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Doctor .This Is Reg My Mother Aged 86.she Was Diagnosed
Question: Doctor .This is reg my mother aged 86.she was diagnosed with senile Parkinson's few years back.Symptoms being lower jaw involuntary movement and one finger movement on rest.Shestarted on plain syndopa 1 per day.
This was for around 2 .5 years.
Later she was switched to syndopa plus one per day at around 4.30 PM . Evening was chosen because by around 6 pm she was getting mild shiver or tremor on the legs.After taking syndopa plus along with 1 mg of pacitane this issue was resolved.
Last few months she is unable to speak properly inthe morning times ..we are unable to understand what she is saying.she puts in lot of effort to communicate.But by evening after syndopa she is able to speak well and eat on her own with out we feeding her by spoon.The abovevis the background of her problem.
NOW I come to the main issue.
SINCE LAST MONTH ..Almost daily after evening dose of syndopa plus along with pactinane 1 mg ...she sleeps sound for 2 hours till 7 to 7.30 PM.Gets up for dinner.Say around 8 PM.. suddenly she gets some sort of dyskinesia s in lower jaw and involuntary finger movement s. Some mild shakes or tremor sort etc.Once this type of issue Sets In...she becomes agitated and unable to speak. ..not able to eat too...and situation gets so out of control ...We immediately resort to giving her some food and give her ALPRAX .5 mg ..this is regular sleeping dose for her last 10 years...After gulping ALPRAX she gets sleep .This episode often happens these days and it becomes night ware for us for her also to manage.ANOTHER IMPORTANT CLINICAL PARAMETER AT THIS EPISODE IS PULSE RATE GOES TO 90 TO 100 ALSO.....AND SHE GETS SORT OF BREATHLESS XXXXXXX SAYING haa haa haa etc..This episode calms down only after 30 minutes of ALPRAX going down and she gets sleep...
THE ABOVE EPISODE HAPPENS ONLY AROUND 8 PM ..she takes syndopa plus along with pacitane at 4 .30PM..
WHY THE ABOVE IS HAPPENING????I have following questions which I expect answer .
1)Why this episode nowadays which was not der earlier?
2)we are giving only 1 Syndopa plus ..along with pacitane 1mg at 4.30 Pm.. daily ..Seeing this episode daily ...It make s us to be clear whether this medicine itself is required or not??why not to stop this and see for 2 or 3 days...so that let herbody adjust to her natural available dopamine itself as she she is in morning times...The episode s are so scary doctor..and we feel very pity on her to undergo this...
3) As I understand once syndopa plus metabolise s in her body.. dopamine surge and same rate dropping.. she is not able to withstand this and when weaning period ..when supplement al dopamine by way of syndopa drops.... this panic attacks kicks in creates havoc...pulse rising ...BP rising...have to skip dinner.. breathless XXXXXXX etc etc..I read in one article that..if the body can't withstand the surge and drops of dopamine ...by way of syndopa plus....the right method is to give EXTENDED RELEASE FORM ...IS THIS RIGHT??If so can we try and see SYNDOPA CR 125 WHICH IS A CONTROLLED RELEASE FORM ..ISNT??is this correct?! our GP says try and see..Our GP came home today to see her and said to try CR..form or to try giving 50mg of Gabapentin along with syndopa plus during evening...
4) we are unable to reach out neuro during this covid crisis.
I look forward to a solution to the above XXXXXXX issue for my mother..It's creating night mares daily of late...she is not able to have dinner...So pathetic to see her suffering... during these episode ...ONLY SAVER IS ALPRAX .... DOCTOR.
Kindly give ur opinion and suggestions to over come this.. I repeat ...she is taking only 1 Syndopa plus along with pacitane 1mg... daily at around 4.30PM.
kindly note her PULSE rate shoots up to around 95 to 100 inspite of taking supermet XL AM in morning and also Prolomet XL 25 mg daily along with syndopa...
Kly reply.
Best regards .
This was for around 2 .5 years.
Later she was switched to syndopa plus one per day at around 4.30 PM . Evening was chosen because by around 6 pm she was getting mild shiver or tremor on the legs.After taking syndopa plus along with 1 mg of pacitane this issue was resolved.
Last few months she is unable to speak properly inthe morning times ..we are unable to understand what she is saying.she puts in lot of effort to communicate.But by evening after syndopa she is able to speak well and eat on her own with out we feeding her by spoon.The abovevis the background of her problem.
NOW I come to the main issue.
SINCE LAST MONTH ..Almost daily after evening dose of syndopa plus along with pactinane 1 mg ...she sleeps sound for 2 hours till 7 to 7.30 PM.Gets up for dinner.Say around 8 PM.. suddenly she gets some sort of dyskinesia s in lower jaw and involuntary finger movement s. Some mild shakes or tremor sort etc.Once this type of issue Sets In...she becomes agitated and unable to speak. ..not able to eat too...and situation gets so out of control ...We immediately resort to giving her some food and give her ALPRAX .5 mg ..this is regular sleeping dose for her last 10 years...After gulping ALPRAX she gets sleep .This episode often happens these days and it becomes night ware for us for her also to manage.ANOTHER IMPORTANT CLINICAL PARAMETER AT THIS EPISODE IS PULSE RATE GOES TO 90 TO 100 ALSO.....AND SHE GETS SORT OF BREATHLESS XXXXXXX SAYING haa haa haa etc..This episode calms down only after 30 minutes of ALPRAX going down and she gets sleep...
THE ABOVE EPISODE HAPPENS ONLY AROUND 8 PM ..she takes syndopa plus along with pacitane at 4 .30PM..
WHY THE ABOVE IS HAPPENING????I have following questions which I expect answer .
1)Why this episode nowadays which was not der earlier?
2)we are giving only 1 Syndopa plus ..along with pacitane 1mg at 4.30 Pm.. daily ..Seeing this episode daily ...It make s us to be clear whether this medicine itself is required or not??why not to stop this and see for 2 or 3 days...so that let herbody adjust to her natural available dopamine itself as she she is in morning times...The episode s are so scary doctor..and we feel very pity on her to undergo this...
3) As I understand once syndopa plus metabolise s in her body.. dopamine surge and same rate dropping.. she is not able to withstand this and when weaning period ..when supplement al dopamine by way of syndopa drops.... this panic attacks kicks in creates havoc...pulse rising ...BP rising...have to skip dinner.. breathless XXXXXXX etc etc..I read in one article that..if the body can't withstand the surge and drops of dopamine ...by way of syndopa plus....the right method is to give EXTENDED RELEASE FORM ...IS THIS RIGHT??If so can we try and see SYNDOPA CR 125 WHICH IS A CONTROLLED RELEASE FORM ..ISNT??is this correct?! our GP says try and see..Our GP came home today to see her and said to try CR..form or to try giving 50mg of Gabapentin along with syndopa plus during evening...
4) we are unable to reach out neuro during this covid crisis.
I look forward to a solution to the above XXXXXXX issue for my mother..It's creating night mares daily of late...she is not able to have dinner...So pathetic to see her suffering... during these episode ...ONLY SAVER IS ALPRAX .... DOCTOR.
Kindly give ur opinion and suggestions to over come this.. I repeat ...she is taking only 1 Syndopa plus along with pacitane 1mg... daily at around 4.30PM.
kindly note her PULSE rate shoots up to around 95 to 100 inspite of taking supermet XL AM in morning and also Prolomet XL 25 mg daily along with syndopa...
Kly reply.
Best regards .
Brief Answer:
It is better to stop SYNDOPA PLUS and PACITANE one by one.
Detailed Answer:
Thank you for getting back with details about your mother.
Based on the description, it seems to be adverse effects of her anti-parkinsonian drugs. Syndopa plus is known to cause dyskinesia and pacitane can cause agitation, hallucinations etc. In all likelihood, the benefits of these medicines in her case are either very minimal or not there at all. However, side effects are severe and troublesome.
I would suggest stopping them for a few days and observing her.
1. Stop pacitane first and observe her for a few days (at least 3-5 days). Look for any problems or any improvement.
2. If that goes well, then, I would suggest stopping SYNDOPA CR too and observing for 3-5 days.
After 7-10 days, we can make a decision, whether she really needs these two drugs or whether she can manage better without them.
Dr Sudhir Kumar MD DM
It is better to stop SYNDOPA PLUS and PACITANE one by one.
Detailed Answer:
Thank you for getting back with details about your mother.
Based on the description, it seems to be adverse effects of her anti-parkinsonian drugs. Syndopa plus is known to cause dyskinesia and pacitane can cause agitation, hallucinations etc. In all likelihood, the benefits of these medicines in her case are either very minimal or not there at all. However, side effects are severe and troublesome.
I would suggest stopping them for a few days and observing her.
1. Stop pacitane first and observe her for a few days (at least 3-5 days). Look for any problems or any improvement.
2. If that goes well, then, I would suggest stopping SYNDOPA CR too and observing for 3-5 days.
After 7-10 days, we can make a decision, whether she really needs these two drugs or whether she can manage better without them.
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by :
Dr. Yogesh D
Many thanx for the answers doctor.I have the following questions . kindly clarify.
1) ,As suggested we are stopping pacitane from tomorrow.shd we totally stop or reduce to 0.5 Mg from 1Mg?
2) shall we resort to Syndopa CR from tomorrow evening same time instead of Syndopa Plus?
3) Shd we see her behaviour on syndopa CR for 3days before taking a call on stopping it ?
Kindly clarify .
1) ,As suggested we are stopping pacitane from tomorrow.shd we totally stop or reduce to 0.5 Mg from 1Mg?
2) shall we resort to Syndopa CR from tomorrow evening same time instead of Syndopa Plus?
3) Shd we see her behaviour on syndopa CR for 3days before taking a call on stopping it ?
Kindly clarify .
Brief Answer:
Stop pacitane completely.
Detailed Answer:
Thank you for getting back.
1. Stop pacitane completely from tomorrow- (no need to give any dose of pacitane),
2. Continue Syndopa CR at the same time as she takes Syndopa CR now (4:30 PM) for 3-5 days. So, she will only take SYNDOPA CR for the next 3-5 days.
3. After that (3-5 days later), she would stop SYNDOPA CR also and we would watch her for the next 3-5 days.
I hope it clarifies.
Dr Sudhir Kumar MD DM
Stop pacitane completely.
Detailed Answer:
Thank you for getting back.
1. Stop pacitane completely from tomorrow- (no need to give any dose of pacitane),
2. Continue Syndopa CR at the same time as she takes Syndopa CR now (4:30 PM) for 3-5 days. So, she will only take SYNDOPA CR for the next 3-5 days.
3. After that (3-5 days later), she would stop SYNDOPA CR also and we would watch her for the next 3-5 days.
I hope it clarifies.
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Many thanx doctor.
Till today we are giving only syndopa plus and not CR version as explained by me above.
SO from tomorrow evening u suggest to use CR version instead of Syndopa plus at same time without pacitane and watch for few days before taking a final call on Syndopa itself...
AM I right doctor??
Kindly clarify.
Till today we are giving only syndopa plus and not CR version as explained by me above.
SO from tomorrow evening u suggest to use CR version instead of Syndopa plus at same time without pacitane and watch for few days before taking a final call on Syndopa itself...
AM I right doctor??
Kindly clarify.
Brief Answer:
Yes, you are right.
Detailed Answer:
Syndopa plus is more likely to cause adverse effects as compared to Syndopa CR. Therefore, we want to test its efficacy and safety in her. In case we are forced to use one drug, it should be Syndopa CR and not Syndopa plus.
Pacitane is more likely to cause adverse effects and less likely to give benefits (as compared to both syndopa plus as well as syndopa CR). So, we would prefer to at least stop this (if not both pacitane and syndopa CR).
Dr Sudhir XXXXXXX MD DM
Yes, you are right.
Detailed Answer:
Syndopa plus is more likely to cause adverse effects as compared to Syndopa CR. Therefore, we want to test its efficacy and safety in her. In case we are forced to use one drug, it should be Syndopa CR and not Syndopa plus.
Pacitane is more likely to cause adverse effects and less likely to give benefits (as compared to both syndopa plus as well as syndopa CR). So, we would prefer to at least stop this (if not both pacitane and syndopa CR).
Dr Sudhir XXXXXXX MD DM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doc.As suggested by you..we have done the following.
1) Pacitane has been stopped totally last 8 days.
2) SYNDOPA plus is relplaced with syndopa CR 125.We are giving same time daily for last 7 days at same time as we used to give syndopa plus..i.e at 4.30 PM.Week s observation is as follows.
1) She is sleeping after taking syndopa CR also as syndopa Plus but slightly more duration .say 30 to 45 minutes . Around 8 to 8.15PM she gets up.
2) No dyskinesia s noted at that time.She s able to take dinner ofcourse we have to feed her with spoon.
3) Then around 9.15 to 9.30 PM she takes her ALPRAX .5 mg and sleeps.
Now the issues are as follows.
a) Around 12PM slowly she gets some distortion in sleep and starts murmuring slightly saying haa haa like that...This goes on for about 30 minutes and then subsides as she sleeps ...Is this the time Weaning effect of CR version???How to avoid this?
2) When during the earlier months of Syndopa plus...she used to get up on her own..walk with Walker few yards take dinner on her own from plate etc...All these she s not able to do....Her response for questions asked to her is also getting delayed. and not able to speak clearly ...This is seen last 7 days on CR version...How to address this??
3 ) She we stop CR also for 3 to 5 days and see or she we add dosage in morning also or in evening CR version of higher power need be given?? Now at this moment also she is murmuring and not stable and thus takes 30 mts to settle..
Kly advise..
I will be following up on the above constantly doctor .
Or without Pacitane she we try Syndopa plus again at same time??
1) Pacitane has been stopped totally last 8 days.
2) SYNDOPA plus is relplaced with syndopa CR 125.We are giving same time daily for last 7 days at same time as we used to give syndopa plus..i.e at 4.30 PM.Week s observation is as follows.
1) She is sleeping after taking syndopa CR also as syndopa Plus but slightly more duration .say 30 to 45 minutes . Around 8 to 8.15PM she gets up.
2) No dyskinesia s noted at that time.She s able to take dinner ofcourse we have to feed her with spoon.
3) Then around 9.15 to 9.30 PM she takes her ALPRAX .5 mg and sleeps.
Now the issues are as follows.
a) Around 12PM slowly she gets some distortion in sleep and starts murmuring slightly saying haa haa like that...This goes on for about 30 minutes and then subsides as she sleeps ...Is this the time Weaning effect of CR version???How to avoid this?
2) When during the earlier months of Syndopa plus...she used to get up on her own..walk with Walker few yards take dinner on her own from plate etc...All these she s not able to do....Her response for questions asked to her is also getting delayed. and not able to speak clearly ...This is seen last 7 days on CR version...How to address this??
3 ) She we stop CR also for 3 to 5 days and see or she we add dosage in morning also or in evening CR version of higher power need be given?? Now at this moment also she is murmuring and not stable and thus takes 30 mts to settle..
Kly advise..
I will be following up on the above constantly doctor .
Or without Pacitane she we try Syndopa plus again at same time??
Brief Answer:
Let us stop Syndopa CR also.
Detailed Answer:
Thank you for getting back.
Let us stop Syndopa CR 125 also. If someone is requiring only a single dose of Syndopa CR, they can manage without it also (usually). After stopping, let us watch for any worsening of Parkinsonian symptoms such as tremors, rigidity of arms or slowness of movements (as compared to while she was on syndopa CR). This observation should be continued for 4-5 days.
Observation is also needed for any disturbance or improvement with regards to sleep and behaviour.
Best wishes,
Dr Sudhir Kumar MD DM
Let us stop Syndopa CR also.
Detailed Answer:
Thank you for getting back.
Let us stop Syndopa CR 125 also. If someone is requiring only a single dose of Syndopa CR, they can manage without it also (usually). After stopping, let us watch for any worsening of Parkinsonian symptoms such as tremors, rigidity of arms or slowness of movements (as compared to while she was on syndopa CR). This observation should be continued for 4-5 days.
Observation is also needed for any disturbance or improvement with regards to sleep and behaviour.
Best wishes,
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by :
Dr. Kampana
Dear Doc.
As advised we have stopped SYNDOPA CR TOO Last 5 days.Following are the clinical observations.
1) Her response to any queries is very muted and delayed.
2) No energy or any briskness at all.Always on bed.Unable to get up on her own.
3) Severe lower jaw involuntary movement s..thereby causing tongue to protrude out and do dryness sets up in mouth.Also some mild involuntary jerks on finger.THIS WAS THE PRECISE CLINICAL CONDITION WHEN INITIALLY SHE WAS STARTED WITH SYNDOPA PLAIN ONE PER DAY.
4)Looks body is getting rigid and movements are tough.
5) NO ATTENTIVENESS AT ALL.
6) Evening dyskinesia s when syndopa plus and pacitane was given around dinner time..is not seen ....But no attentiveness at all.Dinner we are only feeding by spoon.
7)Her pulse rate stand s between 85 to 100..any time...
8)She is unable to speak properly and pronounciation is very difficult which was not seen earlier to this extent.
ABOVE ARE THE OBSERVATIONS.KLY ADV FURTHER COURSE OF ACTION .
WE WERE GIVING PLAIN SYNDOPA INITIALLY WHEN LOWER JAW INVOLUNTARY MOVEMENT S..WERE OBSERVED.
KLY ADV WHETHER WE HAVE YO START SYNDOPA AGAIN??? PLAIN OR PLUS OR CR??If we have to then what needs to be done to stop dyskinesia s from occurring ???
Awaiting reply.
Thanking you.
As advised we have stopped SYNDOPA CR TOO Last 5 days.Following are the clinical observations.
1) Her response to any queries is very muted and delayed.
2) No energy or any briskness at all.Always on bed.Unable to get up on her own.
3) Severe lower jaw involuntary movement s..thereby causing tongue to protrude out and do dryness sets up in mouth.Also some mild involuntary jerks on finger.THIS WAS THE PRECISE CLINICAL CONDITION WHEN INITIALLY SHE WAS STARTED WITH SYNDOPA PLAIN ONE PER DAY.
4)Looks body is getting rigid and movements are tough.
5) NO ATTENTIVENESS AT ALL.
6) Evening dyskinesia s when syndopa plus and pacitane was given around dinner time..is not seen ....But no attentiveness at all.Dinner we are only feeding by spoon.
7)Her pulse rate stand s between 85 to 100..any time...
8)She is unable to speak properly and pronounciation is very difficult which was not seen earlier to this extent.
ABOVE ARE THE OBSERVATIONS.KLY ADV FURTHER COURSE OF ACTION .
WE WERE GIVING PLAIN SYNDOPA INITIALLY WHEN LOWER JAW INVOLUNTARY MOVEMENT S..WERE OBSERVED.
KLY ADV WHETHER WE HAVE YO START SYNDOPA AGAIN??? PLAIN OR PLUS OR CR??If we have to then what needs to be done to stop dyskinesia s from occurring ???
Awaiting reply.
Thanking you.
Brief Answer:
She seems to have a narrow therapeutic window for LEVODOPA
Detailed Answer:
Thank you for getting back with detailed observations.
She seems to have a "narrow therapeutic window" for LEVODOPA. This means, the difference between the dose that helps relieve her symptoms, and the dose that causes side effects is very little.
It is clear that she needs a small dose of LEVODOPA. Let us use SYNDOPA CR 125 mg half tablet at her usual evening dose time (4:30 PM). If she tolerates it without much side effects such as dyskinesia, then, make it one full tablet after 4-5 days. If she tolerates the full tablet of SYNDOPA CR, the same can be continued. On the other hand, if she tolerates half tablet, but has adverse effects with full tablet, only half tablet can be continued.
Best wishes,
Dr Sudhir Kumar MD DM
She seems to have a narrow therapeutic window for LEVODOPA
Detailed Answer:
Thank you for getting back with detailed observations.
She seems to have a "narrow therapeutic window" for LEVODOPA. This means, the difference between the dose that helps relieve her symptoms, and the dose that causes side effects is very little.
It is clear that she needs a small dose of LEVODOPA. Let us use SYNDOPA CR 125 mg half tablet at her usual evening dose time (4:30 PM). If she tolerates it without much side effects such as dyskinesia, then, make it one full tablet after 4-5 days. If she tolerates the full tablet of SYNDOPA CR, the same can be continued. On the other hand, if she tolerates half tablet, but has adverse effects with full tablet, only half tablet can be continued.
Best wishes,
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Dyskinesia will settle on own.
Detailed Answer:
Levodopa-induced dyskinesia would settle on own, as the effect of drug wears off. Usually, there is no need to give any medicine to stop it.
Dr Sudhir Kumar MD DM
Dyskinesia will settle on own.
Detailed Answer:
Levodopa-induced dyskinesia would settle on own, as the effect of drug wears off. Usually, there is no need to give any medicine to stop it.
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doc
Thanks so much for your advice.we shall start half from today itself.
In the event of dyskinesia s developing what needs to be done to at that time?? Any suggestions pl.
Will it settle on its own?
Or we have to give ALPRAX ? any dosage?
Awaiting your reply.
Thanks so much for your advice.we shall start half from today itself.
In the event of dyskinesia s developing what needs to be done to at that time?? Any suggestions pl.
Will it settle on its own?
Or we have to give ALPRAX ? any dosage?
Awaiting your reply.
Answered by
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