dalina
01-09-2002, 12:06 PM
My father has had Parkinson's disease for 10 years. During that period he has been taking SELEGILINE and AMANTADINE. It has now been recommended that he go on to ROPINROLE as his symptoms have worsened. Anyone out there know of any side effects of taking these 3 drugs in combination? Or should he stop the other 2 and just use ropinrole? Grateful for any replies here and/or at dalingwater@hotmail.com
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md1817
01-09-2002, 10:06 PM
The risk for side effects- nausea, lightheadedness, visual hallucinations, leg edema, to name some- probably increases as the number of medications is increased. I say probably because this has not been studied in an organized fashion.
Selegiline has only a slight effect on improving symptoms, and amantadine is modestly helpful. However, selegiline MIGHT have an impact on slowing the disease progression, and it appears to reduce the risk of developing freezing. Amantadine is useful for reducing dyskinesias, the involuntary movements sometimes caused by l-DOPA.
Speaking in general, if symptoms are not adequately controlled by selegiline with amantadine, perhaps ropinerole could replace the amantadine.
Selegiline has only a slight effect on improving symptoms, and amantadine is modestly helpful. However, selegiline MIGHT have an impact on slowing the disease progression, and it appears to reduce the risk of developing freezing. Amantadine is useful for reducing dyskinesias, the involuntary movements sometimes caused by l-DOPA.
Speaking in general, if symptoms are not adequately controlled by selegiline with amantadine, perhaps ropinerole could replace the amantadine.
Bruce
01-09-2002, 10:47 PM
I was curious why, after 10 years of pd, hasn't sinemet been prescribed. It is consideed to be the "gold standard" of the pd drugs and is still an effective drug.
Bruce
Bruce
Googy
01-09-2002, 11:33 PM
I wondered that myself.This is the only med that helps Bill after all this time.Sinemet CR.
Googy
Googy
Bernie812
01-10-2002, 12:22 AM
Hi Guys,
I just got home from my support group meeting. I saw this post and had to jump in. A new guy showed up at my meeting, 48 yrs old and diagnosed 8 years ago, with obvious PD symptoms. He tells the group that he's been treated by a regular MD for the past 8 years. He's now got an appointment with a neuro and the only meds he's ever taken is Permax. That's it. This man had the masked face, bent posture, rigidity, soft voice, etc..... He's only 48. Well rest assured I pulled out my MDS's card and gave him and another newcomer the phone number. It bothers me that many people with PD don't know all their options. I was lucky. My wife, a nurse, found a great MDS right away.
So anytime I see a post like this I'm going to chime in.
Dalina - the right combination of meds with PD is crucial. It takes an expert to help you find that combination. FIND A MOVEMENT DISORDER SPECIALIST NEAR YOU!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!
If you need help post again.
Bernie812
I just got home from my support group meeting. I saw this post and had to jump in. A new guy showed up at my meeting, 48 yrs old and diagnosed 8 years ago, with obvious PD symptoms. He tells the group that he's been treated by a regular MD for the past 8 years. He's now got an appointment with a neuro and the only meds he's ever taken is Permax. That's it. This man had the masked face, bent posture, rigidity, soft voice, etc..... He's only 48. Well rest assured I pulled out my MDS's card and gave him and another newcomer the phone number. It bothers me that many people with PD don't know all their options. I was lucky. My wife, a nurse, found a great MDS right away.
So anytime I see a post like this I'm going to chime in.
Dalina - the right combination of meds with PD is crucial. It takes an expert to help you find that combination. FIND A MOVEMENT DISORDER SPECIALIST NEAR YOU!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!
If you need help post again.
Bernie812
Bruce
01-10-2002, 09:42 AM
Bernie, I suspect their are many people like the man you descriibed, not getting the right combination of drugs, suffering needlessly and probably assuming this is good as it gets.
I just hooked up with an MDS and had an adjustment to my DBS stimulators and for the first time saw a definite improvement. One major difference was I was adjusted while off all pd drugs. So after the adjustment, it was like starting over, which was good.The MDS told me he did not have a clue as to how much drugs to take. Hearing that, was very refreshing to me.
He allowed me to adjust my own drugs, and I felt confident I could do it. After a few days, I wasn't doing to good, so I went back to Sinemet CR and added Comtan. I was discouraged taking the CR and my ex neuro deleted the Comtan. Well I got news for them, so far, I am doing better than I had done in several years. The Comtan extends the effectiveness of the sinemet and I can extend the time between doses to four hours, Their is no wearing off (off time) and no dyskinesia.
I believe, unless the patient is an advanced stage of pd, their should be no reason why a pd patient can't get the same results. It just takes a lot of patience and much trial and error adjusting the drugs.
Bruce
I just hooked up with an MDS and had an adjustment to my DBS stimulators and for the first time saw a definite improvement. One major difference was I was adjusted while off all pd drugs. So after the adjustment, it was like starting over, which was good.The MDS told me he did not have a clue as to how much drugs to take. Hearing that, was very refreshing to me.
He allowed me to adjust my own drugs, and I felt confident I could do it. After a few days, I wasn't doing to good, so I went back to Sinemet CR and added Comtan. I was discouraged taking the CR and my ex neuro deleted the Comtan. Well I got news for them, so far, I am doing better than I had done in several years. The Comtan extends the effectiveness of the sinemet and I can extend the time between doses to four hours, Their is no wearing off (off time) and no dyskinesia.
I believe, unless the patient is an advanced stage of pd, their should be no reason why a pd patient can't get the same results. It just takes a lot of patience and much trial and error adjusting the drugs.
Bruce
Googy
01-10-2002, 05:28 PM
Bernie,Bruce,
This makes it all worth while.The help you and Bruce give to this BB and the others in your support group.I was in a group for over 20 yrs .
MD1817 , I wondered why you didn't mention Sinemet to Dalina's post.
Googy
[This message has been edited by Googy (edited 01-10-2002).]
This makes it all worth while.The help you and Bruce give to this BB and the others in your support group.I was in a group for over 20 yrs .
MD1817 , I wondered why you didn't mention Sinemet to Dalina's post.
Googy
[This message has been edited by Googy (edited 01-10-2002).]
Bruce
01-11-2002, 03:46 PM
I posted on another board my daily challenge in adjusting my pd drugs and it stimulated a lot of responses. Several people had a lot of questions about sinemet. It seemed they didn't have the courage or what ever to ask these questions in the past.
Bruce
Bruce
Pelicangirl
01-12-2002, 01:47 PM
Hello Dalina,
I took a combination of selegeline, amantadine and Requip (ropinerole) for many years, along with sinemet and a bunch of other things, so I don't believe the combination would be harmful. But I agree with Bruce, Googy and Bernie, why isn't he on sinemet if he's had the PD for over 10 years? I know they are starting people off differently than when I was first diagnosed in 1988, because they have come up with new drugs that forestall the use of sinemet. But it seems like 10 years is a long time to wait.
If you haven't already seen one, please see a Movement Disorder Specialist who can assess your father more and perhaps prescribe sinemet if he feels it is needed.
------------------
Pelicangirl (aka Ruth)
I took a combination of selegeline, amantadine and Requip (ropinerole) for many years, along with sinemet and a bunch of other things, so I don't believe the combination would be harmful. But I agree with Bruce, Googy and Bernie, why isn't he on sinemet if he's had the PD for over 10 years? I know they are starting people off differently than when I was first diagnosed in 1988, because they have come up with new drugs that forestall the use of sinemet. But it seems like 10 years is a long time to wait.
If you haven't already seen one, please see a Movement Disorder Specialist who can assess your father more and perhaps prescribe sinemet if he feels it is needed.
------------------
Pelicangirl (aka Ruth)
Bruce
01-13-2002, 12:54 AM
I have posted separately that the latest recommendiaation by a panel of experts that Sinemet can be used as a first dose which reverses an earlier recommendation that sinemet should not be used as a first dose.So their is no longer any reason that discourages taking sinemet early on.
Bruce
Bruce
md1817
01-14-2002, 02:37 AM
Medication selection in the treatment of Parkinson's disease is highly individualized. There simply is no formulaic approach. Since the 1980's, perhaps earlier, there has been accumulating data and increasing clinical suspicion that l-DOPA is more likely than dopamine agonists to provoke dyskinesias after years of use. This notion persists, and is supported by well constructed, but imperfect, clinical studies. In general, youthful patients with Parkinson's disease may be better served in the long run by minimizing l-DOPA and using a dopamine agonist (Requip, Mirapex, Permax, Parlodel). Agonists and l-DOPA are often used together.
The notion of avoiding l-DOPA is not absolute dogma, and in our litigious society it is important that it be clear that reliance upon l-DOPA is appropriate for some patients.
The notion of avoiding l-DOPA is not absolute dogma, and in our litigious society it is important that it be clear that reliance upon l-DOPA is appropriate for some patients.
Bruce
01-14-2002, 10:43 AM
Well said MD. I have tried to keep the dose of Sinemet CR as low as possible, because dyskinesia is sure to follow. What has worked well for me is the combination of Comtan andSinemet CR. I have to endure some dyskinesia when first starting the Comtan. I stuck with it and now have no dyskinrsia and n o premature wearing off.
After the DBS adjustment, I only take one pill of standard sinemet with th first dose. I was unable to get out of bed until I chewed up a sinemet pill.
The addition of Comtan has enabled me to delete all standard sinemet, except the first dose.
Bruce
After the DBS adjustment, I only take one pill of standard sinemet with th first dose. I was unable to get out of bed until I chewed up a sinemet pill.
The addition of Comtan has enabled me to delete all standard sinemet, except the first dose.
Bruce
Bruce
01-14-2002, 12:30 PM
Well said MD. When I was adusting my meds, one goal was, if possible, was to take less sinemet. Adding Comtan with the sinemet worked very well for me. The Comtan gave me dyskinesia, but I stuck with it and now have no dyskinesia or wearing off effect.With the exception of one tablet of standard sinemet 25/100 with the first dose, I have eliminated all standard sinemet. I was taking 1/2 pill of sinemet with each dose. I have found in my case Comtan does extend the sinemet CR and it works much better than the older selegiline.
Bruce
Bruce
Bruce
01-14-2002, 12:41 PM
Well said MD. When I was adusting my meds, one goal was, if possible, was to take less sinemet. Adding Comtan with the sinemet worked very well for me. The Comtan gave me dyskinesia, but I stuck with it and now have no dyskinesia or wearing off effect.With the exception of one tablet of standard sinemet 25/100 with the first dose, I have eliminated all standard sinemet. I was taking 1/2 pill of sinemet with each dose. I have found in my case Comtan does extend the sinemet CR and it works much better than the older selegiline.
Bruce
Bruce
Bruce
01-14-2002, 12:43 PM
Well said MD. When I was adusting my meds, one goal was, if possible, was to take less sinemet. Adding Comtan with the sinemet worked very well for me. The Comtan gave me dyskinesia, but I stuck with it and now have no dyskinesia or wearing off effect.With the exception of one tablet of standard sinemet 25/100 with the first dose, I have eliminated all standard sinemet. I was taking 1/2 pill of sinemet with each dose. I have found in my case Comtan does extend the sinemet CR and it works much better than the older selegiline.
Bruce
Bruce
Bruce
01-14-2002, 12:44 PM
Well said MD. When I was adusting my meds, one goal was, if possible, was to take less sinemet. Adding Comtan with the sinemet worked very well for me. The Comtan gave me dyskinesia, but I stuck with it and now have no dyskinesia or wearing off effect.With the exception of one tablet of standard sinemet 25/100 with the first dose, I have eliminated all standard sinemet. I was taking 1/2 pill of sinemet with each dose. I have found in my case Comtan does extend the sinemet CR and it works much better than the older selegiline.
Bruce
Bruce
Bruce
01-14-2002, 12:45 PM
Well said MD. When I was adusting my meds, one goal was, if possible, was to take less sinemet. Adding Comtan with the sinemet worked very well for me. The Comtan gave me dyskinesia, but I stuck with it and now have no dyskinesia or wearing off effect.With the exception of one tablet of standard sinemet 25/100 with the first dose, I have eliminated all standard sinemet. I was taking 1/2 pill of sinemet with each dose. I have found in my case Comtan does extend the sinemet CR and it works much better than the older selegiline.
Bruce
Bruce
Bruce
01-14-2002, 12:49 PM
Well said MD. When I was adusting my meds, one goal was, if possible, was to take less sinemet. Adding Comtan with the sinemet worked very well for me. The Comtan gave me dyskinesia, but I stuck with it and now have no dyskinesia or wearing off effect.With the exception of one tablet of standard sinemet 25/100 with the first dose, I have eliminated all standard sinemet. I was taking 1/2 pill of sinemet with each dose. I have found in my case Comtan does extend the sinemet CR and it works much better than the older selegiline.
Bruce
Bruce