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miracleseeker

Namenda XR

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Hi Mark,

 

Do you know why it's ok to open the capsule of a Namenda XR and sprinkle in applesauce to take?  It is extended release so I would think it's the same as Stalevo and therefore Stalevo should be fine taking it crushed in apple sauce as well?  if not then what's the difference?  I saw this about Namenda on their website.

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Since the long acting release mechanism so a Nameda is in the small pellets inside, the majority of the pellets will be swallowed and not crushed my the teeth.

Where as the extended release mechanism of stalevo is in the coating on the tablet. So, when that is crushed, the long acting ability is gone.

Hope this helps and keep me posted.

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The pellets will be chewed if it's sprinkled in apple sauce when given to my mom.  Are you saying then it will be like Stalevo where it will getting absorbed too quickly?

 

I would think the whole idea of being able to eat it in apple sauce means it doesn't  need to be swallowed whole.

 

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That is what most people would think, is that the pellets would be chewed when put in applesauce, or something similar. But studies have shown that 90% to 95% of the pellets will be swallowed and end up in the stomach whole or just have little pieces out of them because the coating on the pellets is (1) very strong, and (2) due to the pellets being so small and round, it is very hard for the teeth to break them entirely.

With the stalevo, the actual coating on the tablet is actually what gives it the slow release mechanism. Once that outer layer is broken, so that you can see the actual white of the tablet, that slow release mechanism is damaged. So, if just one little piece of the end is broken off, the release will not be damaged that much, but it will still not last as long. Now if the tablet is broken in half, the release will be much faster and will not last very long, maybe 13

/3 (maybe 1/2 if you are lucky).

If it is crushed, you have now broken the whole slow release mechanism and have, in turn, made it an immediate release.

I guess the best example I can give, AND THIS HAS NOTHING TO DO WITH PARKINSON MEDICATION, BUT I AM JUST US ING IT AS AN EXAMPLE, SO PLEASE KEEP THAT IN MIND WHEN YOU READ THIS.

There is a medication for pain called Oxycontin. This medication is a slow release medication, and 1 tablet should last about 12 hours. It was a great pain relieving medication. Until some people realized that is they crushed it they could get and extreme high very quickly. Now I am not saying this about you or any people with PD, it is just an example of what happens when a long release tablet is crushed. What ended up happening is that since the slow release coating on the tablet was crushed, the amount of medication someone should have received over 12 hours, they ended up receiving over 30 to 45 minutes...and many of them died.

I am not saying that if you crush stalevo that a person will die, but what can happen is that the amount they were supposed to get over 8 hours, they will now receive over 30 to 45 minutes. This can increase the side effects of the stalevo greatly. Even up to the point where the person can have severe dyskensia, severe lightheadedness, and severe vomiting. Now you are stuck in a predicament of "How much was absorbed, how much was thrown up, and should give another dose.

I hope this helped to clarify things a little more. If not, feel free to ask me anything again. That is why I am here.

Some time's it truly does take a pharmacy or doctor degree to understand some of this stuff, and even then it can still be tough to explain it.

Thanks for you're patience and don't be afraid to ask for another example, or any other question you might have.1

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Yes I get it.  I have to see what the pellets look like.  Hopefully like you said maybe it's small enough that my mom will just swallow it buried in the apple sauce.   If that works then I pray Stalevo will folllow and do the same.  Yeah I know don't hold my breath on that.

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Mark,

 

I just came across something very interesting.  I read Amantadine and Namenda should not be taking together?  My mom takes Namenda 10mg morning and night.  She gets 5 ML Amantadine an hour after taking Namenda.  Do you think  this may be the reason my mom is not getting the benefits that she should be getting from taking Amantadine.  Her balance has been way off since she's been on both and as for staying awake it's more so after 2pm.  Once she takes Amantadine with breakfast she gets sleepy.

 

Her doctor never mentioned this when he prescribed Amantadine.  He probably doesn't know.  He has been trying to get my mom to stop Namenda because he doesn't think it's doing her any good at this point.  I tried but she got more confused so I have her continue with the medicine.  Do you think she can stop the morning dosage of Namenda since she's taking Amantadine.   I read they both affect the same part of the brain so it's like taking Mirapex with Requip? 

 

The reason I want her to continue with Amantadine is because I do feel it's stimulating her brain.

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The amantadine and named a should be separated by 2 hours either. Take Nameda, wait 2 hours, then take amantadine. Or, take amantadine, wait 2 hours, the take nemenda.

Either way, make sure they are separated by 2 hours from each other. Now if she take Nameda and amantadine at the same time, the name da may be getting to the liver first to be metabolised, and the amantadine is sitting in the intestine waiting to be metabolised, which will increase the amount of amantadine that is absorbed.

As far as stopping the nam3nda, that is up to the Dr and you. Even though they work in the same part of the brain, they don't do the same thing. Since PD is in the substantia niagra, almost all PD meds work there.

So, on this one I have to leave it up to you and the dr. It can be worth a try just to see how it turns out.

Keep me posted.

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Mark,

 

My mom's gait got worse after taking Amantadine.  What came out that was good was that she started talking jiberish and stayed awake more than before. I stopped it 3 weeks ago and she is walking much better again but no longer says anything and is sleepy all the time again.  Oh... the teeth grinding was minimized when she was on Amantadine and now it's returned.  She has jerky movements and just won't really sit still a whole lot.

 

You indicated here that  as long as she takes Namenda  2 hours before or after Amantadine then it's ok?  I thought when it's noted that the drugs would interfere with each other it means when it's in your system period.   Please explain.    Thank you.

 

 

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That would be tough to do if some meds or 12 hour or 24 hour meds. I guess the farther apart the better, but 2 hours is the least amount of time.

Hope that helps.

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XR is awesome.  Why can't the makers of Stalevo do the same for their horse pills?  I opened up the capsule and sprinked the tiny pellet to a spooful of applesauce and down they went.  This is the best invention ever!!!

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It is tough to do with one medication, let alone 3 different medications in one capsule. But, I guess we can always dream.

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Mark,

 

My mom has been on the XR for about a month now and it seems around this time she started to have weak legs.  I dreaded switching from regular to XR but since the regular dose is being eliminated I have no choice.  My question is why would it do that if it's suppose to be the same drug and do you think my mom will get used to it sooner or later.  I suppose there are people that do better on regular Sinemet vs. Cr so no 2 drugs are the same.  This is most distressing.

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I know that to most people It sounds simple to say to make everything into pellets. I wish every medication could be put in a patch form that lasted a day, a week, a month, or a year. But from the scientific and pharmaceutical world, it it just not that easy. I wish it was, as do you. But our body is a perfectly balanced system, and when something makes it imbalanced (like PD), just trying to make a drug to help symptoms, let alone cure it, is a miracle in itself.

The greatest minds in the world have not cracked the code to cure pd. So, when it comes to producing a medication to take care of cures, we need to count our blessings that there is at least something there for us. It may not be perfect, but it is there.

Thanks miracle seeker for your time.

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I think the regular will still be around in a generic form. As you said, people may have to get used to it, as to how long, I can only guess. Since she was on the regular, it should be sooner. But if the body becomes so accosmed to the regular, it may be later. Only her body can tell her.

Sorry I don't have a definite answer.

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My mother was prescribed Namenda XR 14mg which was out of stock at every pharmacy I called (Factory backlog which could last months). Then her doctor gave her a prescription for 28mg. The manufacturer's recommended dosage is to start 7 mg and increase it weekly to 14 mg, 21 mg, and finally 28 mg. The titration pack with color coded capsules is also not available and her doctor is on vacation for a month. Is it okay for her to start on 28 mg? Can she sprinkle a quarter of a capsule on applesauce for a week and up the dosage gradually to the full capsule. Should I try to get the on-call physician at her doctor's office to prescribe regular Namenda at the 5 mg dosage for a week first? Thank you for any help you can give.

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This is a medication that definitely needs to be titration d up from 7 mg on up as per manufacturer. This is due to the fact of avoiding possible side effects that might occur when starting at a high dose. Also, the body needs to "get used to the medication" and a sudden jolt of a high dose will cause more bad issues than good effects.

I would try to contact the Dr on call or wait for the Dr to come back.

Hope this helps.

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