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AQHA270

Sinemet CR dose too high. Advice

4 posts in this topic

Dr. Okun ... I have been diagnosed with YOPD. for 3 1/2 year s but most likely looking back i've had this at least 6 yrs. . i am very active,exercise , horseback ride and do all I can to stay active so medication issues really frustrate me. I have been seeing a NP that was working under a MDS and the MDS is no longer there. I had done well until April of this year on Ropinerole Er other some issues with the generic  manufatures and eventually  found a brand that was tolerable.  i decided it was time to start sinemet  in April and so she prescribed  25/100 CR 3x day. I'm not one that sleeps in and start my day very early . The Cr just did't kick in soon and i sometimes had absorption issures. When absorbed properly it worked great.  I just felt I needed a little kick at times so suggested an Ir to help first thing in the morning or if I felt the CR needed a boost.She  refused to do that and  instead prescribed  50/200 CR  3x  a day along with  the 18 mg of Ropinerole. This  seems like too much medication . i feel like i'm on some kind of drug that makes me hyper active . I talk a mile a minute. It's crazy. I can fly thrut the house, run up the stairs like a crazy person and I feel like my whole body is vibrating.  And then when it wears  of I crash. i've also felt ike it wears of that my loints are very stilff and painful.  She will not add the  IR. . She says at my age......52 ...that the Ir has a greater riskl of dyskinesia.  I feel like the 50/200  is already causing dyskinesia's. There has to be a happy medium. when 50/200 of CR is too high and 25/100 Cr works but i feel like a "little" more would work better. My stress level has been over the top so the IBS issuers I've had since a teenager have been acting up too for the first time in a long time.  My Mom has been in the hospital and my horse that has been  a big part of my mental ,emotional  and physical therapy will probably have to be put down soon and I'm not dealing well with that. I'm even wonderiing if due to my stress related IBS issures if a lower dose of Sinemet IR closer together might not be the way to go. Any advice would be greatly appreciated. I feel I need to seek a new  MDS but in the meantime I''m hoping to convince the NP to try something differnt.  I'm really pretty miserable and need to find  something that  works better soon. I don't have time to feel this way. with all of what  I have on my plate right now.                   

 

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A second opinion may be a good idea.  There is actually not much difference in real life between CR and immediate release.  Both do not last very long and CR peaks less in bloodstream and could be better in select cases especially dyskinesia.

 

You are describing classic dopamine induced mania.  One simple approach even with the CR is to take either 1 tablet every 4 hours or 1 1/2 tablets every 4 hours.  The mistake here may be trying to stay with 3 times a day dosing.  Ask your doc to cut down doses and change interval.  Some people will take an extra half crushed with OJ in AM to come on faster with the first dose.  Hope that helps.

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Thank you Dr. Okun! I hadn't been on here for awhile and just saw your response.  We did cut the dosage back to the Sinemet 25/100 every 4 hrs. and that is working much better. I am back to being me again. As long as I stick with the every 4 hrs during the day I'm good. Is it ok  to crush a 1/2 tab of the CR 25/100 ?

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Yes, we have had no problems crushing CR in our clinic but we don't do it frequently.

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