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Hello,  I just found out about your foot surgery.  I hope you have recovered well.  I am having extreme difficulty sleeping at night, but seem to fall into a paralytic type of sleep between 7am and noon.  Is it the PD, the meds or has my circadian clock gone wild?  I have Parkinson's with Dystonia.

Medication Schedule:  7:00am    5mg Rasagiline Mesylate x2 (previously took 1mg,but pharmacist changed for his convenience)

                                                          100 Carbodopa-Levodopa-Entcarpone

                                       7:30am    4mg Tizanidine

                                       9:30am     75 C_L_E

                                     12:00pm    75 C_L_E

                                      2:00pm     4mg Tizanidine

                                      2:30pm    75 C_L_E

                                     5:00pm     100 C_L_E

                                     7:30pm    75 C_L_E

                                    8:30 pm    .25mg Benztropine MES

                                  10:00pm    75 C_L_E

                                 10:30pm   25mg Zonisamide (Dr. scheduled at 7am, but I thought this contributed to deep sleep state in am.  I changed time to pm.  Does not help me sleep at night)

I also take Alprazolam  .25mg PRN and .5mg at 10:00pm.  I take turmeric, Omega red, calcium and Magnesium, if I can swallow pills.  The Zonisamide is a recent addition.  The first two weeks were an adjustment period with severe equilibrium issues and extreme double vision, along with other visual and auditory disturbances.  These issues have pretty much resolved and  now I just generally feel better.   Apparently, the Zonisamide , alone, does not put me in that deep paralytic sleep.  I have been up for four days with a total of six hours sleep and a mild panic attack about 4am this morning.  A crash should be coming soon.  What is the best time to take the Zonisamide?  May I have a occasional alcoholic beverage?

Any suggestions?  I appreciate your help.  Thank you for this forum.

   Deb                                        

Edited by dmCwolfe
incomplete info

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Deb,

I am going to break this down piece by piece to stream line it for us.

1) All of the over-the-counter products (turmeric, Omega red, calcium and Magnesium) should not be taken with the prescription medication. this is mainly due to them causing a decreased absorption of the prescription and not all of the interactions of the over-the-counter products are known because they are mandated by the FDA and not the DEA. You can take them all together, but I would recommend taking them with food, which would avoid them from interacting with the PD medication because most of that should be taken on an empty stomach.

2) I am concerned about the Pharmacist changing the Rasagiline. What strength and when did you take it before the change AND now what strength and how many times a day do you take it? Is it just 5mg at 7:00am?

3) There are some interactions that I will go over with you now:

     (a) Zonisamide and Benztropine: When these are taken together it can cause, mostly in younger patients, but the patient cannot produce sweat when these are taken together and can cause electrolyte imbalances. I don't think it should be an issue, but to avoid it those 2 medications should be separated as far apart as possible. Also, contact the physician if you notice the patient is not sweating.

     (b) Zonisamide and Xanax: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect.

     (c) Zonisamide and Tizanidine: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect.

     (d) Benztropine and Xanax: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect.

     (e) Benztropine and Rasagiline: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect.

     (f) Zonisamide and Rasagiline: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect.

     (g) Rasagiline and Xanax: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect.

     (h) Xanax and Entacapone: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect.

     (i) Xanax and Tizanidine: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect.

     (j) Benztropine and Tizanidine: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect.

     (i) Levodopa and Tizanidine: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect.

     (j) Tizanidine and Entacapone: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect.

     (k) Entacapone and Zonisamide: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect.

     (l) Benztropine and Entacapone: These two when taken together can cause and EXTRA drowsiness effect. Since both of them can cause drowsiness, when taken together that effect can be intensified. I call it the 1+1=3 Effect. They can both cause respiratory depression, so the addition can also cause a 1+1=3 Effect. To a lesser extent than above

** As you can see all of the medications listed under (3) can cause the same similar issue, which would cause the daytime drowsiness you have been experiences. 

(4) Benztropine and Levodopa: Benztropine can decrease the absorption of Levodopa. Which will decrease the amount of Levodopa there is to be used by your body.

(5) Xanax and Levodopa: Xanax can decrease the effects of Levodopa.

(6) Levodopa and Rasagiline: Rasagaline can increase the side effects of Levodopa and can worsen already present dyskensia.

From your list of medications and the many overlapping side effects that have to do with the CNS, such as drowsiness and respiratory depression, I am very surprised that you are not experiencing more drowsiness.

From the list of medications and side effects I would not add alcohol because it will case all of the drowsiness, breathing, and possible "zoning out" sleeping to become much worse.

In my opinion, I think you may want to speak with your doctor about these overlapping issues and try to correct them, or possibly seek a second opinion. Not a second opinion about the Parkinson's Disease but rather about a whole new medication regime.

As you can see from the side effects alone, there are many overlapping meds causing the same issues. Depending on how much Xanax you use during the day could also make this issue worse. 

Here are some of my concerns:

1- The paralytic sleep you speak you experience is because of the Rasagiline, Tizanidine, C/L/E, Benztropine, and maybe Xanax that you take first thing in the morning. All of these interact with each other to have the 1+1=3 EFFECT, but to a greater effect because you have around 7 different ingredients that have the same side effects.

2- I think that either a C/L/E should be used possibly at the 100 strength less times a day OR possibly make a change to Sinemet and Sinemet CR. This way you do not have the Entacapone there to interact with the other medications.

3- I am wondering why Tizanidine is only being used twice a day, in the early morning and early afternoon. Maybe a change to a lower strength more times a day could give better relief throughout the day and possibly help with the sleep issue.

4- If you are looking for something to help you sleep, a medication like Trazadone or certain antidepressants may help with that issue. I think if some of the other issues I mentianed were looked at then maybe your sleeping issue might be a little more stable.

5- I see why the Zonisamide is being used, but some of those symptoms that the doctor prescribed Zonisamide for could be side effects from the interaction of Levodopa and Rasagiline. One such interaction symptoms is hypotension, which can be caused by alcohol, Parkinson's Disease, low body weight, and being dehydrated (which can be caused by the interaction of Zonisamide and Benztropine). Some symptoms of Hypotension are anxiety, dizziness, lightheadedness,vision changes, and balance changes. So, I may look at aking that away and looking at changing times or dosages of Rasagiline.

I hope this helps and please keep me posted.

 

 

 

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