Brief Answer:
Timing is EVERYTHING, isn't it?

Detailed Answer:
Thank you very much for your question on this network.

The timing of domperidone is about 30 min. prior to meals. I typically, don't use this medication in patients UNLESS they've already demonstrated particularly slow transit of food through the GIT tract or if they've demonstrated intolerance to other medications such as MADOPAR in your case in which case I will add a small dose to cover for the anti-nausea effect. I don't like using the medication straight away for a couple of reasons. First, people tend not to use it for the short run which then, reduces (or even eliminates its efficacy). I always caution patients that we really need to RE-evaluate the efficacy of this drug after 1-2 weeks and not overuse it.

Secondly, this drug's mechanism of action makes a risk for causing motor tics referred to as TARDIVE DYSKINESIA. In most people these side effects are well controlled simply by stopping the medicaiton and allowing it to washout. In a small % of patients the side effects may persist and now you've got a patient with a motor tic of some sort or who may have some writhing or extraneous movements that possibly was not necessary to have had the medication not been used right away until assessing whether or not Madopar actually causes side effects.

These are things to discuss with your doctor. Many doctors seem to just give some of these medications automatically to patients before really evaluating them to see what their tolerance levels are to the primary drug and I feel that is not the patient's best interest. I believe one should always start with the minimal amount of medication especially when side effects are potentially active in a cosmetic, behavioral, or other obvious way that the public or patient are aware cause things to happen that could cause embarrassment, etc. The other reason which may be as important as aesthetic is just the fact that putting more and more chemicals into the body without checking first to be sure it is really necessary or makes a difference simply adds to metabolic burdens on the kidneys, the heart, the liver, and the lungs.

I think a stepwise process with people diagnosed with things such as PARKINSON'S Disease is a very reasonable and logical way to manage a patient. The disease is chronic and generally slowly progressive. Therefore, we have time to assess response of patients at different levels and there is no real need in most cases to load someone up with more than one drug at a time before seeing how they react to the first or major medication.

Madopar (Sinemet in the U.S.A) is best taken 1-2 hrs. either before or after mealtime. If meals consist of more than 30% total caloric content of PROTEIN then, there could be an interference with its transport across the gut wall making the drug appear less EFFICACIOUS than it could be compared to being timed as I've suggested. So a time of 7:30p if your meal time is 5p is a good post meal slot to use.

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You can always reach me at the above address for this and other questions. I wish you the best with everything and hope our discussion has aided in your understanding of a few concepts related to your concerns.

Cheers young lady and wishin' you the best!

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