Bbaum,
In a message dated 95-11-21 15:31:49 EST, you write:
<< Hi. Someone suggested to contact you for some information concerning
treatment of Parkinson's. Wonder if you have answers to my questions. My
80-year old plus father has an advanced form of Parkinson's. He has
tremendous difficulty swallowing Sinemet and at times even spits it out the
pills.
Answer: Have you tried crushing the pill and stir it in with apple souse?
This is a common trick used in rest homes when the patient is having
difficulty swallowing.
Question:
Is Sinemet also offered in liquid form or through IV?
If so, how does it pass the blood-brain barrier in liquid form? What dosage
does it come in? Are the reactions to liquid Sinemet different from tablet
form?
Thanks.
>>
Answer:
Liquid Sinemet is a name given to dissolved regular Sinemet pills. It is
made by the patient or caregiver and cannot be input through an IV. Here is
the recipe for Liquid Sinemet:
1 liter of "coffee grade" water
level 1/2 teaspoon of Vitamin C crystals (power form NOT pill form)
combination of regular Sinemet 25/100, Sinemet 25/250 and/or
Sinemet 10/100 pills such that the sum of the second numbers
(levodopa) equals 1000. Use of generric meds is acceptable.
Put the Vitamin C in the water followed by the pills. Shake the
mixture for about 5 seconds. Let it sit for about 5 - 10 minutes
and
shake it another 5 seconds. There will be pill material suspended
in the solution. This is the pill binding. The carbidopa and
levodopa have been completely dissolved along with the
Vitamin C. The pill binding may be filtered out by filtering the
solution through WHITE MILLETA brand coffee filters. Usually
one liter per filter.
The resulting solution contains 1 mg of levodopa per cc or ml of fluid.
A cc and a ml are the same.
Why go to all this work? When one swallows a pill and enough liquid the pill
ends up in the stomach. The pill has no value in the stomach, it must get
into the small intestine to get absorbed into the blood system. To do this
the pill is usually dissolved in the stomach fluids and than passed through
the pylorus valve. This valve prevents unprocessed food parts from entering
the intestine before ready. It all fails, this valve is known to open
somewhere between 30 min and 90 min after eating. However, the pylorus valve
does not shut completely. There is the possibility for liquid to pass
through even if closed.
Now you are starting to get the picture. I can take pills and get a random
time to take effect say from 20 min to 90 min. Or I could drink LS and
hopefully it will pass through the stomach and pylorus and directly into the
small intestine. This could take as long as 1 min. It is from the small
intestine that the medicine is absorbed into the blood and some of it
actually makes it to the brain. Now the Vitamin C was added for two reasons,
(1) Vitamin C acts as a preservative and (2) Vitamin C adds to the acidity
of the meds. This speeds up the processing of the medication.
Thus LS exists only in the patient's chemical factory (kitchen). You cannot
currently buy it. That is changing soon as Athena Neurosciences will be
coming out with power packets that contain the contents of either a 25/100 or
a 25/250 with the vitamin C already added and the pill binding gone. All you
need to do is put it in water. Don't hold your breath on this development,
but it is human trials currently.
Because LS passes through the system quickly, it seems to arrive harder (more
meds at one time) and thus have a shorter holding power. What this means is
that most people using LS take a drink hourly. The high frequency is
possible as you can decide the medication level to the mg of levodopa. This
is done by drinking that number of cc that equals the desired mgs. If the
patient is currently taking a Sinemet 25/100 every 3 hours, than they will
need about 33 1/3 cc every hour.
Now it turns out that a "shot" is one ounce of liquid which is about 30 cc.
Thus in the above case, the patient could start by drinking a "fat" shot of
LS every hour. A "Jigger" is 1 1/2 ounces or 45 cc. That is very close to a
half of a xx/100 pill. Believe me if you put away the shot glasses because
you gave up "drinking" when PD entered your life,. well, dig them out. They
will come in handy.
That is a quick run down on liquid sinemet. Will it help your dad? Possibly
if he is able to keep liquids down. One thing that can be done is to make
the dose of liquid Sinemet have more taste. Some add Tang to it, others use
OJ. I do not like Tang and OJ as it is too acidic for me. The best fluid to
use that I know of is Ginger Ale. You want a sweet fluid that will be easy
on the stomach and nice on the palit. So drink the LS and follow it with
about two ounces of Ginger Ale.
I hope I have answered your questions.
Regards,
Alan Bonander
Age 55, Diag 11 yrs, liquid meds, pallidotomy
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