Levodopa vs Other Parkinson medicines against Fatigue

[gdineshnathan]

Does Sinemet does a good job in improving fatigue compared to other Parkinson's medications?

Case history:

My mom, 58 years old was diagnosed with Parkinson's two years back. Her major symptom is Fatigue and drug induced dystonia. Then the neurologist prescribed the following set of tablets:

Sinemet CR (125mg)- 0.5-0.25-0.25-0.5

Ropinirole CR (2mg)- 1-0-0-1

Amantadine (50mg)- 0-0-0-1

Safinamide (100mg) - 1-0-0-0

With these above set of medications, my mom was doing better - improved fatigue, ability to travel. Although drug induced dystonia existed during Sinemet - usually quite deliberating pain during the evening dose.

Unfortunately the neuro passed away two weeks back and we had to consult another neurologist. He did a complete change over of medications as follows:

Ropinirole (0.5 mg) 1-1-0-1

Amantadine(100mg)1-1-0-1

Safinamide (50mg) - 1-0-0-1

Sinemet (110mg)- 0.25-0-0.25-0 (only if needed)

The problem now is:

No drug induced dystonia

Deliberating fatigue

Lower back pain

Leg feeling uneasy

My questions are:

Although Sinemet is reduced significantlyand also no more Constant Release tablets in the new neuro's medication list, still the other medicine doses have been made high. Won't those help to maintain same levels of Levodopa concentrations and provide relief?

[park_bear]

Firstly, my compliments on your excellent organization and presentation of the situation.

Answer to your question is no, the new neurologist has reduced the dopaminergic medications - both the dopamine agonist ropinirole and the Sinemet, so she's getting a lot less stimulation of the dopamine receptors. The only thing that's actually been increased is the amantadine, to more than the recommended daily dosage: mayoclinic.org/drugs-supple...

It is sort of a secondary medication that does not do a lot to remedy Parkinson's symptoms. Lower back pain is among the potential adverse effects of amantadine: mayoclinic.org/drugs-supple...

I would report this result to the neurologist and request an increase in the dopaminergic medication and a reduction of the amantadine.

[gdineshnathan in reply to park_bear]

Thanks for your clear reply. If Sinemet and Ropinirole are the dopaminergic medications, what role does Amantadine or Safinamide play? Why is it important to add them in the Parkinson's treatement regimen?

[park_bear in reply to gdineshnathan]

Amantadine: mayoclinic.org/drugs-supple...

Safinamide michaeljfox.org/news/xadago...

[Juliegrace]

I would give anything to get rid of my wearing of dystonia. I suggest you play with some of the dosing to see if you can get rid of the uneasy leg feeling and the fatigue. After talking to your doctor.

[park_bear in reply to Juliegrace]

Here is a case report of a patient suffering from wearing off dystonia. Mostly about taping, but there's a statement that the patient was helped by COMT inhibitor opicapone, but not entacapone:

ncbi.nlm.nih.gov/pmc/articl...

[Juliegrace in reply to park_bear]

I saw that and am very interested in the taping. I also have a prescription for opicapone. I am seeing new MDS later this month so I’m waiting to take it. I’m hoping for some relief.

[WinnieThePoo in reply to Juliegrace]

How good are you with a soldering iron?

[Gymsack]

Find another neurologist

[Esperanto]

Probably the decision to reduce the C/L medication is wise. In my post 'Gender Differences in Levodopa Pharmacokinetics in Levodopa-Naïve Patients With Parkinson's Disease' it appears that women simply need less levodopa in their treatment. Neurologists don't take that into account enough, probably the reason that dyskinesia is much more common in women.

frontiersin.org/articles/10...

academic.oup.com/schizophre...

The decision to switch from CR to IR also makes sense to me. Basically, the CR is not made to split. After all, it will then be an IR with a higher proportion of carbidopa. I myself am currently also functioning fine on 2 half Sinemet 10/100 IR per day and I am a 2m man. 😉

So perhaps don't change your neurologist for now and occasionally ask park_bear for advice to check... 🍀

[gdineshnathan in reply to Esperanto]

Thanks for your reply. But doesn't it mean that due to the lingering fatigue the patient experiences after changes in medication, as park_bear suggested, the overall dopaminergic concentrations is less in the new neurologist medication list?

[Esperanto in reply to gdineshnathan]

Amantanine is also prescribed to promote the action of the dopamine and could reduce fatigue. It may be that due to a lower amount of carbidopa in the IR medication, less levodopa reaches the brain, forming less dopamine. This may need to be adjusted. But it is also good to see if there are other blockages due to nutrition, constipation, altered intestinal flora and to the sleep regime.

[gdineshnathan in reply to Esperanto]

Her 110mg Sinemet has 10mg carbidopa. Are isolated carbidopa tablets available?

[Esperanto in reply to gdineshnathan]

In France, loose carbidopa was not available when I needed it. I then decided in consultation with the pharmacist to split Sinemet CR 25/100. But I understand that it can be different outside Europe.

[park_bear in reply to Esperanto]

My generic C/L ER pills can be cut without affecting the time release properties, but not chewed or crushed.

[Esperanto in reply to park_bear]

You are lucky that it is available in the US. So maybe also to be found in India!

[Rebtar]

I split my CR. I had no idea that made it work like IR. Thanks.

[park_bear in reply to Rebtar]

Not so: accessdata.fda.gov/drugsatf...

"SINEMET CR 50-200 may be administered as whole or as half-tablets which should not be chewed or crushed."

The FDA label does not address other dosages or cutting the tablet in general, but the implication is this does not defeat the controlled release effect. That is my experience with the generic.

[Rebtar in reply to park_bear]

Cool!

[Shlim]

Hi,

I don't know the answer to your question, however, fatigue has been my husband's primary issue since day 1. Before he was on any meds he would sleep for 17 hours straight. He complained of ankle stiffness and slept, later his tremor kicked in. We had no idea what was wrong with him. The fatigue got so bad he would fall asleep at work. A neuro psychiatrist played around with uppers to wake him up and downers to get him some rest. A bit of a sh_t show which impacted his personality and family relationships. (Modafinil and Concerta) were two of the drugs. His latest neuro took him off all of this and he is much more stable but still struggles with fatigue. I just don't get it. Is this Parkinson's or something else? I hope you find your answer.

[LeharLover62 in reply to Shlim]

Hubby has the fatigue too. For him, sometimes it’s a sign he needs a bit more dopamine. But nothing else really helps. I’ve been trying to bump up his cpap use and melatonin hoping better nighttime sleep would help, but I don’t know.

[CaseyInsights]

My spouse found Niacin quite effective for fatigue. In particular 500 mg delayed release of Niacin per day.

Niacin is a critical factor in NAD creation and without it there would be no ATP - the body’s energy currency.

You can start here with this post to begin your exploration

healthunlocked.com/cure-par...

[6daniparky]

Ciao, spero tu riesca a tradurre dall'italiano. Anche mio marito è sempre stanco, e la levodopa non lo aiuta, anzi, peggiora quando prende la dose mattutina da 1 compressa intera di Madopar e la sera, se prende due dosi vicine di mezza compressa...però se non le prende non si muove!

[limcheeese22]

Amandatine give you energy that disturb your sleep: insomnia

but beware of the side effect

[Lyrics19 in reply to limcheeese22]

Unfortunately Amantadine made me very sleepy...My Dr. thinks I should try Orovigil instead for fatigue...Anyone have luck with this?

[Lyrics19 in reply to limcheeese22]

Meant to say Privigil not Origil