azilect

[starfire27345]

Hi -- I am new to this community and have a question which I hope can be answered. I am planning to have a colonoscopy in the near future. I am 78 and am taking sinemet and azilect. I have been reading that Azilect can cause problems. Has anyone experienced problems? I would appreciate your help.

[Pelley]

Every drug has an equal and opposite reaction. Im sorry but less is more. Are you currently experiencing colon problems? Is there a reason other than DRs. advice based on age for getting the procedure done?

[starfire27345 in reply to Pelley]

Pelley, thanks for your response. The DR wants me to have it because it has been 8 years and he wants to make sure there are no problems. Upon doing some research on Azilect I read that it could cause a problem.

[mistydog1]

I take both those drugs and haven't experienced any problem.

[Btsnipes]

II have had a colonoscopy, took my azilect and other Parkinson's meds as scheduled. Provide the doctors with your list of meds. I have had no problems during this proceedure or other procedures.

[starfire27345 in reply to Btsnipes]

Thank you for your response, Btsnipes. I was very concerned about that.

[muragod]

Experimenting alternate drug is more useful. Agonist created problem for me.No benefit I could c out of it.

[starfire27345 in reply to muragod]

HI muragod- Could you elaborate a little more? I don't quite understand your post and all information I get will be useful. Thanks.

[Kattripp]

Hi, Starfire, I am a retired Endo nurse and my husband has PD. You are right to be concerned about Azilect and possible drug interactions. I know for a fact that not all nurses and Dr's are familiar with these potential drug interactions one could be exposed to in the hospital setting.

First of all, many Gastro's won't do a colonoscopy at 78 unless there is bleeding or a problem, like constipation (PD?). Especially if multiple medical problems, or life expectation less than 10 years, then the risk/benefit ratio should be weighted.

This is, of course, between you and your Dr to decide.

I do believe anyone taking Azilect (an MAO-B inhibitor) should be wearing a medic-alert bracelet, due to the large number of common drugs that can potentially interact.

Ken bought two ID's thru roadid.com, one for riding his recumbent trike, and on for everyday use. Good price, quality and comfortable, too.

I use drug info/interaction app called Epocrates, which is used by many health professionals.

Drugs that we often used for Endoscopy on patients on Azilect were:

Propofol for anesthesia, Versed for sedation, and Zofran for nausea, if needed.

Our PD patients did well, especially with Propofol.

Here are a few drugs to to watch out for, either in the hospital or home:

Contraindicated:

Dextromethorphan- cough suppressent; do not use within 14 days of Azilect; increased risk of seratonin syndrome, a dangerous and potentially fatal drug reaction.

Symptoms include N&V, overactive reflexes, muscle spasms, high body temp, sweating, shivering, cluminess, tremors, confusion and mental changes. This can be mild to life threatening. In extreme cases, cause a high temp, muscle tissue may break down, and shock may occur.

Avoid/use alternative:

Fentanyl and Alfenta-(narcotics, often used in medical procedures); risk of seratonin syndrome

Caution advised:

Lidocaine can increase the level of Azilect in the blood.

Epinephrine (Adrenaline) exaggerated effect on blood pressure

Phenergan (for nausea and vomiting), may cause dystonia, dyskinesia, restlessness and compelling need to move

Hydroxyzine (vistaril) for anxiety, tension, antihistamine, and for N&V; not within 14 days of MAOI's, may prolong and intensify effects

Phenylephrine-nasal decongestant; do not use with 14 days of Azilect; risk of dangerous BP increase

Dental procedures: Orabloc articaine/epinephrine and Septocaine articaine/epinephrine due to exaggerated effect on BP

This is by no means a complete list, and please consult with your anesthesia physician before your procedure. Good luck- hope I didn't overwhelm you with this info.

[starfire27345 in reply to Kattripp]

Thank you so much, Kattripp, for your post which was very informative and helpful and for taking the time to respond. Can Azilect be stopped for a period of time before the procedure thereby avoiding any problems? Unfortunately some doctors are not familiar with PD and side effects of drugs.

[Kattripp]

Under your Dr's guidence, starfire, you can wean off Azilect slowly, if that makes you more comfortable. This could take a month, however, 2 weeks at half dose, then 2 weeks off entirely, for example, but only as recommended by your neuro.

The other option is to meet with the anesthesiologist and share your concern about the many potentially serious drug interactions possible with Azilect.

If propofol is used (great drug, when properly monitored!), you can ask that no lidocaine be used prior to injecting the propofol, to avoid potential drug interaction.

It will be uncomfortable in your arm briefly, but you will quickly fall asleep, and wake up feeling rested, without lingering grogginess, which is important to prevent a fall, especially with PD!

In our facility, Versed (midozlam) is used for anxiety, before or during the procedure only if needed and Zofran can be used for nausea, again, only if needed.

Best bet-clear communication with both doctors, and you should do well! Good luck!

[Kattripp]

Starfire, one more thought...your admissions nurse who records your history, and your procedure room nurse, along with the anesthesia DR, should listen and record your concerns, especially if a nurse anesthetist takes over, as sometimes happens.

All your paperwork should indicate potential drug interactions with Azilect, so all staff are on the same page.

My husband was started on Azilect at age 63, and it is often used in this age group, to hold off on Sinemet for a while. He is now 66 years old.

It seems the experts can't decide if it is neuroprotective or not, and due to the high cost and the potential risks, we are looking at other options.

There are many Dr's who don't use Azilect in your age group, for the same reasons. But you and your neuro can weigh risks versus benefits in your own individual case.

Again, good luck! You should do fine, either way!