Treating Seniors (Mayo Clinic)

[attyj]

Interesting article for us old folkks

mayoclinicproceedings.org/a...

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Article Outline

TREATMENT NOT NECESSARiLY COMPLiCATED

TIPS FOR TREATMENT OF SENIORS WITH PD

1.. NO DRUGS ARE PROVEN TO SLOW PD PROGRESSION

2.. Dopamine Replenishment Remains the Key to Symptomatic Treatment

3.. CARBIDOPA/LEVODOPA: MOST EFFICACIOUS AND A GOOD FIRST CHOICE

4.. YOU CANNOT SAVE THE BEST RESPONSE FOR LATER

6.. CARBIDOPA/LEVODOPA MUST BE TAKEN ON AN EMPTY STOMACH

7.. THERE IS NO REASON TO RESTRICT LEVODOPA DOSAGE: USE WHAT WORKS BEST

8.. EARLY LEVODOPA ADVERSE EFFECTS PRIMARILY RELATE TO NAUSEA AND ORTHOSTATIC HYPOTENSION

9.. LEVODOPA PHARMACODYNAMICS CHANGE AFTER SEVERAL YEARS: THE SHORT-DURATION RESPONSE

10.. Levodopa Dyskinesias Are Often Benign and Treatable

11.. ANXIETY, AKATHISIA, AND PANIC ARE COMMON IN PD AND ARE LEVODOPA-RESPONSIVE

12.. INSOMNIA IN PD OFTEN RESPONDS TO LEVODOPA

FURTHER CONSIDERATIONSUSE OF PRAMIPEXOLE, ROPINIROLE, SELEGILINE, RASAGILINE, OR ENTACAPONE

OTHER, NONDOPAMINERGIC PROBLEMS OCCURRING IN PD

[redean in reply to Hidden]

thanks Roy.

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4...The controlled-release formulation has less bioavailability than the immediate-release drug18; it generates more erratic responses and is much slower to “kick in.”19 It is also more expensive than the immediate-release formulation and has complex interactions with food.18 Thus, for routine daytime use, immediate-release carbidopa/levodopa is a better option. The role for controlled-release carbidopa/levodopa is very limited in my practice and will not be addressed further in this article.

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After reading this document in its entirety, I feel like I had an appointment at the MAYO Clinic.

[parkie13]

not able to get in

[parkie13 in reply to parkie13]

It's finally opened up

[Xenos]

Very interesting, I feel like RoyProp : as if I had an appointment with a wise neuro.

The only point is : it's dated 2011.

[Dylpup]

Thanks for posting. I saw this list last year but lost the link.

Regarding extended release (ER) Sinemet. It is reported to lose more potency than IR, but it works well for my husband who takes 25/100 immediate release (IR) and ER plus Comtan 200 mg 4x/day (every 3 1/2 hours). ER kicks in slower but that's the effect he's after. With the ER and Comtan he seldom has off times. Has worked for nearly 2 years. Knock on wood!!! Diagnosed 14 years ago and taken some amount of Sinemet for 11 years.

He avoids protein 1 hour before meds and half hour after which gives him morning and afternoon windows of 2 hours to eat whatever he wants.

Without ER, he would need to medicate more often and who knows when he could eat.

But everyone is different and these 12 principles can play out differently. That's why an experienced clinician is important.

I think starting Levodopa early is so important to staying active. It's much harder to regain movement once it's lost.

Use it or lose it.

Medicate with Levodopa early when the stiffness and slowness start to creep in. Waiting often means working even harder to regain what's been lost with no guarantees.