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Sinemet and lightheaded

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We are new to this PD life....but not really!  Recently diagnosed but knew it for about a year!  My husband, 69 years old, has all the classic symptoms.  He's healthy and still working, tho we have sold our business and retirement is finally on the horizon after a bit of a consultant gig in that business.  

He was having issues walking, tremor on the left side (arm mostly sometimes leg) slowness, quiet voice, the facial "duh" look, no arm swing when walking  and don't even expect to read his handwriting unless you have a magnifying glass!  His sister had PD so we are more aware than most.  He and I are emotionally in a good place and laugh a lot over the crap that has been handed him.

But........ (there is always a but!) he has been prescribed Sinemet 25/100 right out of the gate.(pun intended). He started 9 days ago.    1 pill 3 X daily.  He started out at 9 am, 5 pm, and 11 pm.  All went well for the first 7 days. He takes the pills with oyster crackers and water, on an empty stomach, no protein in sight.  He's been making sure he waits at least 2 hours after eating protein and waiting 2 hours before eating protein.  He was told by his neuro to expect an upset stomach.  Nothing like putting thoughts in peoples heads!  We are looking for a new neuro!  But so far....no upset.  All was going well until yesterday.  After he took his first pill at 9am (after sleeping all night and his last dose was at 11 pm) he became really lightheaded and and sort of spacey.  I made sure he had water and he ate a grapefruit.  After about 1/2 hour he was ok.  The medicine has made a big difference.  He now has a regular gate and he's less "frozen"  But.....the lightheadedness happened again off and on all day.  We weren't sure if it was because he was getting too much Sinemet or not enough or if we needed to tweak the time.  I am suspecting that the 10 hour gap from the previous night till the first morning dose was too long.  Or????????  

We are thinking about changing the dosage times to 7 am, 4 pm and 10 pm.  Why would he get a reaction now and not during the first week?  And, is lightheadedness a common problem?  We also took his blood pressure and it was fine.  He is on no other medication except a pravastatin taken at dinner along with an omeprizole at the same time.  He's healthy, not overweight, no blood pressure issues.  Just a cute guy who shakes a bit!  

What is your spin on the dosage times and the lightheadedness?  Thank you for your help on this journey!

PS: we did purchase a Theracycle that he has been riding for about an hour a day, but he was doing that before starting meds

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Lightheadedness  and dizziness are very common side effects of Sinemet. As to why it did not happen straight out of the gate I am not sure. One thing to make sure of is that when he rises from a laying, sitting, or kneeling position that he does it slowly. The same should also be used if he arises from a position of being bent over. Since Sinemet can cause some dizziness and lightheadedness, it must also be pointed out that Parkinson's itself can cause Orthostatic Hypotention. This phenomenon happend when someone tries to get up to quickly and the blood pressure does not correct itself quickly causing the person to feel lightheaded and dizzy. So it could have beed a combination of the two that could be contributing to this issue.

I also noticed that you gave him some grapefruit. Grapefruit is actually contraindicated when taking Sinemet because it can cause spike pr decreases in the amount of Sinemet into the system. It may also cause a blockage of Sinemet being absorbed in the stomach and intestines. If he were to take the grapefruit (even grapefruit juice) one hour prior to taking Sinemet or take the grapefruit 2 hours after taking Sinemet he should be in the clear.

I hope this helps and please keep me posted.

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