My wife suffering from Multiple System Atrophy Parkinson since 2018. She is bedridden for past year and half. Of late her hallucinating has increased Dr has addeded only selegiline 5mg a month back she is taking following medicines
Rasagiline 1mg 1400hrs, Pramipexole. 25mg at 1830hrs,
Selegiline 5mg at 2100hrs, calcium D3 500 at 0830,vit E 250 morning and evening, metthylcobalamin 1500 at 1930hrs, Clonazepan. 5mg , Astrovastin 20 mg, levadopa 250mg CR at 2230hrs.
She has little more tremors, twitching of left cheek and hallucinating is troubling more anyone having similar experience or advice please share regards
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" The adverse reactions most commonly causing discontinuation of treatment were related to the nervous system (hallucinations [3.1% on MIRAPEX[Pramipexole] tablets vs 0.4% on placebo]..."
"Pramipexole, a dopamine agonist has a tendency to induce psychotic symptoms, when used to treat Parkinson’s disease (PD). In most of the cases, patient’s psychosis developed after addition of Pramipexole and exacerbated after increasing the dosage. However there has been no case report in which Pramipexole has caused psychosis at lowest starting dose without any add on drug. Here we present a case of PD in which dyskinesia and psychosis appeared with first dose of Pramipexole, as low as 0.125mg. The patient was a 76 year old man with a one year history of PD. One year back patient observed tremors in his hand and slowing of movements. The neurologist prescribed Syndopa plus - 125, Benzhexol (schedule also same as Syndopa) and Pramipexole 0.125 mg at bedtime. The patient decided to start all medicines next day except Pramipexole (125mg) which he took at bed time. Within half an hour, patient started having visual and auditory hallucinations, along with abnormal movements and myoclonic jerks of hand, feet and mouth. He could be seen doing movements as if he is inserting needle in thread. According to him, he could visualize thieves trying to steal his car. Dechallenge with Pramipexole led to complete resolve of psychotic symptoms."
Other concerns:
I note that prescribing both MAO-B inhibitors at once, Rasagiline and Selegiline, is quite unusual.
I question the atorvastatin. I do not know your wife's age but consider:
Many older adults have high cholesterol. Their doctors usually prescribe statins to prevent heart disease.
But for older people, there is no clear evidence that high cholesterol leads to heart disease or death. In fact, some studies show the opposite—that older people with the lowest cholesterol levels actually have the highest risk of death.
Statins have risks.
Compared to younger adults, older adults are more likely to suffer serious side effects from using statins.
Statins can cause muscle problems, such as aches, pains, or weakness. Rarely, there can be a severe form of muscle breakdown.
"There is no specific treatment for MSA. Treatment is aimed at controlling the symptoms of the disease. Drugs that are used to treat people with Parkinson’s disease, most notably levodopa (given in tablets of Sinemet), may also be prescribed for individuals with MSA. However, the effectiveness of such medications varies greatly among affected individuals. In many cases, individuals do not respond or respond poorly to such therapy. Approximately 1/3 of affected individuals respond to levodopa therapy. However, in most cases, the effectiveness of this therapy decreases over time. In addition, these drugs must be used with caution because they may lower blood pressure.
In addition to levodopa, other drugs used to treat Parkinson’s disease may be used to treat individuals with MSA. These include dopamine agonists such as ropinirole (Requip) and pramipexole (Mirapexin) and an antiviral drug known as amantadine (Symmetrel)"
Hubby has troubles with hallucinations (but he has probable PDD or Lewis Body, not as likely MSA.)
When they first popped up his Movement Disorder Specialist at Stanford had him gradually reduce one drug at a time, with levadopa being the last as it’s the least likely to cause hallucination. You would want the support of a neuro to go through this and it should be quite gradual and you may find a culprit.
He also found that adding High Dose Thiamine helped for awhile but it was hard to dose. We tried Niacin but had trouble with orthostatic hypotension. I’d like to try it again however.
Once you’ve removed all the drugs if nothing reduces the hallucinations you can look at other meds to help with them but fingers crossed it’s the selegiline. Hubby has hallucinations from azilect which is similar so it could be.
Good luck! They’re not easy to control and life can be very difficult once they start. Let’s hope it’s a medication.
If you are open to it, Dr. Costantini had mentioned that he had seen benefit in his MSA patients using high dose thiamine. He also mentioned that it seemed to require higher dosing than he used for his PD patients. If it helps, it may allow reduction or removal of the Pramipexole.
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What on Earth is going on? Meds lasting 1 hour?
Trying requip and 
How much Levadopa after 7 years of Parkinson's?
Can carba levedopa worsen Parkinsons symptoms?
Dyskenesia treatments
