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MComes RPH

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Everything posted by MComes RPH

  1. MComes RPH

    Rytary experience

    DMy experience was pretty straight forward. I was initially taking Sinemet Regular Release about every 4 hours and Controlled Release three times a day. When Rytary came out it showed a great deal of promise for everyone with PD. I tried it with the hope the hope of improving my quality of life. My 3 month period started off with a dose that caused dyskensia, even though the conversion was calculated correctly. The next next dosage was low across the day. The first month ended on a mix note with daily dosages being too many or too few capsules which resulted in fluctuations in on and off periods. The second month consisted of trying to specifically controlling long term symptoms. An attempt was made to add small doses throughout the day. Instead of two doses at once we tried one dose every few hours which was defeating the purpose of the change. The third month consisted of a combination of Rytary and Sinemet CR. The Sinemet CR had to be added for long term control. It was more reasonable to add 2 Sinemet CR's than 4 or more capsules per day. Eventually the decision was made to return to go back of the Regular Sinemet and Sinemet CR therapy. In many people the Rytary has been a change for the positive. I had long term control issues which were better taken care of with controlled release Carbidopa/Levodopa therapy. I hope this helps and please keep me posted.
  2. MComes RPH

    LongQT

    Waywrd, Thank you for the list. It is one that I have used in the past and is very comprehensive. I am glad to see that your issue is being narrowed down, but I am sorry there has been do conclusive diagnosis. When this happens it can be very disruptive to the patient and even a contributing factor to the issue as a whole. If there is anything I can do for you please let me know. I hope this helps and please keep me posted.
  3. MComes RPH

    Meds At Bedtime

    Robert, Vivid dreams occur in about 30% of the patients receiving Carbidopa/Levodopa theraby. The dreams can be classified as vivid dreams, nightmares, or night terrors. If the vivid dreams or nightmares are interfering with your sleep pattern, you may want to talk to your Doctor about the possible use of a sleeping aid to help with your sleep. I hope this helps and please keep me posted.
  4. MComes RPH

    rytary and quetiapine

    Gene, Quetiapine (Seroquel) may reduce the effectiveness of Levodopa. In addition, using these medications together may increase the risk and/or severity of side effects like low blood pressure, dizziness, lightheadedness, and drowsiness. I would recommend that the medications be separated by at least an hour. This will allow for one to be metabolised before the other is introduced into the body. The order in which they are taken is not of concern because the outcome will be the same. I hope this helps and please keep me posted.
  5. MComes RPH

    Interaction?

    Tracey, It may not be the Rytary that is causing the insomnia, but rather Rytary wearing off that may be causing the wakefulness. Wakefulness can be a result when any Carbidopa/Levodopa falls below the therapeutic level. Rytary and Sinemet contain the same ingredients, Carbidopa/Levodopa. Sinemet CR is a controlled release formula of Carbidopa/Levodopa which lasts longer dose per dose. Rytary is comparable the regular release Sinemet when dosed. I hope this helps and please keep me posted.
  6. MComes RPH

    pain medicine

    Noah, I prefer and recommend Ibuprofen (Motrin, Advil) over Acetaminophen (Tylenol) when it comes to pain and/inflammation relief. First, because it is more effective. Two, because Acetaminophen is metabolised by the liver which can cause a hindrance or delay in metabolism of other medications, like Trazadone. More than 60%of the prescription medications available are metabolised in the liver, so taking a medication that is not primarily metabolised in the liver can lessen the amount of drug-drug interactions. One note of caution, Ibuprofen can be hard on the stomach so it advised to be taken with food. I hope this helps and please keep me posted.
  7. MComes RPH

    Medication and dosage help.

    Diane, That is fine.please keep me posted.l
  8. MComes RPH

    Medication and dosage help.

    Diane, I would stick with the Sinemet. Easier to dose and change between fast acting and long acting. More predictable results and not as sensitive as Rytary. Anything else, let me know.
  9. MComes RPH

    Meds question

    You're welcome.
  10. MComes RPH

    Too many meds?

    Melinda, I have gone over this several times, and every time I see the same issue. I am not being smart, but all of the PD meds must be handled by the specialist. I can suggest changes, but you will then have to go to the corresponding doctor to get that change taken. Here are the most serious issues. Hydroxyzine can cause increased contact of potassium on stomach lining which can cause bleeding and can be serious. A change to a liquid potassium would be advised. Atorvastatin with either levodopa or hydralazine can cause peripheral neuropathy. It can be mad worse since both are involved. Hypotension, low blood pressure, caused by levodopa, can be made worse by adding hydralazine. This can cause fainting and lightheadedness. These are some of the more severe. I strongly suggest to let the PD specialist take care of all PD meds and they work in conjunction with the family doctor for the common goal of the patient. I hope this helps and please keep me posted. ,
  11. MComes RPH

    Medication and dosage help.

    Everything looks good as far as spacing and timing of medications. I would really like to see only one form of carbidopa/levodopa used. I think that when you use different varieties you will probably run into issues of off times that will be more difficult to correct. Since the majority of the carbidopa/levodopa are derived from Sinemet, I would recommend using that form throughout your dosing. Other than that, timing and spacing appear correct. Are their any issues you are having? Thank you, I hope this helps
  12. MComes RPH

    Meds question

    You should separate them. Try Rytary one hour before breakfast and Azilect with breakfast. If you take them together, Azilect can increase the severity of Rytary side effects. I hope this helps and please keep me posted.
  13. MComes RPH

    Need to switch meds?

    Brenda, Sinemet is the true gold standard for Parkinson care. That does not necessarily mean we stop looking if it starts to fail us. I don't like to make a lot changes, so I would suggest changing the Ropinirole to Sinemet CR. This way you have consistency with your primary meds. You may have to tapper off Ropinirole and slowly increase Sinemet CR. Make sure all Sinemet is taken one hour before food or two hours after a meal for best absorption. Also, an add on of Amantadine to take 1 capsule twice daily would probably help. Lastly, there is the Apokyne Injection, which works like an epi-pen that you can hardly feel, that brings you out of "off" periods very quickly. I hope this helps and please keep me posted.
  14. MComes RPH

    Sinemet and morning Blood Glucose increase

    Sometimes that feeling can feel like neuropathy, but it is very difficult to explain. Some say it can also feel like ants crawling in their bones. It can also feel like the start of dyskensia. I hope this helps and please keep me posted.
  15. MComes RPH

    Too many meds?

    Melinda, I am working on this for you and will have it for you shortly. Thanks
  16. MComes RPH

    Interaction?

    Tracy, There is no interaction between Rytary and Synthroid. They can be taken together with water. Food can be eaten about 1 hour after taking meds. The interaction between a decongestant and Azilect is to be used with caution. Azilect is a selective MAOI-B Inhibitor. Some other ones are not selective and hit MAOI-A & MAOI-B. When this happens it causes a severe hypertensive reaction which could lead to passing out, or worse. It has been shown that people who use Azilect are able to eat tyramine like food and have no problem. I hope this helps and please keep me posted.
  17. MComes RPH

    Azilect drug interaction?

    That is only is it is taken orally. The eye drops work topical and do not get absorbed into the blood stream.
  18. MComes RPH

    Sinemet and morning Blood Glucose increase

    Doc, I hope all is as well as it can be. Please keep me posted. Also, if you had to go to the ER, make sure you get a copy of the chart notes about the visit. I'm sure your Neurologist would appreciate them for a case study. Or at least the hospital he works with could use them. I have a busy day tomorrow, but I'll be checking for updates. <Praying for you>
  19. MComes RPH

    Sinemet and morning Blood Glucose increase

    Dave, I'm not sure when Linda will get back with you, but here is basically the nuts and bolts of it. I'm sorry, but I do not have the link. But here is what I do know and what I have learned from the study by Dr. Shankar. A- Cortisol levels in PD patients peak in the morning and evening B- Glucose levels in diabetes increase in the morning and evening Glucose and insulin metabolism in a great number of PD patients appears very similar a low level form of diabetes where Sinemet interferes with glucose absorption in skeletal muscles. This causes an inincrease in insulin levels as the body tries to overcome this action. **The study noted found insulin levels tripled after a year of therapy on Levodopa. C- Hyperglycemia can quickly trigger hypoglycemia by over production of insulin. Here is a study by Dr.De Leon that describes the reaction. Could Rampant High Glucose Intolerance among Parkinson’s patients lead to an increased risk of diabetes? The other day, I had a follow up with my endocrinologist because I have been concerned about a slowly increasing sugar levels as well as HgA1C (glycosylated Hemoglobin used to detect sugar levels in the last 3-6 months to help diagnose diabetes and then gauge management) possibly being caused of increased night sweats and overall sweating. Although I am not diabetic, I am becoming slowly at risk…which initially I attributed my increase glucose levels to the number of steroids I have received over the past 12 months for treatment of various other illnesses. Then I began to wonder if this process had anything to do with my Parkinson’s? I then seemed to remember reading something about dopamine increasing sugar levels and tried to recall by first year of medical school when we discussed physiology. After my visit my doctor confirmed that I was becoming glucose intolerant and would be best to start treatment to avoid developing diabetes. Well of course this was not a pleasant experience to add yet another medication to my already long list of medicines but more importantly sent me in search of answers? What I discovered to my great astonishment and chagrin was that indeed there is a connection between having Parkinson’s, dopa intake and developing insulinresistance leading to diabetes. What amazed me the most was study after study detailing this information dating back to the late seventies; yet no one in neurology or Parkinson’s specialty much less others outside this field have ever made any comments, concerns, or indications to monitor a patient’s sugars or discuss risk of diabetes!!!! In the presence of high sugars, dopamine stimulates insulin secretion from pancreatic cells. (1) The substancia nigra plays a crucial role in controlling structure and activity of these pancreatic islet cells which produce insulin. When lesions occur in this area of the brain or there is loss of dopamine there is a decrease in the content of insulin thus unable to properly regulate blood glucose levels causing an increase? This process is mediated via D2 receptors in the pancreas. However, as with all things pertaining to the brain things are not always straight forward. At increased concentrations outside of the brain it has an inhibitory role while it stimulates insulin at lower concentrations. Here are some of the studies below. **If you google "levodopa induced hypoglycemia" there is a post entitled "The role of Levodopa induced glycemic in PD normal. " It has a great PDF attachment that you can download that describes this effect. https://www.ehealthme.com/ds/sinemet/high-blood-sugar/ https://www.ncbi.nlm.nih.gov/m/pubmed/8082998/ I know this is a lot of information, but what I provided will hopefully help you. Mark "The Pharmacist"
  20. MComes RPH

    Azilect drug interaction?

    Those are absolutely fine to use together. I hope this helps and please keep me posted
  21. MComes RPH

    Sinemet and morning Blood Glucose increase

    I'm on call for you. Keep me posted and good luck.
  22. MComes RPH

    Sinemet and morning Blood Glucose increase

    Linda, Here is the post I replied to, it was under forum post "Sinemet vs Sinemet CR for overnight" post. Dr Comes -- it seems I have worse problems than this. Please see the urgent post I just sent. Would it be at all poss\sible to get back to me on that post asap as I have a dr appt on Monday and will need to make my case with all the ammunition I can find. It's tough when I'm having only 5-6 hours of ON time a day now, but I must find as much information as I can (about sinemet causing a "rebound" reaction linked to diabetes -- you originally posted this info on July 26 2017; again, I need a many relevant leads or links as you can give me. Thank you so much! Linda
  23. MComes RPH

    Sinemet and morning Blood Glucose increase

    Doc, What are you going through right now?
  24. MComes RPH

    Sinemet and morning Blood Glucose increase

    Doc, I found them and I'm not sure how they got there, but here you go. I'll keep my forum and updates open, so I will see it as soon as you get. I'll be on stand by. Doc, I wish I had the time to look over and get all of them. I have a few, but if you could get some friends to Google"diabetes and Parkinson's Disease" and "Diabetes and Sinemet" that is where most of the information is. Here are a few: https://www.ncbi.nlm.nih.gov/m/pubmed/8082998/ https://www.diabetes.co.uk/diabetes-complications/parkinsons-disease.html https://defeatparkinsons-com.cdn.ampproject.org/v/s/defeatparkinsons.com/2015/08/16/could-rampant-high-glucose-intolerance-among-parkinsons-patients-lead-to-an-increased-risk-of-diabetes-by-dr-de-leon/amp/?amp_js_v=a1&amp;amp_gsa=1&amp;usqp=mq331AQCCAE%3D#amp_tf=From %1%24s&amp;ampshare=https%3A%2F%2Fdefeatparkinsons.com%2F2015%2F08%2F16%2Fcould-rampant-high-glucose-intolerance-among-parkinsons-patients-lead-to-an-increased-risk-of-diabetes-by-dr-de-leon%2F https://www.medhelp.org/posts/Diabetes---Type-1/What-is-the-effect-of-Sinemet-on-blood-sugar-levels/show/2991817 https://www.diabetes.co.uk/diabetes-complications/parkinsons-disease.html https://scholar.google.com/scholar?q=diabetes+and+parkinson's+disease&amp;hl=en&amp;as_sdt=0&amp;as_vis=1&amp;oi=scholart https://parkinsonsdisease.net/living-with-pd/diabetes-risk-link/ https://www.movementdisorders.org/MDS/Scientific-Issues-Committee-Blog/The-Relationship-Between-Diabetes-and-Parkinsons-Disease.htm http://care.diabetesjournals.org/content/30/4/842 https://www.everydayhealth.com/type-2-diabetes/treatment/are-parkinsons-disease-type-2-diabetes-linked/ https://www.mdedge.com/neurologyreviews/article/73401/movement-disorders/there-underlying-biologic-relationship-between I'll be waiting.
  25. MComes RPH

    Drug Interaction

    The overall stomach acid will be a bit lower, but it should not affect the c/l dosage. This would be great time to use a journal and see if it does affect the c/l timing. I hope this helps and please keep me posted
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