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klmdoc

DESPERATE FOR SCHEDULING HELP

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Dr Comes please help!  I can't make my schedule work and now am sleep-deprived.  Can't seem to get the tranxene taken at the right times!  Current PD meds/schedule:

SYNTHROID 7AM THEN ...

800am, 200 pm, 800pm = 1 mg requip + two 25/100 sinemet

11am + 200 pm = 2 sinemet

am only sleeping 4 hrs max 900pm -100/130am

PLEASE HELP - WHERE DO I PUT TRANXENE 3.75 MG TID ??

 

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Klmdoc,

I am having trouble deciphering the medication schedule you posted.

Here is the part I am having trouble with:

800am, 200 pm, 800pm = 1 mg requip + two 25/100 sinemet

11am + 200 pm = 2 sinemet

(1) Are you taking 1 Requip and 2 Sinemet at

     8:00am, 2:00pm, and 8:00pm

(2) Are you then adding 2 Sinemet at 11:00am & 

      2:00pm.

I want to make sure I understand this so I can give you the best advice to help you with your situation. If I read the schedule as it has been written, it appears you are then taking a total of 4 Sinemet at 2:00pm.

So I can better understand your medication schedule, could you please write it in this form:

Medication.  Strength.   Number of tablets    Time

(Example schedule below)

Synthroid 0.5 mg 1 tablet at 7am

Requip 1mg 1 tablet at 8am, 2pm, 8pm

Sinemet 25/100 2 tablets at 8am, 11am, 4 tablets

at 2pm, and 2 tablets at 8pm

When should I take my 1 tablet of Tranxene 3.75mg?

This way I know exactly how many tablets of each medication you are taking at what time.

Sorry for the inconvenience, but I just want to make sure how many tablets you are taking at what time do I can give you the most accurate times to take your Tranxene.

Thank you and I will get back to you after you send me the updated medication schedule.

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I am so sorry for the confusion!

700 am = 25 mgc levothyroxine

800 am = two tabs 25/100 Sinemet + 1 mg Requip

930 = (OFF period where NOTHING works!  a half tab sinemet is too much;  no tab and I'm OFF by 945!)

1100am = two tabs 25/100 Sinemet

1200/1230 = scant or no protein lunch

200 = same as 800 am

500 = same as 1100 am

800 = same as 800 am  & 200 pm

1000 = doc added 3 mg melatonin

PROBLEM:  I take one 3.75 mg for anxiety (sorely needed but can't seem to schedule effectively around the above) + 1 5mg flexeril that i usually take around 4pm

You answered a later post with good suggestions for timing but you didn't have my PD med schedule clear at that time so maybe this will help. The melatonin helps me sleep but after going to sleep between 930-1000, I wake up about 130-230 and take one benadryl 25 mg + my 3rd tranxene.  Then I sleep until 5-6 am.  I've tried taking a half sinemet instead, but the B/T combo seems to work better.   So I'm  working with a 24-hour schedule instead of 12.  I CANNOT THANK YOU ENOUGH FOR YOUR HELP.

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klmdoc,

As I look at your regime, I would change one thing. I see that you take Sinemet and Requip at the same time at 8:00am, 2:00pm, and 8:00pm. Sinemet should be taken on an empty stomach, so taking it with Requip could affect the absorption on the Sinemet. Some doctor's do recommend taking them at the same time, but I usually see that when the Sinemet is taken 1 hour prior to Requip the off times seem to be lessened. 

I would keep the Sinmet at 8:00am, 2:00pm, and 8:00pm. I would then change the Requip to an hour later, which would be 9:00am, 3:00pm, and 9:00pm.

As far as the Tranxene is concerned, I would probably keep with my original advice. With newer meds available, with less side effects, and longer lasting. I would suggest changing or adding, at least at bedtime, to one of the medications I had suggested in the last post.

I hope this helps and please keep me posted.

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You are not alone my schedule is wack as well.

I was having a terrible time from 500 on. I was spacing my sinemet at 5 and then again at 7.  I found that no matter what I did the sinemet wasnt being absorbed so I was off every night shaking sweating ect. this went on for months.  I finally decided that I would take a liquid form and i wouldnt eat until 1 hr after my 7 dose.  This is such a pain in the  but i can make it until 9!!

I am still trying to figure out mt trazadone at bed. I take melatonin and velera root to sleep.  After taking it like everyone else does and just take it and go to bed it didnt work

So i am grinding it up and taking it with applesauce.  I sit on the floor in my bedroom for about 1/2 hr then i go to bed.  I am afraid to take the trazadone and walk around for fear of falling

This whole thing is exaperating

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Noah, 

Thanks for sharing Noah. We have been trying to get Noah on a schedule for quite some time. A lot of fine tuning,  but I believe we have made some steps,  even though they may be small,  in the right direction. 

To let you know,  I will be working on a NEW medication schedule while I am off on surgery. My surgery is on 3/28/18 and I will be having a new big toe joint replacement. It is a new procedure that is mainly used on younger,  more active patients and replaces the joint fusion, that used to limit a patients movement. 

I'll keep you updated. 

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I still am having some trouble at night 

I am up to 25 drops of valerian roo,t 50 mg of ttazadone which I grind up with applesauce  I take the trazadone and the Valeria at about 9  and at 930 I take the melatonin and I try to stay up for at least15 minutes 

I then get in bed and I lay there for what seems like hours before I fall asleep 

i just started taking tolterodine 2mg at bed. Could they be aggravating my sleep issue 

Edited by noah
left out some information

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Yes, thanks to Noah and to you, Dr. Comes, as well. I know that all of us in your forum wish you all the best and quick healing for your surgery!   Please do keep us updated! 

And Noah, while I'm so sorry that you,  too, feel the frustration of this insane quest to make PD meds "work right," (because they never fully do), thank you for posting because it helps to know that I'm not the only person who is going off the rails with what seem should be such an easy thing to fix!   I've tried EVERYTHING to keep my 8am-11am interval ON (like all the others do the rest of the day) but I've struggled with this issue for  two years (out of the 18 since my dx), so I decided yesterday that I was just going to live with it and the devil take the hindmost!  I'm exhausted trying to keep charts and variables and such like.   You could paper the National Portrait Gallery with my Excel spreadsheets!

Thanks again, all.

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Klmdoc, 

I was going over some old material I ha published years ago,  I think it might help. 

As I discussed keeping the Sinemet at 8:00am and changing the Requip to 9:00am,  try for about 3 days to see if it works. 

If not,  here is an option that might help.  Take the Sinemet at 8:00am, the Tranxene at 8:30am,  and the Requip at 9:00am. Try it for 3 days and if it helps,  let me know.  If not,  also let me know. 

Keep a journal of meds,  times taken,  and when off times occur.  I want to work this dose by dose (morning,  afternoon,  evening,  and night time). Since the off periods in the late morning are a big issue,  I want to focus on that first. 

As most people who know me will tell you,  I never give up until I find a result that is the closest option to "normal" as I can get. 

I truly live up to the meaning of my name "Mark" which is:

"God of war"

"to be warlike"

I never give up. 

I hope this helps and please keep posted. 

 

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Thank you.  Its not until the 28th,  so I'll be putting in my time until then.  I'll probably be in and out for a few days,  but I'm glad its not my hands. So I shouldn't be off the board too long. 

I appreciate all of you also. 

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Quick question; Did you want me to take the Requip later on the first dose only, or on all three?  I take 5 Sinemet doses and add 1 mg Sinemet to doses 1, 3 & 5.

 

 

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On all 3 doses,  like I had on the updated medication regimen. 

I think for now,  let's try the first daily Tranxene at the time I just recommended.  Keep the other 2 Tranxene tabs at the regular times you have been until I (1) see how this morning regimen works, and (2) I really get a chance to see if the regimen changes I recommended work. 

I hope this helps and please keep me posted. 

PS I feel odd calling you klmdoc,  so if you would like to give me your name that would be great.  If not,  I completely understand.  My name on many boards were "DocMRC, "so I understand. 

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I still am having some trouble at night 

I am up to 25 drops of valerian roo,t 50 mg of ttazadone which I grind up with applesauce  I take the trazadone and the Valeria at about 9  and at 930 I take the melatonin and I try to stay up for at least15 minutes 

I then get in bed and I lay there for what seems like hours before I fall asleep 

i just started taking tolterodine 2mg at bed. Could they be aggravating my sleep issue

i am sending this through again because I am not sure it went through the first time 

I was hoping to catch you before your surgery

 

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Noah,

The tolterodine 2mg does not interact with the other meds you are on.

I hope this helps and please keep me posted 

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Any thoughts about what I can do to improve my sleep

whst is the max dose of the tazadone

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Noah,

The tolterodine 2mg has no interaction or effect on your other meds.

I know the Desyrel can cause some foggy head in the morning, so may I suggest you take that first, and take the Melatonin and Valerian later. Just basically switching places with each other.

I'm not sure, but maybe the order of the meds may be messing things up.

it may be worth a try for about 3 days or so.

I hope this helps and please keep me posted. 

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Noah,

The max dose of Desyrel is 300mg. Some patients do not get relief until the reach these 100mg to 150mg dose at bedtime. 

I hope this helps and please keep me posted 

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There are no minimum or maximums per se but most people do not need more than 50-100mg (side effects as you get to higher doses but again it is possible).

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Hi Dr Comes - sorry for the delayed answer but I have been sans computer for over a week!   First, please feel free to call me LINDA and thanks for asking!!  I'm a Ph.D. (communication psychologist), hence the "doc" handle. Sorry about that.  I have 2 questions. I cannot locate the final schedule you came up with for me; would it be too much trouble to  copy and paste it into a new reply?  Also, I'm having severe insomnia due to NEUROPATHY (tingling & burning in my legs & feet) at night when I am otherwise mostly OFF.  As you know my carbidopa load is 25 ms X 12 tabs = 300 mg and I've taken Sinemet for about 10 years.  Please suggest what I should do (besides see my neuro).  THANK YOU SO MUCH AND I HOPE YOUR OPERATION IS A RESOUNDING SUCCESS!!  Linda

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Linda,

Here is our past conversations about dosing:

klmdoc,

Sleep is so important for Parkinson Patients because it is the only time during the day that our muscles use the least amount Dopamine. Because of this, Dopamine that we do produce is stored up and used as soon as we awake in the morning. The same situation also applies to naps. I encourage Parkinson patients to listen to their body. If you feel tired, lay down. Even when we just sit or lay down, our bodies can still store up our body can still produce.

If I remember correctly, you were to take the Tranxene 3 times a day. If that is correct, I would start my doses later in the day. Most medications that are prescribed 3 times a day are usually given at 9:00am, 3:00pm, and 9:00pm. In your case I believe if you adjust the timing of the Tranxene it may help at bedtime. I usually call this the "Wind Down Time.)

I would start by taking the Tranxene at 12:00pm (noon), 5:00pm, and 10:00pm. I would try this for a week and see how things go. If you keep a journal of when you take and how you feel in betwee doses, this may help you figure out a dose that may work better.

If that does not seem to work, then I may suggest you take them at 1:00pm, 5:00pm, and 9:00pm for 1 week.to try a different medication. Again, see how that works. If you appear to be getting more sleep you know you are on the right track.

If that regime does not seem to work, You could then try 2:00pm, 6:oopm, and 10:00pm for 1 week. Again, see how that works.

Lastly, if you do not see ANY imporvement at all, I would have you try to take it at 3:00pm, 6:00pm, and 9:00pm. This would be last adjustment I would recommend for this medication. If this still does not show ANY improvement, I would probably ask your doctor for a change in medication.

When Tranxene is prescribed to take it 3 times a day, it is probably being used for anxiety and sleep. If that is the case, there are newer medications with less side effects that can be used.

A few examples of antidepressants that are used for anxiety AND sleep are Lexapro, Zoloft, Celexa, Paxil, and Prozac. All of these medications come in a variety of strengths so you can start off at a low dose which can be increased over time.

A second option could be to use one of the antidepressants above during the day and take Benadryl at night. Benadryl is mainly used for allergies and allergic reactions, it is also the number one sleep aid used in hospitals because it causes drowsiness. With this in mind, you could use one of the above antidepressants above and take Benadryl 

Another option that may work is to use one of the antidepressants above during the day and take a medication like Desyrel at bedtime. Desyrel is also an antidepressant, but does have a more sedating factor than the above antidepressants.. This medication also comes in a variety of strengths so you can "start low and go slow." Desyrel can also be used at low doses during the day along with a higher dose at bedtime

The last option that you can discuss with your doctor is to use a medication ( Ex. Xanax or Ativan) specifically used for anxiety during the day and a sleep medication (ex. Ambien or Restoril) at night. This combination is mainly used in desperate situation.

Here are a few non-medicine things you can also use to get a better sleep. A study that was performed at the University of Chicago and posted in Men's Journal says that a routine is just as important as sleep itself. Here are the 10 best rituals for better sleep:

1) Dim the lights

2) Turn down the thermostat

3) Stay clear of the bedroom unless it is for sleep

4) Power down electronic devices, such as cell phones, computers, and tablets.your sleep area

5) Keep out of the kitchen. Finish dinner no later than 3 hours before bed

6)  De-clutter your sleep space, Tidy up and make sure you make the bed every morning

7) Do not drink alcohol within 3 hours of bedtime. Once it is metabolized, it will cause you to possibly wake up and/or toss and turn all night

8 ) Save stressful things for the morning. Also, if you write them down before bedtime, this will keep your mind from constantly thinking about it

9) Face your alarm clock to the wall and/or turn your cell phone face down

10) Ban pets from the bedroom. This will probably be the hardest thing for you and the animal may have to adjust to.


klmdoc,

I forgot to mention in the previous post I made that there is Drug Interaction between Tranxene and Sinemet. If they are taken too close to each other, the Tranxene can decrease the effects of Sinemet.

There are two different ways to avoid this interaction:

(1) Avoid the is to take the Sinemet at least one hour PRIOR to taking the Tranxene. This way the Sinemet will be absorbed before the Tranxene is taken

(2)  The second possibility to avoid this interaction is to take Sinemet two hours after Tranxene. This will allow for the Tranxene to be absorbed and metabolized before the Sinemet is even taken.

I have found that the first option, taking the Sinemet one hour prior to the Tranxene, appears to work best. This is because the Sinemet can start working to diminish the tremors and other PD issues, which can be a precursor to anxiety.

FROM YOU:
Can I take REQUIP with tranxene and not diminish the Requip's effects?  

Same question with RequiP & FOOD ?  (taking the R prior to swallowing any food)

The REQ strength is 1 mg (TID) and you told me to take my R an hour after taking my Sinemet.  As a reminder I take two 25/100 S's at 8, 11, 2, 5 & 8 and REQ at 8-2-8 which you said to move to 9-3-9.   So you can see the tranx issue right away (I hope).   That said, I did move my first R just to 830 as a trial today and it seemed to help a lot. I think you're a genius at this!  Thank you so much for your fast responses!!

ANSWER:
Klmdoc, 

Thank you for the compliment. Taking them together is fine,  there is no interaction.

Also,  both can be taken with food and will not create any absorption issues. 

I always put in the disclaimer that these meds,  especially Tranxene, should not be taken with alcohol.  It is,  what I call,  a 1+1=3 reaction.  If you combine two products,  that can both cause drowsiness,  the resulting effect is about 3 times worse.  Besides drowsiness,  there'd will also be serious issues with memory,  speech,  walking,  etc... 

As far as the neuropathy issue, you may want to talk to the Dr. about adding a low dose of Gabapentin or Lyrica. They have both shown success with this issue. This is also another medication that should start at a low dose and slowly increase.

I hope this helps and please keep me posted. 

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Hi Dr - I've been through "hell and half of GA" with a movement specialist that my regular neuro wanted me to see, so I'm back to square one.  Short version: I agreed to try extended C/L and ended up with NO IMPROVEMENT +  the first "freezing" episode ever -- It seemed to result from sinemet overload. i was told that  I could split the CR Sinemet but although that gave me longer sleep times, I think it wreaked havoc with my previously-stable day schedule.  In fact, other than a few "failed" doses (never kick in) my day schedule is almost back to normal.  I've also found that taking 1/2 of an IR Sinemet twice during the night gives me at least 6 and often 8 hours' sleep, albeit in "chunks" (but it's ok because I return to sleep nearly immediately.

My first question to you now is this:  I used to take four 1-mg Requip per day and slept sufficiently.  Now I take only 3, but since I've had so much trouble and since that was a stable regimen, I don't want to rock the whole boat yet.  WHAT DO YOU THINK WOULD HAPPEN IF I TOOK A REQUP XL just at my last dose of the day?  Or better still, could I first try adding back a 4th requip and see what happened?  The easy thing would be to sub the XL for the IR @ last dose -- but would there be a titration issue  or  other complications?   Good to be back and to have you back after surgery!  Thanks, Linda

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Linda,

I think the easiest thing to try would be to add the 4th tablet of Requip to your regime. you would know  by morning of the next day if it was successful. If you were to add an XL as the last dose, I'm afraid it may last too long and overlap with the morning dose.

There would be some decreasing of the IR and adding the XL if you were to want to use the XL. For now, I think trying the 4th tablet of Requip IR would be your best bet.

I hope this helps and please keep me posted.

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