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BillBRNC

Alternatives To Sinemet

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Dr. Okun, I seem to keep coming back to you with more questions, and I am sorry to bother you. The question being considered by my neurologist and cardiologist is this: Sinemet provided very good relief from my Parkinson symptoms. But the Sinemet also made my cognitive issues from Lewy Body Dementia worse. We ultimately found that by taking CR rather than fast acting solved the acute aggravation of my non-Parkinson symptoms from Lewy Body Dementia. And that has worked well over time for me. Then along the way the autonomic dysfunction associated with LBD became very significant in that the orthostatic hypotension  got rediculous, with very low BP reading upon standing up, sometimes in the 65/45 range. So my cardiologist approved the reduction and ultimate elimination of several heart failure medications I was taking that were intended to lower my blood pressure. One final cardiac medication, Coreg, had the dosage lowered to almost sub-therapeutic, and the Coreg is the biggie for lowing BP, but it is also the biggie for me staying our of heart failure. All the reductions of cardiac medications didn't solve the problem. So, the Sinemet was slowly reduced until I got my OH blood pressure drops to fall more into the 80/65 range that I could handle reasonably well. Unfortunately, the Sinemet got reduced so much that a significant part of my Parkinson symptoms returned. I can live OK with some of the symptoms, but the pain from muscles and joints is really rather significant. And pain medication at reasonable levels doesn't seem to provide any relief. So the question now is whether there is an alternative to Sinemet that can take care off my Parkinson issues as well as the Sinemet took care of them before we cut the dosage so low. In looking at the alternatives to Sinemet, we found that the alternatives specially listed orthostatic hypotension as a significant issue. I have reached the point of not really getting excited about making changes anymore in my medications, for all kinds of reasons. So, I don't want to go into a trial and error search for a alternative medication for Sinemet unless there is a very good chance that the new medication would not cause the same problems with OH and low blood pressure. Also, I noted the alternative medications also listed a number of cardiac function issues, and my heart failure is stable now but is unlikely to stay that way if a new medication were to introduce an additional cardiac issue other than OH.

 Dr. Okun, are there any good option with other Parkinson medications to manage my Parkinson problems without also making my OH worse? 

Oh, I think I probably questioned you about each of the steps we have taken before I took them per my local doctors, and you have been very helpful in all of those.

Thanks very much. Bill.

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Sinemet is the best and another alternative may be a Duopa pump where you can control the levels.  Rytary is another dopamine formulation and some people also use mucuna.

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