Madopar


#1
Hi All,

A couple of questions.

(1) If taking Madopar three times daily, should the times be, more or less, 8 hours apart?

Reason is Neuro 2 and GP said it doesn't matter. Neuro 1 and chemist said it should be 8 hours apart. PD nurses, who seem to have more time for patients from what I have read, don't exist here.

Mum takes her Madopar at 7.00, 15.00 and just before bed (which could be as early as 20.00) if she is _really_ tired. Is there a problem waiting up to 11 hours between meds?

(2) She also takes 150mg of Effexor to keep calm. This is usually before bed. Is anybody else taking this tablet (or similar) at the same time as Madopar?

Best wishes,
Rico

#2
hi rico
there are different release types of madopar - which one is you mum taking?
eg prolonged release, capsules, dispersable
and how much?

#3
Cheers Turnip,

Knew I forgot something in that post, now I know! :flushed:

Mum taking 125mg (green container) capsules. Thrice daily. Titrated up from the 62.5mg (blue container). I believe they are immediate release. Will check bottle and will report back.

Thanks for your response!

#4
I take Madopar 125 green container, mine are immediate release. I could not wait eight hours between dozes (its more like 4 hours). First one around eight on getting up, then next one 12.30 approx, then third approx 5.30-6 pm. If I dont feel the need, I stretch the time in between a little. Teatime one is my last for the day. I take 10 mg baclofen (muscle relaxant) ay bedtime. Prescription for madopar was one morning, midday and evening. Maybe other people have a different regime.

#5
the following site http://www.medsafe.govt.nz/profs/datasheet/m/Madoparcapdisptab.pdf
has a good overview of madopar

Maintenance therapy
The average maintenance dosage is 1 capsule of Madopar 125 three to six times daily. The number of
individual doses (not less than 3) and their distribution throughout the day must be titrated for optimal
effect. Madopar HBS and Madopar dispersible may substitute standard Madopar to achieve an
optimal effect.


so doses can be up to 6 times a day

Standard forms
Levodopa is mainly absorbed from the upper regions of the small intestine, and absorption there is
independent of the site. Maximum plasma concentrations of levodopa are reached approximately one
hour after ingestion of standard Madopar.
The maximum plasma concentration of levodopa and the extent of levodopa absorption (AUC)
increase proportionally with dose (50-200 mg levodopa).
Food intake reduces the rate and extent of levodopa absorption. The peak levodopa plasma
concentration is 30% lower and occurs later when standard Madopar is administered after a standard
meal. The extent of levodopa absorption is reduced by 15%.


so, if my understanding is right, the peak amount in the blood is one hour after taking if you didnt eat a big meal, the effect of the drug will be later. the slow release is completely different.

Controlled release form
The pharmacokinetic properties of Madopar HBS differ from those of standard Madopar (capsules)
and dispersible form. The active ingredients are released slowly in the stomach. Maximum plasma
concentrations of levodopa, which are 20 – 30% of those achieved with the standard dosage forms,
are reached about 3 hours after administration. The plasma concentration-time curve shows a longer
‘half-value duration’ (time span during which plasma concentrations are equal to or exceed half the
maximum concentration) than with standard Madopar, which indicates pronounced controlled-release
properties. The bioavailability of Madopar HBS is 50 – 70% of that of standard Madopar and is not
affected by food. Maximum plasma concentrations of levodopa are not affected by food, but occur
later (5 hours) after postprandial administration of Madopar HBS.


so it lasts longer but you need to take a lot more.
i get this one at night and the standard during the day which i find works well, though i usually take a second one in the early hours.

#6
As levodopa(Madopar/ Sinemet) is a short acting drug(except for the slow release form) there is no point taking it just before bedtime. You want to have the benefit during the day, not while you're asleep. Most people have a long gap between the last dose of the day(usually early evening) and the first the next day(just before getting up). Some (I do) take slow release levodopa at night time so they can get up and go to the toilet during the early part of the night.
Venlafaxine is an anti-depressant, can be taken in the morning or evening(with food)

#7
Effexor=venlafaxine

#8
Thanks guys!

Polly, mum is on the same as yourself.

Cheers Turnip for the information sheet. It gives a lot more info than what comes with the Madopar box and what the pharmacist gave me.

Kate, I'll have to inquire about whether mum can take a slow release tablet at night. I think neuro wanted to make it simpler by prescribing immediate release but the controlled release at night makes more sense.

Thank you!

#9
To be exact, after being on just Madopar for six months, Neuro decided I would benefit from adding another medication, so now take pramipexole to boost effect of Madopar (dopamine agonist), but thats another story!

#10
Turnip,
Thanks very much for printing that link -- very helpful.

Have also been greatly helped by a Parkinson's Nurse on the helpline over another concern, this evening. How lucky we are to have such help from forum members and the phone line.

#11
How is this regimen going Polly?

Neuro said we will throw Comtan (Entacapone) in this mix if we hit problems with straight Madopar. DA's and advanced PD procedures like DBS out for mum.

#12
Well, first, you will be aware of the gambling etc side effects of dopamine agonists. However on a small doze I am OK, apart from eating a bit more maybe. It has helped my tremor and generally improved me, walking excellent. Drawback is I fall asleep if I take it during the day as I am meant to, and am sleeping less well at night which is likely due to this medication. Also, after taking it I become very quiet and cannot be bothered speaking much to people. Have a v good Neuro in France, sees me often, and I am going to review it with him in August and see if he can adapt the doze better to me. I as on a bit of a high when I started it, but OK now.

#13
Hi Rico, I too take venlofaxine I take 1 175mg and 1 50mg, I think that's a bit more than your mother at the moment. They have been a life saver for me and they were named as the most appropriate anti depressant to be prescribed for pwp, at the World PD Congress which was held in Scotland last year.

Keep us updated about your mothers progress and of course ask ask ask?

Take care

Glenchass

#14
Hello all at moment i am not on any medication i was dx jan this year and my next app to see neurolgist is in august i feel very scared about taking meds as i have never had to take any before how do i know when its the right time to start taking them chris

#15
Hi !
I have taken Madopar for 12 months now and get the timing right occasionally.

Don't take with a meal but an hour before or an hour after.
Madopar takes about an hour or two to kick in. Lasts for a reasonable time (hour or two) but very much depends on what you are doing, more effort less time.

Taking last thing in evening is not that useful as has been said already.

I try and take the first Madopar when I wake, second before lunch and the third at about 4 or 5 pm

Take Care !

westby

#16
one slight re-emphasis - for some of us the night time dose is as important as the daytime, we dont sleep well when we are rigid (titter ye not) and a goodish sleep is very important for the next day. the slow release is useful but i find it is only at its best for 6 hours. too much madopar can give extraordinary dreams - i once spent some time, i think it was an hour, dreaming about number 7.

#17
Thanks for that Glenchass.

I wanted an overview of the Effexor prescription in light of mum's PD. I was worried about it exacerbating the tremor (read it somewhere). Specialist took out trusty book and looked like he was reading from a matrix and said it was a 1.6% chance of Effexor exacerbating tremor.

I am glad to hear both your +ive experience from using it and the fact that it was "named as the most appropriate anti depressant to be prescribed for pwp, at the World PD Congress which was held in Scotland last year.".

No more research needed on that then :grin: Was that a big grin? :fearful:

Chris46, from what I have read the best time to take meds is when your physical life starts to be affacted. Given the fact that PD usually gets diagnosed when at least two of Tremor, Rigidity, Akinesia and Postural Instability exist then by that logic it would be immediately.

But, and it is a very big *BUT*, ....

The diagnosed on this site can give you a more valid opinion. Should it be started upon diagnosis or later on, and is this age-dependant?

All the very best,
Rico

#18
Hi Westby,

Thanks for that info! You don't have trouble getting through the night then? For eg. do you find it harder getting up at 6 to go to bathroom than getting up at 10 and doing so?

And cheers Turnip for your info. If you had to take three doses of a PD tablet (you may well do) how would you break it up?

Thanks!

All the best,
rico

#19
i dont think there is any one answer - it depends what is important to the person and how they interact with the drug. most people seem to need to vary timing until they get whats best for them. i dont think that 3 doses is likely to cover 24 hrs without gaps, but that may be ok for your person, there may be reasons why the neuro recommends it that way. sorry there is no simple answer. but if she is happy with the current timings i wouldnt think there was any need to worry (am desperately trying to NOT give medical advise!).

on starting drugs, the research trend (as far as i have read) seems to be that an early start with DAs and/or ldopa may be protective to some extent, but that seems far from clear as its unclear how to measure it.

#20
Hello, I am currently taking 1 x Madopar 62.5 dispersible 6 times per day and 1 x Stalevo 150 6 times per day.
Through experimentation I now take the medication at 7.30am, 10.00am, 12.30pm, 3.00pm, 5.30pm and 8.00pm which suits me as I work from home.

Cheers,


Rhino