^^^^^^WARM GREETINGS  FROM^^^^^^^^^^
Ivan Suzman  48/10         [log in to unmask]
Portland, Maine   land of lighthouses   25  deg. Fstill dark outside
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On Fri, 13 Feb 1998 15:38:38 EST Diane Lucas <[log in to unmask]> writes:
>Dear Ivan
>
>
>thank you for your concern re my Mum.
>
>In answer to your questions
>
>1) My Mum is 62   she was prescribed about three years ago
> She has rheumatoid arthritis and I think the doctors were unsure for
>sometime. She has had rheumatoid for about 10 years.
>
>2) she suffered hallucinations BEFORE stating Tolcapone
>
>3) 1 sinnemet at 10.00am  and 1 tolcaone at 10.00am
>
>    1 sinnemet at 12.30pm
>
>    1 sinnemet at 3pm
>
>    half sinnemet at 6 pm  (ish)
>
>Her neuro wants to introduce another tolcapone at some stage
>
>I would really be greatful for any info from any one
>
>Many thanks and best wishes
>
>
>Diane
>
  Hi Diane,

   I'm not a country doctor, but here goes...Most of us on the list are
learning that Sinemet is best taken 30 or 40 minutes before eating.  The
"four times a day" theory, to keep Sinemet flowiing in the bloodstream,
must be altered to accommodate meal times. Also, for many of us, the
doses should be spread out further apart than within the 10:30 to 6
schedule your Mum is on. My schedule starts at about  7:15 AM and runs
through to bedtime--and I NEVER have hallucinations.

  Proteins in foods can block Sinemet( a combination of Carbidopa and
Levodopa) from reaching the brain, because Sinemet's more important
component, for Parkinson's persons, is levodopa, also called L-dopa, or
L-dihydroxyphenylalanine,  which is a PROTEIN.  THe L-dopa is blocked at
the "gateway" to the brain, the "blood-brain barrier," by other proteins
in the foods that have been eaten, and which, once digested, can be a
problem. So taking SInemet AFTER meals is a poor strategy.

   I'm in my 10th year so at this point, chicken, tuna, hamburg, and even
a SMALL amount of milk can INACTIVATE my SInemet doses.  But I NEVER have
had hallucinations, even when my belly is fairly empty of food .

    As for the Hallucinations, your Mum had them before starting
tolcapone.  That indicates that either Sinemet or something else is
causing them. so I would wonder if these hallucinations are due to
either:

   1) Too much Sinemet in each dose, or
   2) Sinemet taken at certain  times of day in an appropriate strength
per dose, but on an empty stomach, and with no meal to follow, or
   3) cross-reactions of Sinemet and other drugs she may be taking.

  Now I have three further questions about your Mum.

  1)   Diane, can you please consider these 3 points, and then try to
remember what time of day her hallucinations have occurred in the past??

  2) Did  her hallucinations occur  BEFORE she began to use SInemet, or
only more recently?

  3) What is the strength of the SInemet tablet (in milligrams) she
takes?  Do you notice any mental confusion or other signs of
disorientation after she has taken a tablet?

  4) is there a relationship between the time of day of the tolcapone
tablet, and the hallucinations?  I am afraid that another tolcapone would
possibly make matters worse, and I am wondering if your Mum is too
heavily medicated, at least for part of the day.

     Dr. Charles Meyer of our List is a wonderful and thoughtful
resource.  I was very glad he responded to you, Diane, and hope he has
further advice for you.

  Watching for your answer,

IVAN