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So Curious

Basics of PD Meds

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Hi Mark,   After dealing with PD for 15 yrs, you would think that I would know a lot, but, I don't.  I have received varying and sometimes contradictory info from my doctors.  I totally understand mechanisms of action, blood brain barrier, liquid and solid gastric emptying times and physical and biological half-life.  When to take what meds remains somewhat of a mystery to me.  Could you please clue me in to the following basic questions?  I would truly appreciate some clarification.

  • Should azilect be the first drug taken in the am and can it be taken in the pm?
  • After taking azilect, how long should I wait to take first dose of stalevo?
  • Can benztropine be taken in the am?
  • What is considered "first thing in the morning" - when I first wake at 6am or when I get out of bed at 8:30am?
  • Stalevo, name brand & generic, should be taken on an empty stomach for optimum benefit.  It appears to me that dyskinesia worsens throughout day unless I my stomach is partially filled when med is taken.  Is this a paradoxical reaction or my imagination?
  • If I usually take 6 stalevo per day, will it be okay to miss final dose at 10pm if I go to sleep early occasionally?
  •  Protein really seems to inactivate my meds for several hours.  Any suggestions?

Thank you for help.

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Curious,

I have copied your questions so I can answer them in order for you.

  • Should azilect be the first drug taken in the am and can it be taken in the pm?
  • ANSWER: Azilect can be taken first thing in the morning to best relieve the symptoms throughout the day. If a patient experiences side effects that interfere with their daily life. then it may be suggested that change to an evening dosage regime. The main idea to remember is that no mater when this medication is taken is that it should be taken about the same time every day to achieve the maximum benefits.                                                                                                                                                                                                                                              
  • After taking azilect, how long should I wait to take first dose of stalevo?
  • ANSWER: Since they are medications from different classes and work differently they can actually be taken at the same time, but I rarely recommend it. My usual rule of thumb would be to take Stalevo first, them take Azilect about 60-90 minutes later. The reason for this is due to the fact that the Carbidopa/Levodopa act rather quickly at relieving symptoms. The stalevo can get into the system and start relieving symptoms before the Azilect would do so.                                                                                                                                                                
  • Can benztropine be taken in the am?
  • ANSWER: Benztropine, if taken once a day, is usually prescribed at bedtime. The reason for this is due to the main side effect of drowsiness. Some people do not experience drowsiness or, the medication may keep them awake. In either of these cases, or is it is prescribed more than once a day, it can be taken in the morning or during the day. Another thing to keep in mind is that if you take other medications during the day that may cause drowsiness, Sinemet, Stalevo, Mirapex, etc... you may want to separate benztropine from these medications because they may have an additive drowsiness effect (like a 1+1=3)                                                                                                                                                                      
  • What is considered "first thing in the morning" - when I first wake at 6am or when I get out of bed at 8:30am?
  • ANSWER: First in the morning is different for everybody. I know that if I sleep too long than my symptoms will hit me immediately when I get up. To combat this, I set an alarm for about 5:00am to take my medication, lay back down, then get up with my alarm at a later time. Some people need to take the medication before they arise while others are able to get up with very little symptoms and then take their medication.                                                                                                                                                                                                               
  • Stalevo, name brand & generic, should be taken on an empty stomach for optimum benefit.  It appears to me that dyskinesia worsens throughout day unless I my stomach is partially filled when med is taken.  Is this a paradoxical reaction or my imagination?
  • ANSWER: I believe this is a real reaction and I have heard of it before. If this is the case, I recommend taken a few bites of food or a snack along with the medication. Make sure that what you take is not protein based because that interact with the Carbidopa and delay or nullify the actions of the  Stalevo                                                                                                
  • If I usually take 6 Stalevo per day, will it be okay to miss final dose at 10:00pm if I go to sleep early occasionally?
  • ANSWER: By missing the final dose of the day it may result in you getting up at some time during the night with symptoms or that your symptoms may be worse in the morning.
  •  Protein really seems to inactivate my meds for several hours.  Any suggestions?
  • ANSWER: The best rule to limit the interaction with protein is to take the medication about one hour before eating any protein. If you are not able to, the the next best option is to take the medication at least 2 hours after consuming protein                                                                                                                                                                                                                           I hope this helps and please keel me posted
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Thank you.  I feel so fortunate to have you for a resource.  I am able to relax, knowing that I will receive accurate information.  Your contribution is much appreciated.

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Curious,

I'm so glad I can be of help. All of us are very committed to helping as many people as we can. If I can help you with anything please let me know. 

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