Treatment


#1
Hi was hoping if anyone had experienced the use of sinemet and the slow release type not lasting the distance, my o/h who had surgery in April of this year and now has PEGJ with Duadopa as his day time medication, the issue is overnight .
Prior to duadopa he had apomorphine infusion and as nights were a nightmare used madaopar dispersible and apogo pen as he suffers with really bad Dystonia which affects his diaphragm thus impacting on his breathing.
The poor chap spends most of the night kneeling on floor over the bed or more difficult now with PEGJ lying on floor on his front.
The Apogo and Madopar regime was stopped due to not reacting well with Duadopa ?he now takes Sinemet and Sinemet plus starting at about 10pm until 7 am when he can start pump again the problem is the meds do not seem to last any longer than 45 minutes is this normal ? he is setting his alarm every 2 hours (that's if he is asleep) and needing to take more meds its a nightmare for him and me (I work full time).
We have discussed with Neuro and he tells us no other oral medication will solve this and hopes to get funding for Duadopa for 24hours (not holding my breath, as not sure this will happen as our PCT have just turned someone down they have funded to many ( 3 in 6 years !!)

As he has never taken Sinemet before was wondering what is the usual longevity of it working for.

Best wishes x

#2
does he actually get sinemet CR as well as sinemet and sinemet plus?
CR should slowly release for up to 6 hours but a lot less makes it to the brain.
sinemet and sinemet plus are absorbed quickly and i believe have a half-life of 1 hour. so after 1 hour 1/2 the dose is still available, after 2 hours 1/4 (i think that is roughly correct!).

first of all he has CR?
second is the non-CR being absorbed? my [u]personal opinion[/u] is it should be taken with plain water (not too cold and definitely not orange juice or milk) and have nothing to eat 1/2 hour before and an hour afterwards.
i presume he has problems with nausea? I have been told a plain cracker helps if required.

cheers

#3
I presume he doesn't eat during the night, so absorption problems should be minimal. Sinemet and Sinemet Plus are, as Turnip already wrote, short acting drugs(As is Madopar, all three contain levodopa as the main PD drug). I do very well on them, but the effect generally disappears (and this can be very abrupt) after 2 hours. The only really long acting drugs are the dopamine agonists Mirapexin and Requip, but they are less effective in their symptom relief, and more side effects. Sinemet can give me, when it works, for about a couple of hours my normal life back. Nighttime problems remain very difficult to resolve, even with Sinemet CR, which can be fairly effective for up to 4 hours, however, I only take it at bedtime, which results in being "off" most of the latter part of the night as I would not want to set an alarm every few hours waking me up, whereas I still hope to sleep right through till morning, which occasionally happens.
Has Entacapone been mentioned? Or Stalevo? The latter is a tablet containing the same ingredients as Sinemet with Entacapone added. So either Entacapone as a separate pill or Stalevo is given. Entacapone also increases the time the levodopa is effective. What I understood about Sinemet CR is, that the amount of levodopa your brain absorbs in CR's case is uneven. Some people do not get on with Entacapone, but that is to be expected in PD, it will always be trial and (t)error when changing your pill regime.
In the end , if the pump is doing the best job, I would suggest pestering the neurologist about the pump being made available 24/7 until this is granted....

#4
Im sorry if this is not in right but please can anyone advise me on the best times to take sinemet please thank you chris

#5
Best times are the times that fit into your lifestyle and give the relief from PD symptoms, when most required. Some patients still work, most would like to function well all through the day. When starting the patient on levodopa medication (Sinemet, Madopar,or Stalevo)the neurologist will generally prescribe the drug to be taken three times a day. Levodopa works best on an empty stomach and should be taken at least half an hour before a meal or 1,5 to 2 hours after. Levodopa is a protein and competes with protein in the food for absorption. Therefore no milky drink with your tablets. Water is best. Add a biscuit if nausea is a problem. I take my first dose half an hour before breakfast and can feel its effect 25 to 35 minutes later quite profoundly. In the early stages three times a day works very well (there seems to be a residue left to carry you through the evening and night), but I am now, in my 13th year of PD, taking Sinemet 6 times a day in small doses at times that suit me best as much as possible evenly spread throughout the day.

#6
its good to know your still doing ok Kate. there's some self-interest in the sentiment in that i think we have a similar disease trajectory only i'm 8 or 9 years behind!
best regards
t

#7
i wondered if anyone knows what exactly the new drug regime is that has allowed Michael J Fox to imprve so much and begin making a new TV series?
All the articles I have found say it is an amazing improvement but don't say what it is!
http://www.foxnews.com/entertainment/2012/08/16/new-drug-regimen-helping-michael-j-fox-return-to-series-television/

#8
look under sanofi drugs trial with michael j fox

#9
Thanks Buzzicles.
I had seen this but it said the phase 1 trials would be recruiting patients later this year.
The drug is aimed at cognitive improvement and MJF is experiencing much improved mobility.
Are you saying he is taking this drug pre the trial? not much chance for non-celebrities like us then!

#10
Pharmatimes.com/michael j fox .....sounds like sanofi are working directly with michael j fox foundation

#11
As far as I can gather he will be playing a person with PD, so any display of symptoms are part and parcel of his role. And he must have some time during the day when he functions better?