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sinemet and benzo drugs schedule

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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:



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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.

I hope this helps and please keep me posted.

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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.

Once again, I hope this helps and please keep me posted.

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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!!

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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... 

I hope this helps and please keep me posted 

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