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miracleseeker

The longevity of Sinemet

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Mark,

 

How long does half a 25/100 regular Sinemet last in the body? From ingestion to completely be gone from the body?  I've given my mom half a Sinemet around 2 am for about a week and she started to grind her teeth again so I stopped 2 nights ago.  Yesterday she was so mobile and alert that I wondered if it was the extra Sinemet getting the credit but then she had not taken it the night before so I wondered if that's possible.  She has not grind her teeth since yesterday so it is Sinemet that's doing it to her.  A year ago when the grinding started she was walking by herself and moving very well but breaking  her teeth so I decided to decrease it so she could stop grinding.  She has not walked alone for half a year now but seeing how she was yesterday I'm getting hopeful again but that would start up Sinemet again. 

 

This is why I ask do you think half a pill would last all day for her meaning blending in with her other PD drugs to create this perfect harmony?

When she sees her doctor next week and get the Amantadine to see if she will have more energy do you think it will help with the teeth grinding then maybe she can continue taking the sinemet?   She was givien Amentadine for dyskinesia which is what her doctor said is the reason for the grinding but instead I deceased her meds which worked so she never took it.  At the time I didn't want to have her take more drugs but if Amantadine will perk her up then I'm ok with that.

 

 

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The questions you are asking is a great one, but there are too many factors to be able to measure that. What they do measure is what they call "half life." Half life is the time it takes for the medicine (once in the blood stream) to be broken down to 1/2 of it's strength.

On the sinemet, in a person who has PD and no other issues (such as liver or kidney problems) and is at an age of 55-60 years old is ONE HOUR. Now this changes, as you are aware, with age due to the ability to metabolize may be compromised due to liver issues. It can also be affected by stomach acid, food, intestinal issues (food in the intestine), other meds, time of day, etc..

So, that is all the info they have on medication levels in the system.

Keep ke posted. Good to hear from you again and stay strong!

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1 hour?  That's for someone younger and in better health than my mom too.  Well.... I think it lasts like 2.5 hours for her until she looks like she needs a pick me up.  I guess the burst of energy in the afternoon has nothing to do with it then.  I'm not complaining of course just wanted to know the cause. 

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Mark,

 

Today's the 3rd day on liquid Amantadine 100mg and my mom is worse than before.  She has no energy, can't walk much and is hallucinating and mumbling with her eyes closed.  I am so discouraged. 

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I know it is discouraging, aggravating, and all out disappointing. But remember what I have always said about PD meds. The main thing to remember is to "Start low and go slow." Most people, with or without PD, who have to take a med for any length of time, give up because they do not give it time to work.

You have been through a lot and you and I have discussed your mom's issues for so long that I feel like I should call her mom also. I know it can be frustrating, but you are a great care giver. It may take some time, but I know you know deep inside that there is no miracle overnight cure.

Hang in there and keep me updated. You know where to find me if you have a question or just need to vent. I wear many hats, but the one I am most proud of is the hat I wear in this forum. I know I help a lot of people, but you have no idea what great therapy this is for me. Every day, almost, it get to converse with so many great people, such as yourself.

I know some higher power gave me PD for a reason. That reason took a while for me to figure out. That higher power gave me Parkinson's because I am a pharmacist who cares for people. Since there is no cure, who better to have PD than a caring pharmacist.

Hang in there and keep me posted.

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I feel stopping it is for the best.   Today my mom seems 100 times better than the last few days while she was on it.  Since she can't tell me how she feels I can only watch and observe.  You know how you feel when you take cold medicine and get all weird?  I think that's what Amantadine was doing to her.  After her afternoon naps she's usually wide awake and can go outside for  a short walk.  Yesterday her legs were like noodles and I walked her out and came back in less than 3 minutes later.

 

Quick question for you -  My mom will need more dental procedures mainly deep cavities that I blame on the partials she started wearing since the last surgery.  They grasp on to existing teeth and all kinds of food gets stuck on there and you know what happens from that.  Anyways, she was out for 20+ hours from IV sedation last year so her dentist refuses to use that again.  My suggestion was to have my mom take some Benadryl before we go so she will be knocked out by the time she sits in the chair and not fidget like she would if she were awake.   The dentist was open to the idea but it's my call.  So.... what do you suggest for the dosage and how  long do you think it takes to start working and how long before it leaves the body?  The procedure should only last an hour.  What do think about giving this our MOM? :-P

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That is a fine idea. As to how much and when to give it to her, you may want to try it at home so you can see.

Usually 1 tablet 30-45 minutes before bed usually will work. Try it before hand at home, that way you will know if it has to be 30 minutes or an hour. It will also tell you 1 or 2 tablets.

FYI? Benadryl was one of the first medications used to slow down tremors in PD patients.

Hope that hels and good luck.

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Back to Amantadine.  On the 4th day which was the day I stopped the dose my mom was fully awake and started talking.... A LOT.  Not making sense but at least talking.  Do you think you were right that maybe I didn't give it enough time for her body to adjust to it?  She was so out of it and was so weak in the legs on the 3 days that was why I stopped.   Little by little day after day then she stopped talking again and is back to her sleepy ways.  Coincidence?

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I think it was just the fact that either (1) it was not given for a long enough time, or (2) maybe she may need a lower dose, which can be given in a liquid version.

I think it may be the case of a lower dose, so maybe 1/2 the regular dose may be the answer. Because it was still in her system, just at a lower blood level.

So as much as I would LOVE to say I am right, I think it is the dose issue this time.

Keep me posted.

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Possibly 50mg twice daily then possibly try to lower it every 3 days or so. Or a few days on and a few days off.

Keep me posted.

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Gee Mark if I have my mom take it a few days here and there and keep lowering the dosage then what's the point?   I'm not trying to get her off the med.  As I stated earlier she was not doing well the first 3 days but on the 4th day she was wide awake and light as a feather.  That was also the day I stopped the Amantadine.  That was why I asked you if you think maybe the drug was finally working and was still in her system from the previous 3 days  and not because I stopped it the 4th day and she was rid of the drug completely which was why she seemed so much better.  Even so without Amantadine she was not like that.  So talkative and alert.

 

In the meantime I'm giving her coconut oil at 2 tablespoon  a day to see if that may help her.  I've read about people doing well on this and people on this forum.  I'll try anything natural first.

 

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I may have mis-stated myself. I meant to do that and decrease the dose each time because I thought you were trying to get her off of it. Maybe we just got our wires crossed.

You are trying to get her off of it, am I correct? So that is why I communicated to slowly decrease the dose over time because I know how sensitive she is.

If I misunderstood that, please restate the goal you are looking for.

I guess we have known eachother so long and I know the situation so well, maybe I jumped the gun to answer the question

So, reply back so we can her on the correct track.

Hope to hear from you soon.

Truly, Your Pharmacist

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Sorry Mark, it was Mirapex that I tried to wean my mom off of with no success.  I was trying to start her on Amantadine for energy.  I got her back on Friday night and by yesterday she was having convulsion like fits that finally stopped today after i decided to give up.  Her doctor prescribed 15ML twice a day.  I only gave her once a day and she was like this already.  I always think doctors over medicate.  Not everyone is young healthy and of a bigger build.   Last month when I gave it to her for 3 days she was only taking 10ML and now I gave her 15ML and it was awful.  Maybe I could give her  5ML but I really don't want to chance it now.  The only good thing that came out of these few days is that she started to talk again.  I know that will go away soon. I think the drug was stimulating her brain which explains the zapping she got all over her body.  I don't have the time or energy to wait and see if it will work and at what dosage.    Thanks.

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I understand, you have done so much for so long and this is a medication that really takes time to find the correct dose. Especially in someone such as your mom who has tried so many meds, some that worked and some that did not.

In the end, I have a feeling this might be another one of those meds that worked for a while and then just stopped working.

Like I have always said to you, it is up to you if you want to continue with her med or not.

I think it might be a time to maybe just keep her what she is on for a while and not try to add anything new. Her mind and body have been through so much with all the changes, now might be a good time to just sit and wait.

Keep me posted on what you see or think. Sometimes, the best thing to do is nothing.

Good luck and keep me posted.

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I stopped it.   No use giving her a drug that will eventually wear off and then she has to continue taking it anyways cause by then she's hooked like all the other drugs.  If it really made her well then I would do it but not worth it right now.

 

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I agree with you at this point. She is on so many meds, in this situation, less may be more. At some point it may come down to really bringing her down to her bare bones meds, under a dr's care and probably in a hospital, where they will then assess her. Then from there they can add, take away, then adjust what she is on.

Some times that is what it has to come down to.

Keep me posted and stay strong.

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For a 75 year old with PD for 16 years she's only taking 4 medications  (Stalevo, Mirapex, Namenda, and Norvasc)  That's pretty good and no hospitalization needed.   I'm just trying to find ways to make her stay awake and/or get her to swallow the Stalevo whole so she won't act high with every dose because it's crushed and going at her all at once.

 

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Well, the instant sleep issue van be taken care of by using a product called Provigil (1-2 tabs per day) or Nuvigil ( 1 tab a day). They both works very well. Some dr's may also use a low dose of Ritalin to combat the drowsiness.

As far as the stalevo goes, it should never be crushed because you are defeating the purpose of the long acting system. One way to her around this, because I have hestd this before about the size of the tabs, is to use a sinemet CR and a Comtan. Both are the same incredients in stalevo, and both ate smaller tablets.

Hope this helps. Keep me posted.

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No and no.  My mom's doctor won't give Provogil or Ritalin.  He thinks she will have a heart attack from them due to her age.

Sinemet CR shouldn't be crushed either so why bother since she won't swallow it. Have you seen the size of Comtan? They are HUGE.   My mom won't swallow anything whole.  That's just the cruel face of dementia.

 

I am not giving up on Amantadine just yet. I will give her 50mg over the weekend and see if it helps any.  Maybe a small dose is what she needs.  150mg is way over the top and 100mg last month was too much too but she seemed to be ok after a few days however I stopped it by then.   The thing I know for sure is that she started to talk on Amantadine. It's like it stimulates her mind.  I miss her voice.

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Let me take a look at some possible compounding that you can possibly do at home, or, if she has good insurance and you have a good compounding pharmacy in you're area, it is amazing what they can do with medication these days.

I do apologize, I was not aware that she was unable to swallow almost all meds and was not aware that her Dr was that opposed to those types of medications, even at their lowest doses.

I will check into some alternatives that could possibly help her.

Thanks.

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That's alright Mark.  We went through this before.  My mom's insurance does not cover compounding.

Ok, I thought it might be worth a try.

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Back to Amantadine - My mom was taking it once a day at 5 ML liquid once a day before breakfast.  She seems a little more awake but most importantly she's talking again.  Not like conversations but blurting out words or sentences now and then which is great.  Makes me think her brain is moving.   After a month of this dosage I have now increased it to 10 ML in the morning.  I hope this will make her stay awake longer and keep talking.

 

Question -  Her gait is not that great since being on it.  I thought PD people benefit from this by walking better.  I don't get it.

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