but as of today, I still have the release date of ABOUT FEBRUARY 2017. Here are the 2 terms used when it comes to patent law: TERM DEFINITION Drug Patent: A drug patent is assigned by the U.S. Patent and Trademark Office and assigns exclusive legal right to the patent holder to protect the proprietary chemical formulation. The patent assigns exclusive legal right to the inventor or patent holder, and may include entities such as the drug brand name, trademark, product dosage form, ingredient formulation, or manufacturing process A patent usually expires 20 years from the date of filing, but can be variable based on many factors, including development of new formulations of the original chemical, and patent infringement litigation. Drug Exclusivity: Exclusivity is the sole marketing rights granted by the FDA to a manufacturer upon the approval of a drug and may run simultaneously with a patent. Exclusivity periods can run from 180 days to seven years depending upon the circumstance of the exclusivity grant. Hope this helps clear up some confusion out there.
  18. 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
  19. The onset of action of Sinemet CR is 30 minutes to 45 minutes. The medication is available in low amount after being metabolized and having much of the medication being released over the 4 to 6 hour period then decreasing in plasma concentration as the medication is expelled from the system. When you look at the mechanism of the medication it will show that the peak plasma concentration happens after about 2 hours. What we have to remember is that it will pass in the blood before it will cross the Blood Brain Barrier, where it works. So that is why it appears there is a discrepancy between Peak plasma concentration of 2 hours and the medication reaching it's release time of 4 to 6 hours. I hope this helps and please keep me posted.
  20. If you ever get overwhelmed with confusion feel free to contact me. I am glad to hear you bought a new bike. If you still have a good bit of balance, biking is a great way to not only strengthen the muscles but also to stretch the muscles as well. Speaking of stretching, make sure you do a few stretches of the legs and back before each ride because this can truly help you from pulling any muscles, ligaments, or tendons. I just took my bike in for it's annual check-up before riding season is here. I hope this helps. Have fin and please keep me posted.
  21. As far as hearing complaints about the different generic brands, I have only individuals state what works best for them and it is usually a hit or miss tactic or trial by error. What has complicated now is that TEVA Generics has acquired Actavis Generics for a about $41 Billion dollars. The confusion comes in because it appears that when the pharmacy orders Actavis generic they are still getting the TEVA tablets. I have contacted both companies and neither one of them tell me if eventually all will be under TEVA or Actavis names. I personally have been taking the Mylan generic of the CR (controlled Release) and it has worked well for me. A friend of mine has taken the Mylan brand and has had many gaps in his "on/off" times. I also take the Regular Sinemet (also know as Sinemet IR for Immediate Release) to help with off periods between Sinemet CR doses, and the TEVA brand seems to work best for me. I would have to tell you it is probably going to be a trial and error. One thing to remember is that there may not be any brand that will completely rid you of all of your symptoms throughout the day. This is the price we pay when our system cannot give us a constant supply of dopamine and we have to regulate it ourselves. I hope this helps and please keep me posted.
  22. When it comes to brand name versus generic there only has to be one consistent factor, that being that the amount of active ingredient has to be the same in both. The other factors in making the tablet are what usually makes the difference in how long or how fast the medication works. The generic company may use a different filler. The filler is used to an inactive ingredient that is added to the active ingredient to make it into a tablet. The other factor that comes into play is how hard the ingredients are pressed together to make a tablet. If they are pressed too hard, the tablet will not break down as quickly. If it is pressed to softly, the tablet will fall apart to quickly. At this point the inactive fillers could also then slow down or speed up the absorption process. As far as the Brand Name Sinemet working better than the generic, I would have to apply the previous rules to this product as well. I only have come in contact with a few patients who take the name brand Sinemet and that is usually because they say it is an allergic reaction issue with a certain generic brand. If you do notice that the Sinemet seems to work during the day but seems to have a shortened activity at night, you may want to take to the doctor about adding a Regular Sinemet (many call it an Immediate Release Sinemet) about one hour prior to your evening dose of Sinemet CR. This Regular Sinemet has a fast onset of action which takes care of the off time you may experience. This will then carry you over to your next dose of Sinemet CR. I hope this helps and please keep me posted.
  23. I agree with you. YOPD is very rare and many ER doctors look at you with a side eye when you tell them you have it. Usually they run run the usual CBC blood tests to get a wide range view and then narrow it down if anything in the CBC is not within normal. Thanks for the information and please do keep me posted.
  24. Please do keep me posted. The QT wave issue was one issue I brought up because when it happened to me I decided to look up any and all correlations between prolonged QT wave and PD. The search revealed very little information, but enough that I felt it need to be mentioned. The urea cycle has 5 parts and is very difficult to understand let alone explain. The urea cycle mediates the removal of ammonia as urea through the urine. A diagnosis of of defective urea cycle is usually made by a blood test called an aminogram where it has been found that glutamine and alanine levels are high. When there is decreased activity glutamine synthesis a result can be to excessive amounts of glutimate. We do know that glutimate plays an important role in Parkinson's Disease. I hope this helps and please keep me posted.
  25. To All, I would like to take this time to apologize for the delay in answering your questions. About a week ago I dislocated my shoulder and, to anyone who has ever had this happen to them or someone they know, it is almost impossible to do the smallest things let alone type. I am in a "arm to body sling" which basically keeps my arm against my body so movement of that arm id minimal at best. You are really only able to use that hand that is against your body. I went to the surgeon yesterday and the X-rays did not show any broken bones or any fragments in the shoulder, which is good news. My next step is to have a CT Scan, scheduled for next Monday, which will tell us if there is a tear in the rotator cuff or any other tissue damage in the area. I will keep you all posted and thank you again for your understanding. My replies may take a tad bit of time but I will get to them. Thank you, Mark R. Comes R.Ph.