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MComes RPH

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MComes RPH last won the day on May 23

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About MComes RPH

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    Board Certified Pharmacist, Medical Board Member, & Consult
  • Birthday 05/24/1968

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  1. Miracle, Pharmacies make more money if they can order a medication directly from their own wholesaler, which is usually owned by their company. Most retail pharmacies usually have a secondary wholesaler, either McKesson or Cardinal, where they can order different brands of generic. The problem with this is that it will affect there bottom line and probably become an issue with their boss. I guess I had a better understanding of the fact that with certain diseases different medications work differently for different people. I always called it, "The difference factor." I hope this helps and please keep me posted.
  2. Soccertese, What we need to know is that Extended Release (ER) medications have 2 categories, Sustained Release (SR) and Controlled Release (CR), which Sinemet CR falls into the last category. A CR medication must maintain that the drug is released over a sustained time period at a constant rate. This means that even the generic medications must comply with that same release mechanism as the brand name medication. With that we need to keep in mind that there is a range that comes along with that. When the medication is researched outside of the body, in vitro, the environment is the same for the product tested. When a medication is tested in the body, in vivo, the environment is not the same because no two people have the same digestive system, intestinal absorption, or liver metabolism. this is where each medication may vary. I have never been a big believer in splitting any CR tablets, but I do see it has it's reasons. Especially with the Sinemet CR 50/200 because there is a Sinemet CR 25/100 which would probably return better results. I hope this helps and please keep me posted.
  3. Miracle, It is primarily used in MS patients for spasms, but it it used quite often off label for dystonia in PD patients. As I wrote in my previous post to you, It is related to GABA, which decreases the effects of chemicals in the brain that can cause spasms. A starting dose of 5mg is reasonable. As I always say, "Start low and go slow." There is plenty of room to move with this medication due to the fact that the maximum dose of the medication is 80mg per day. I hope this helps and please keep me posted.
  4. MComes RPH


    Caryl, External temperature should have no effect on how effective the medication works.This may have been confused with a very rare side effect of the medication whereas it can cause an increase in temperature in the patient, along with rigid muscles, and in and out of consciousness. It sounds like the dose may be a little low which may not fully control your symptoms. Rytary dosage can be increased every three days, but should only be done so with a Doctor's approval. I hope this helps and please keep me posted.
  5. Hi Michelle, As you know, when it comes to different generics, especially with Sinemet, many people will react differently to different medications. Now I did some research and contacted I believe all the manufactures of generic Sinemet and primary pharmacy chains and it looks like all of them are producing the generic and have the ability to obtain many different products by the various companies. With that said, I would recommend that your Doctor write a prescription with a specific company name on it, that way you will receive medication from that company. I would also have them write the prescription for just a month supply, that way then you give it ample time to see if it works. The companies, making the generic Sinemet are Accord, Actavis, Mayne, Mylan, Sun, and TEVA. For example, let's say you are taking the Carbidopa/Levodopa 25/100 three times a day. So that you get a different generic than what you already have tried, the Doctor should write it: Carbidopa/Levodopa 25/100 (TEVA) Take 1 tablet three times a day #90. After trying that specific company for a month you can then gauge if you should try a different company. The key is too improve quality of life and not to try and compketely get rid of the symptoms. This may not be achievable. I hope this helps and please keep me posted.
  6. Twitchy, There is no "official" interaction but there are a few issues you are dealing with. People with PD sometimes experience with orthostatic hypotension. This is a drop in blood pressure when they are trying to get up from a seated or laying down position. Secondly, products like Rytary and Sinemet that contain Carbidopa and Levodopa, have also been shown to lower blood pressure. It may only be a few points but it can make a difference when added to the fact that PD can also cause a decrease in blood pressure in some patients. Lastly, when adding a blood pressure medication into the mix, a patient can experience a drop in blood pressure that can cause issues like those you are experiencing. One solution that I usually recommend is that the patient switch to taking the blood pressure medication at bedtime. When a person is sleeping there is a less of a chance of experiencing theses side effects. If the patient is already taking it at bedtime and theses issues are happening in the morning, then I would suggest that they take the medication in the evening or around dinner time. This would then avoid the problem in the morning. I hope this helps and please keep me posted.
  7. Appala, I have had mine for 10 years this year in August. Since symptoms change over time it looks like I may have to have some leads changed in position due to the different places where the dystonia has become more problematic. It was one of the best things that I could ever ask for. I was lucky enough to have an open minded Doctor who was willing to listen and try it. Without it I would be in a wheelchair. I think you would be a good candidate due to the pain and possible dystonia that could be causing weakness in the lower extremities. I hope this helps and please keep me posted.
  8. Thanks Sherry. I think it is the same form you can get at the Rytary.com site, but we all appreciate your insight. We are in this together and need to help each other.
  9. Waruna, The prices that I have seen, using the Good Rx discount card, which anyone can get, are as follows: Azilect 0.5mg #30: Lowest price is at Costco (which you don't need a membership to have prescriptions filled there) $166 Highest price is at Rite aid $270 All other pharmacies fall in between the two. Azilect 1mg #30 Lowest price is at Walmart $217 Highest price is at Rite Aid $270 All other pharmacies fall between the two. If you download the Good Rx app. you can look up the price of any medications at pharmacies in your area and print off your discount card. I hope this helps and please keep me posted.
  10. Gerald, I would stay on the amantadine unless the Doctor tells you otherwise. Since Rytary and Sinemet contain the same ingredients, Amantadine can be used along with both medication to help with symptom relief. I hope this helps and please keep me posted.
  11. Shannon, I looked into this and I don't see anything that would point to high blood pressure. In fact, if anything should occur it should be low blood pressure because the disease itself, Sinemet, and the blood pressure medications can all lower the blood pressure and, when added together, should lower it more. You may want to post this question on the "Ask the Doctor" forum and see if Dr. Okun might have some more insight. I hope this helps and please keep me posted.
  12. David, I have copied your post so I can answer the questions more easily. Question 1) I am wondering, if, at this stage of the game, the quantity of medications that I am taking would be considered typical or unusual? (See, quick overview my present illness and medication list below) ANSWER: As you know every patient is different. I don't see any issue with the medication that you are taking or the amount of each medication that you are taking. It is a very reasonable medication regime. Question 2) I currently am seeing a neurologist for overall management of my care w/o movement disorder specialty. In moving forward, should I consider seeing a movement disorder specialist? ANSWER: That is a discussion that I would recommend you have with your neurologist. Many neurologist's wear a multitude of hats, from Psychiatry to movement disorders. PD is a disease that affects patients differently. The disease may stay the same for a long period, suddenly get worse, the stabilize again. The disease itself is like off periods during the day. You don't know if they will happen, but when they do you don't know how long it will last. The symptoms can affect our lives the same way. It sounds like you are very active, so I would recommend having that heart to heart conversation with your neurologist. Any good doctor will want what is best for their patient and will not take offense to the question. When I went to rehab for evaluation and exercise training 2 yrs ago, I was considered "high functioning." Though, since, I have generally progressed with the disease, I am still able to ride a real bike 12 miles/20 miles electronic bike gym. Most noticeable to me, I often feel sleepy and I am inclined to micro-nap in chair; sometimes with company. I am having some troubles with concentration and short term memory, especially if multitasking. Sleep is very erratic--no doubt, a contributor. My family says that my response time to conversation/dialogue can be delayed. My wife thinks I am a little "spacey;" I think I stopped noticing because I am just used to it. But I am aware and agree with those observations in my behavior. ANSWER: Three of the medications, Sinemet, Gabapentin, and Pramaipexole can all cause drowsiness. Also, the Sinemet and Pramipexole can cause spontaneous drowsiness, which it appears you are experiencing. There are a couple of ways to handle this. One would be to decrease the amount of medication you are taking, which in this case is not advisable. The second would be to add a medication like Provigil or Nuvigil. They are both the same medication except that one is taken twice daily while the other is taken just once daily. These are both considered stimulants and are normally used for Narcolepsy, but I have seen it used often in PD patients to combat sudden sleep syndrome. Other medications that have been used are Adderall or Ritalin. Inchildren, theses are used for ADD or ADHD but in adults they can be used to combat drowsiness. I am currently on the following medications: Sinemet 25/250 x 6 daily Gabapentin 400mg daily Pramapexole 3mg daily Entacapone 200mg x 6 daily Plus others, e.g. folic acid and etc. I would also like to recommend that you take any vitamins or minerals separate from your other medications so as they do not interact. At least try to separate them by 45-60 minutes if possible. I hope this helps and please keep me posted.
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