On Wed 16 Oct, Delfeld, Kristin wrote:
> Good morning friends. Dad went to see his PD neuro. yesterday and I wanted
> to give you an update and ask for help.
>
> So...,yesterday Dad sees the neuro and they discuss the possibility that the
> tremor is not PD related. He thinks this because Dad has not responded to
> the Amantadine. Neruo. decides to test Dad with Sinemet to see if he
> responds, thus solving the "Is it PD or not?" question. Dad is now taking,
> in addition to the above, 25x100 Sinemet twice/day for a period of 30 days.
> After the 30 days, if Dad's tremor does disappear, he most likely has PD.
> Sounds reasonable I guess.
>
> In the case of a firm PD diagnosis, the neuro will either drop the Sinemet
> dose to the minimum necessary (does that mean 10x100? I don't understand
> these numbers) or try another anti-tremor drug. Probably not
> anti-cholinergics because Dad has mild glaucoma and is 68. Side effects I
> hear can be terrible.
>
> I am curious about what dietary restrictions he should be aware of. Joyce
> suggests taking the Sinemet with OJ, some people say take with water, and
> others yet say to stay away from protein for an hour or so. I'm SO
> confused! Please advise.
>
> Also, does this 30-day trial period sound reasonable to all of you?
>
> Thanks for listening. I'll be anxiously awaiting any suggestions and
> comments.
>
> Kristin
Hello Kristin. I think your dad is doing fine so far: The decision to try
Sinemet is a logical one, and should settle the question about whether he has
PD.
First, a crash course in Sinemet, which is a Trade name, but seems to have
become as universal as Kleenex is to paper towels.
Sinemet is a mixture of two drugs, Levadopa and Carbidopa. The Levodopa is
what we want in our brains, but if we just took levodopa by itself it would
be broken down before it had travelled from the lower intestine to the
Blood/Brain barrier which protects the brain.
Carbidopa is added to shield the levodopa during this hazardous journey. That
is its sole function, and it is stripped off from the Levodopa because the
size of the molecule is too large to go through the Blood/Brain barrier.
Ideally, we need about 100 mg per day of Carbidopa, regardless of how much
levodopa we take, but that value is not critical. To keep things simple,
Sinemet comes in two mixtures: 25 mg Carbidopa, 100 mg Levodopa and
10 mg Carbidopa, 100 mg levodopa. So, if you
are only taking two tablets, it is best to take the 25/100 type.
Having completed the 30 days trial, if your dad responds favourably then it
is just a matter of working out the best dose- I would be pleased to give
you a bit more guidance then. However, if he does not respond, then you
need to consider whether you have tried a large enough dose. Thanks to the
Amantadine, your father is what, -2 to 3 years into PD? A brief excursion to
a higher dose would settle the question - You only need one positive result
to settle the question of 'Is it PD?' Positive response to levodopa is
considered to be one of the best indicators that a patient has PD.
>From what I have seen of 'liquid Sinemet' (Sinemet in orange juice) it
appears to result in most of the levodopa being released as one big spike at
the start, and then a steady decline. This is not what you want, in my view,
so I would not advise OJ.
I hope that is of some use,
Regards, Brian Collins.
--
Brian Collins <[log in to unmask]
