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Having read Pat Schark's message, the answer MIGHT be in an article which appeared in a couple of UK Newsletters to do with PD: USEFUL TIPS WHEN TAKING YOUR MEDICATION 1. The role of the stomach regarding absorption of medication. The stomach is just a reservoir, so far as most drugs are concerned; although some can be decomposed to some extent by stomach acid and a little absorption of some substances (e.g. alcohol) may take place from the stomach, for the majority of drugs (including PD medication) the stomach is just a holding area. If the stomach is full of food, medicines taken after the meal will have to wait in the stomach until it has finished its work on the meal and allow the valve at the far end (the pyloric sphincter or pylorus) to open for its contents to pass into the duodenum on their way down to the small intestine. This delay may be of several hours' duration, depending on how heavy the meal. Therefore, if medication would need to be taken during, or soon after, a big meal, it is better to take it before the meal - with a good drink of water (or other liquid) to flush the tablets through the stomach quickly. "A tablet in the gut is worth two in the stomach!". You might as well have the medi cation working for the duration of your meal: if you go 'off' soon after beginning to eat, and haven't taken your medication, you can be in for a long wait to come =91on' again, if you have taken your dose duri ng or after the meal! 2. Side effects of drugs taken on an empty stomach Many people do experience some undesirable effects when medication is taken this way for the following principal two reasons:- a. An empty stomach leaves its lining rather exposed to drugs released from tablets and capsules when these disintegrate. Some of these drugs may cause local 'irritation' under these circumstances. b. Drugs taken on an empty stomach pass quickly through it to the small bowel from where they are usually' rapidly absorbed. This may in some cases lead to rather higher blood levels (i.e. blood concent rations) than are necessary for adequate drug action. These higher levels may be responsible for side effects in some cases. (absorption of drugs, taken on a full stomach, may be so slow that the opposite effect occurs; too slow a rate of absorption may result in blood levels too low for efficacy. The need i s to keep blood levels within the 'therapeutic window' between too high (side effects) and too low (lack of effect) levels). There are two ways of approaching this: c. It is sometimes reasonable to halve tablets and take one half of the dose an hour or so after the other. If both are on a more-or-less empty stomach the resulting blood level peaks may well be just about in the 'window'. d. Alternatively the full dose of medication may be taken after just light food - perhaps a few biscuits or a couple of slices of bread - with a cup of tea or something to make the stomach contents less solid. There will be some spreading out of release of drug from the stomach but not the major hold-up that a main meal would cause; the 'spreading out' may be just what's needed to keep peak blood levels within the 'window'. Not all tablets can be halved, but if the tablet has a break-line, even if it is a controlled release formu lation, it should be OK to divide it. If in doubt, ask your pharmacist!. 3. Taking tablets and capsules without a drink If no liquid is taken with solid dose forms they will absorb water (in the process of disintegrating to release their drugs) from the mucous layer covering the surface of the oesophagus (gullet). This makes the mucus go stiff and adhesive and fixes the tablet/capsule to the oesophagus wall. The drug is released, therefore, at this point and reaches high local concentrations because of the lack of fluid in which to dissolve. Many drugs may damage the oesophagus, inflaming or ulcerating it, sometimes even lea ding to perforation. A similar set of prob lems can arise if medication is taken while reclining as gravity greatly helps tablets etc. to drop down into the stomach. Hence the slogan 'Don't take your medicine lying down!' 4. Absorption into the blood stream - levodopa=92s competition with protein. Levodopa is an amino acid, one of the basic building blocks of proteins: large amounts of other amino acids are pro duced in the digestion of protein (meat, fish etc.), and are absorbed in the gut to be carried by the blood to the liver for processing. Absorption of amino acids is an active transport process carrying the amino acids from gut level to blood level. The bloodstream has a finite handling capacity and levodopa needs to take it=92s share of this. If it gets crowded out because all the capacity is being taken by products of protein digestion - your levodopa doesn=92t get to the brain to be converted into dopamine! So. if you are about to have a meat, fish or cheese meal (even only a small one) and a dose will be due shortly, it=92s best to take at least some of your next dose of levodopa before you start eating. The rest can follow an hour or two afterwards when the digestion system has cleared the amino acids from the food. > ---------- Forwarded message ---------- > Date: Sat, 24 Aug 1996 06:35:46 -0500 (CDT) > From: P. Schark <[log in to unmask]> > To: [log in to unmask] > Subject: Eating and Meds > Here's what I've tried: > 1. Eating low-protein or no-protein meals. > 2. Eating two instead of three meals so I won't be "off" as much. > 3. "Grazing" instead of eating formal meals. > 4. Taking propulsid or cysipride, which supposedly speeds up the digestive > process. > 5. Supplementing sinemet CR with a 10/100. > I'm at my wit's end. I've lost weight because I can't eat and go > anywhere or do anything, but I can't afford to lose any more weight eithe= r. I hope this helps a bit, Pat. Best regards, -- Jeremy Browne, Hampshire, UK [log in to unmask] Shaking Hands BBS, Fidonet 2:252/160 (+44 1252 626233, also FAX)