Drug induced Dyskinesia - some measures to control

[gdineshnathan]

Dear all,

My mom is 59 years old, diagnosed Parkinson's two years back post COVID, takes the below set of medications currently.

Levodopa/Carbidopa CR 100/25 mg - 1/2-1/4-1/4-1/2 (6.30am-11am-3.30pm-6.30pm)

Ropinirole CR 2mg 1-0-0-1 (10:00am - 8.00pm)

Safinamide 100 mg (1-0-0-1) (10:00am - 8.00pm)

She also takes Magnesium Citrate, Magnesium Glycinate on alternate days and Vitamin D once a month as supplements.

She develops drug induced dyskinesia with Levodopa/Carbidopa CR tablets. She finds the dyskinesia pain intolerable somedays. Particularly today the evening dose gave approximately 2.5 hours of hand and lips twitching. Usually it begins approximately 1 hour after taking it. Is there something we can do to control this?

Her main PD symptoms are freezing in left leg during OFF period, fatigue, difficulty getting up from bed and drug induced dyskinesia. Out of all this, fatigue and drug induced dyskinesia tops the list

We were wondering to add Amantadine 100mg along with her evening Levodopa/Carbidopa CR tablet. Does this help to control the dyskinesia? any sensory tricks that might help to curb the twitching if possible? or should we do some change in timings of the Levodopa dosages ?

Thanks for taking your time to read this, any comment would be helpful.

[Hikoi]

i wouldnt have expected your mother to advance this quickly, (she was diagnosed at the same age as me.) Amantadine works well for me but it interferes with sleep. It is given in the morning.

However rather than adding a drug I would be taking away. I know nothing of solfinamide but wonder why she needs it at this stage. Long acting meds are difficult to work out as they overlap and accumulate. I see your mother takes LA Ropinerol twice a day, it is usually a once day medication. Overall I think your mother is overmedicated, she could do with a med review by another specialist.

[Hidden in reply to Hikoi]

Yes I am inclined to agree with you - my husband has that reaction when he is getting too much.

[LAJ12345]

my husband had a bad reaction quickly after switching to the CR madopar which improved also very quickly when switching back to the IR. The ER made him very bad at night which I think was due to each dose of the day overlapping the previous one so the last one was on top of the the tail of all the others for the day.

I would try changing to the IR, but she might need to take them more frequently like every 3 hours, perhaps at half dose.

[Always_hope]

Is she also taking B vitamins. There are a few groups on Facebook.My hwp (59) was diagnosed 3 years ago. Lost his smell over 10 years ago. He's not taking any medication, only B1 and other B vitamins. It's helping him a lot. So far coping with just vitamins and exercise.

[Tribselyov]

don’t try to treat to perfection

[Gallowglass]

I feel sympathy but don’t know enough to offer a suggestion other than ask a good neurologist

[freefallmode]

Try taking caffeine out of the diet for a day or two (coffee, tea, cocoa, soft drinks etc). It makes a huge difference to my own dyskinesia.

[4grandbabies]

I cannot speak to adding a med. however, I take C/L also a d about 1 hour after I experience dystonia on whole R side. It lasts as long as it chooses.

If I take less of a dose, I experience Bradykinesia, everying slows down, I can;t get out of a chair, and my limbs become very weak The meds are so fussy ie. cannot take it with my magnesium, watch the protien intake) It is exhausting. I use a heat pad, take hot spsom bath, use a small massager for pressure points/sore muscles/I have a ibratrim vibrating machine that is suggested for parkinsons and arthritis . As far as meds go, I have a sensitive system and tend to respond negatively to any changes. hope this is helpful