 |
 |
hi judith At 00:54 1998/12/29 -0500, you wrote: >Dear listmembers, >A PWP friend is in hospital due to medication problems, >and I'm hoping that someone can help me understand what >is happening. Since being weaned off Tasmar early this >month, my friend has gone steadily downhill, but it isn't >just been because of the Tasmar. I feel his medications >have been out of control for a long time. why do you feel this? how old is he? how long has he had pd? how long has he been taking sinemet? >He was taking Sinemet, regular and CR, but his dosage kept >climbing. He had been part of a Mirapex study, and continued >taking it when the drug study was finished. I thought he should >be able to decrease his Sinemet intake, but because he felt he >wasn't getting much effect from Mirapex, was this confirmed by the drug study? why did he continue taking mirapex? >the Sinemet was increased and he has been taking 1600 to 2000 mg >daily. Then, when Tasmar was approved, it was added and for some >time he was taking all three, still with what I feel is a high >Sinemet intake. During the summer he began hallucinating, was >dyskinetic, experiencing extreme "on/off" times and lost thirty >pounds, so Mirapex was dropped. this sounds like levodopa overdose to me it also sounds like he was getting worse after adding the tasmar so why didn't he take a step 'backwards' by removing the tasmar to regain some ground? >The Tasmar was increased to 600 mg daily, (gradually) which I >believe is the maximum. (?) At some point he was able to decrease >the Sinemet to about 900 mg daily, but that was short-lived and >the Sinemet climbed again. it sounds like he is self-medicating to an over-dosed degree does he see a neuro? has he had a second opinion? has he been evaluated over a period of time [during both 'on' and 'off'] by a movement disorder clinic? >then the bombshell. Tasmar was withdrawn from the Canadian market and >early this month he was weaned off it, and Requip was started. After the >fourth week, though he had titrated up to the recommended amount, he >began having severe "off" times. More adjustments were made, (increase >Requip) but the Sinemet remained in the 1600 to 2000 mg range. Two weeks >ago he got to the point of being "off" more than he was "on." did he back down on the requip to see if the 'offs' were decreased? i'm uncomfortable with all the med switching jumping from one to another to another they can all interact with each other changing one med at a time, very slowly, is the only way to evaluate the effect of that specific med i'm a conservative when it comes to my own brain chemistry and hadn't even taken the plunge into tasmar by the time it was pulled >After a frantic phone call from his wife yesterday, we got >him admitted to the hospital. He hadn't been able to swallow, >he is now almost completely immobile, and in severe pain from >muscle cramping. has he had muscle cramping before? has be been in pain before? would that explain the ever-increasing 'need' for sinemet? how much carbidopa is he getting in a day? >The last instructions from the neuro before he left for Christmas >vacation, were 1/2 Sinemet, 100/25 every 1/2 hour, Requip 1 mg - I've >lost track of how often, Amantadine 100 mg in the morning, Amitriptyline >10 mg at bedtime, Tylenol, and the last I heard tonight was that they >were going to give him morphine, all of which, BTW, is being >administered through a tube in his nose. It seems as if the PD >meds have stopped working. >He is no better tonight and his is wife is exhausted. I'm sorry for >this rambling post but Al and I and a couple of others from the support >group who have been helping as much as we can, are getting tired and we >are all very worried. Any suggestions would be very much appreciated... isn't morphine a no-no for parkies? or is it a no-no with selegiline? i'll have to check it out when was he last in relatively good control? what was he taking then? yikes my instinctive reaction to this tale of meds and symptoms running rampant [apparently] is to pare his meds down to the hard core basics for awhile [at least - that's what i would do if i were in his shoes] i believe that there is some evidence of 'addiction' to levodopa [which i admit to feeling cynical about] i'll go do some digging on that you and al are good friends to have your cyber-sibling janet janet paterson - 51 now /41 dx /37 onset - almonte/ontario/canada [log in to unmask]