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Suggest An Alternative Medication For Clonazepam And Melatonin
Question: I have had Parkinson's Disease for about 5 years now. I am taking carbidopa/levodopa 25-250mg every three hours to get relief from muscle tremors in my right hand, right leg and left leg. My right leg is the worst as the muscles contract and become painful. Other autonomic symptoms have been eliminated with the above treatment. Insomnia is a problem. In addition to an ER C/L 50-200mg tab I take gabapentin 300mg, 2-3 tabs before bedtime along with melatonin and clonazepam 0.5mg. Questions: Is there another drug that I can take during the day to give me more than 3 hours of relief such as a dopamine agonist or an ER carb/levo? Is there another drug that I can take that will relieve tremors by lessening brain activity caused by anxiety, excitement, etc without causing depression? Is my night time treatment for insomnia alright? Is there an alternate treatment for insomnia? Note: I am 77. A regular exercise program has helped me a lot.
Brief Answer:
Drug changes can be done under guidance of a neurologist
Detailed Answer:
Hello XXXX,
I have gone through your question and understand your concerns.
The drug response decreases with increasing duration of parkinson's diseasea and escalated doses leads to side effects.
First and most effective drug is carbidopa/levodopa and its dose can be increased as well as frequency. If the effect is not sustained, then liquid formulation can be used.
Dopamine agonist like pramipexole or ropinorole can be used.
For tremors along with these drugs, trihexyphinydl , propranolol or clonazepam can be added.
Sustained muscle contraction in lower limb can be due to increased tone or dyskinesia. Possibility of restless leg syndrome(RLS) is less likely but can not be ruled out.
Get iron profile done and add iron in the case of deficiency. Dopamine agonist also helps in RLS.
Melatonin can be continued for sleep problems. Other drugs like zolpidem or clonazepam can also be tried in increased dosage.
Surgical options are also available for uncontrolled tremors.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr N Kumar
Neurologist
Drug changes can be done under guidance of a neurologist
Detailed Answer:
Hello XXXX,
I have gone through your question and understand your concerns.
The drug response decreases with increasing duration of parkinson's diseasea and escalated doses leads to side effects.
First and most effective drug is carbidopa/levodopa and its dose can be increased as well as frequency. If the effect is not sustained, then liquid formulation can be used.
Dopamine agonist like pramipexole or ropinorole can be used.
For tremors along with these drugs, trihexyphinydl , propranolol or clonazepam can be added.
Sustained muscle contraction in lower limb can be due to increased tone or dyskinesia. Possibility of restless leg syndrome(RLS) is less likely but can not be ruled out.
Get iron profile done and add iron in the case of deficiency. Dopamine agonist also helps in RLS.
Melatonin can be continued for sleep problems. Other drugs like zolpidem or clonazepam can also be tried in increased dosage.
Surgical options are also available for uncontrolled tremors.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Naveen Kumar
Regarding iron profile I also have Hemochromatosis. Serial Phlebotomies aim to keep my serum ferritin at 50 or below so it is not wise for me to take iron supplements. B12 is supposed to be helpful. Are B12 tablets helpful?
It seems that too much exercise of my legs or too strenuous leg exercises increases the "tone" or mass of my thigh muscles and seems to increase the severity of the leg muscle tremors. What exercises are the best for PD patients with leg tremors being the major symptom?
It seems that too much exercise of my legs or too strenuous leg exercises increases the "tone" or mass of my thigh muscles and seems to increase the severity of the leg muscle tremors. What exercises are the best for PD patients with leg tremors being the major symptom?
Brief Answer:
Exercises like walking and light aerobic exercises
Detailed Answer:
Hello,
In case you have hemochromatosis, then iron profile is not required at present and no need of iron supplementation. Vitamin B12 can be taken but pyridoxine can decrease the effectiveness of levodopa / carbidopa. So take either only vitamin B 12 or combination separated by atleast 2 hours from levodopa / carbidopa.
Leg spasm can reduce by taking calcium supplements and adequate hydration.
Don't do excessive exercises which leads to muscle fatigue and dehydration.
Normal walking may be done.
Regards
Dr N Kumar
Neurologist
Exercises like walking and light aerobic exercises
Detailed Answer:
Hello,
In case you have hemochromatosis, then iron profile is not required at present and no need of iron supplementation. Vitamin B12 can be taken but pyridoxine can decrease the effectiveness of levodopa / carbidopa. So take either only vitamin B 12 or combination separated by atleast 2 hours from levodopa / carbidopa.
Leg spasm can reduce by taking calcium supplements and adequate hydration.
Don't do excessive exercises which leads to muscle fatigue and dehydration.
Normal walking may be done.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Raju A.T
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