Excellent advice, as always, Charlie. Let me just add that
the more patients we see that are  prescribed Risperdal,
the more Parkinsonian side-effects we are seeing in
particularly sensitive patients. Just another example of a
newer drug marketed as free of (most) side-effects that
isn't...Carole

--- "Charles T. Meyer, M.D." <[log in to unmask]> wrote:
> Ves,
>
> I am afraid your brother's doctor doesn't know some of
> the basics about PD
> and/or the pharmacology of Haldol.  Haldol should not be
> given to PWP.  It
> blocks the action of DOPAMINE enough so that it often
> causes Parkinson's
> symptoms in people without PD.  I presume his symptoms of
> PD got worse with
> the Haldol.  Respiridol is supposed to cause less
> Parkinsonian side effects
> but it still can make the PD worse in some cases.  I am
> also concerned that
> your brother may be oversedated with the Ativan.  His
> falls may be related
> either to worsening of his PD or oversedation  and if he
> is on a medical
> unit of a  general hospital rather than a psychiatric
> unit they probably
> have little tolerance for confused behavior and may be
> too liberal with the
> sedation.
>
> As a retired psychiatrist with PD who has not seen the
> patient and therefore
> must make judgements based on what you tell me,  in my
> opinion,  he should
> be seen by a physician competent in both geriatric
> psychiatry and
> knowledgeable about PD  to evaluate whether he is
> experiencing dementia or
> something reversible like medication toxicity.    He
> should not be put into
> a chronic care facility without a good psychiatric +
> neurologic evaluation.
>
> Good luck and keep us informed of how he is doing.
>
> Charlie
>
>   ----- Original Message -----
> From: ves <[log in to unmask]>
> To: Charles T. Meyer, M.D. <[log in to unmask]>
> Cc: <[log in to unmask]>; marla ross
> <[log in to unmask]>; wayne
> shirley <[log in to unmask]>; diana valenzuela
> <[log in to unmask]>;
> Joyce Bechard <[log in to unmask]>; vestel b.
> shirley <[log in to unmask]>
> Sent: Sunday, January 23, 2000 10:00 PM
> Subject: Re: improper meds?
>
>
> > Wayne Shirley, age 65, weitht 145 lbs (lost 40 pounds
> in one year)
> > REcent dosage:
> > sinemet - one CR 50.200 three times daily ( 9 am, 1 pm
> and 5 pm)
> > Haldol:  Prescribed as needed for agitation:  2 mg by
> injection every four
> > hours.  Given three injections in two weeks (jan 8th,
> 15th, and 17th)
> > Risperdal:  1 mg/dose at 8 am and 5 pm.  This
> medication was stopped on
> Jan
> > 15th since he was becoming extremely sleepy.  Then
> resumed on the 21st at
> 0.5
> > mg/dose at 9 am and 5 pm
> > Ativan: 1 mg injection every 6 hours as needed or 1 mg
> by mouth as needed.
> > Three injections were issued.  On the 21st there was
> one injection.  And
> two
> > injections were administered on the 22nd.
> > He fell twice on the 21st and twice more on the 22nd.
> He is now in the
> > hospital and the doctor is trying to get him committed
> to an asylum or
> another
> > geriatric facility.
> > He is supsected of also having alzheimers.  I am in the
> process of getting
> his
> > affairs straight so he can qualify for medicaid and
> then get him with me
> in
> > North Carolina.  It appears as if I am running out of
> time.
> > Thanks, CHarles.
> >
> > "Charles T. Meyer, M.D." wrote:
> >
> > > Ves,
> > >
> > > Since your brother has been diagnosed with PD has he
> been prescribed any
> > > Haldol?  Please be more specific about what , when
> and how much he took
> of
> > > the different medications.  I think that if you can
> provide us that
> > > information there are a number of us on the list
> that would venture an
> > > opinion on whether his medication regimen has been or
> is being less than
> > > optimally managed (or frankly mismanaged).
> > >
> > > Charlie
> > >
> > > ---- Original Message -----
> > > From: ves <[log in to unmask]>
> > > To: <[log in to unmask]>
> > > Sent: Sunday, January 23, 2000 9:13 PM
> > > Subject: improper meds?
> > >
> > > > My brother has parkinsons and I think has been
> > > > mis-medicated(?).
> > > > Reasons for this suspicion:
> > > > 1.  Has been on sinement for about 7 years.
> > > > 2.  Has been being previously medicated with
> Haldol.
> > > > 3.  More recently medicated with Risperdal and
> Ativan.
> > > > I understand sinemet can have delayed symptoms as
> well as a
> > > > reduced affect with prolonged use.
> > > > I also understand from the parkinsons drug database
> that the
> > > > meds in items 2 and 3 can have some negative
> effects with
> > > > parkinsons patients.
> > > > He is in the hospital in Electra Texas and the
> doctor really
> > > > does not want to take into account these pieces of
> > > > information I have told her of.  Any PK patients
> around
> > > > wichita falls or vernon texas who might refer me to
> some
> > > > kind of second opinion that is an informed second
> opinion on
> > > > meds for PK patients?
> > > >
> > > > ves shirley
> > > > 336-342-3641
> > > > I will accept collect calls.
> > > > I really need some quick feedback.
> >
>
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