Dear jstaker-ga;
Thank you for allowing me an opportunity to answer your interesting
question.
As we often do with questions of a medical nature I must preface with
the disclaimer that anything we discuss here should not be taken as
medical advice, nor should you ever assume that anything you learn
from anyone in an anonymous internet forum is better than
recommendations made to you by your licensed physician. With that
behind us I think it is important to break this discussion up into
issues before coming to a conclusion, keeping in mind that what I know
about your specific situation is relatively minimal.
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First, let’s discuss the drug Sinemet for use as a treatment for
Parkinson’s disease and Parkinsonism:
It is believed that the symptoms of Parkinson's disease are caused by
a lack of dopamine (DOE-puh-mean), a naturally occurring chemical
produced by certain brain cells. Dopamine has the role of relaying
messages in certain regions of the brain that control muscle movement
and as such, difficulty in movement results when too little dopamine
is produced. It has been found that the drug Levodopa acts to
replenish dopamine in the brain, while Carbidopa ensures that enough
Levodopa gets to the brain where it is needed. In many patients, this
reduces the symptoms of Parkinson's disease.
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ABOUT SINEMET:
Sinemet is actually a combination of the drug Levodopa, the metabolic
precursor of dopamine, and Carbidopa, an aromatic amino acid
decarboxylase inhibitor. It is designed to treat the SYMPTOMS of
Parkinson's disease and as such is also used to treat the SYMPTOMS of
Parkinsonism. It is not a cure and does not necessarily work in all
patients. Sinemet also contains several non-pharmaceutical ingredients
such as cornstarch, magnesium stearate, microcrystalline cellulose,
and pregelatinized starch. Sinemet 100/10 tablets and Sinemet 250/25
tablets also contain indigotine (a food additive) and Sinemet 100/25
tablets also contain quinoline yellow (another food additive). Anyone
who is allergeic or has sensitivity to these ingredients should
refrain from taking the medication. Other conditions also make it
impractical to use Sinemet:
Those who have moles or skin lesions that are suspiciously indicative
of cancer (Levodopa can activate some malignant cancers).
Those who have had previous bouts with certain cancers.
People who are being treated for depression with certain MAO inhibitor
drugs.
Patients who have been diagnosed with narrow-angle glaucoma.
In addition to these concerns, there are some factors that are known
to reduce the clinical effectiveness of Levodopa and Carbidopa
treatments. It has been reported that people who are taking iron salts
(like those found in multivitamin tablets), people who have excessive
stomach acidity, and those who have a high protein diets can be
deprived of the positive effects of these drugs because these
circumstances tend to reduce the amount of the drug that is absorbed
by the body. If your father fits any of these descriptions he might
not be getting the necessary dosage that the physician originally
intended even though he is taking the prescription correctly.
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SINEMET INGREDIENTS:
Here is a detailed description of the various kinds of Sinemet:
“Sinemet 100/25 (Levodopa, Carbidopa) is a yellow, oval, scored,
uncoated tablet, engraved SINEMET 650 on one side, which contains 100
mg of Levodopa and 25 mg of Carbidopa as the active ingredients.
Sinemet 100/10 (Levodopa, Carbidopa) is a dark dapple-blue, oval,
uncoated tablet, engraved 100/10 on one side and SINEMET on the other
side, which contains 100 mg of Levodopa and 10 mg of Carbidopa as the
active ingredients.
Sinemet 250/25 (Levodopa, Carbidopa) is a light dapple-blue, oval,
scored, uncoated tablet, engraved SINEMET 654 on one side, which
contains 250 mg of Levodopa and 25 mg of Carbidopa as the active
ingredients.”
SINEMET
http://www.rxcanadapharmacy.com/htmFiles/Sinemet.asp
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SINEMET SIDE EFFECTS:
There are potentially some undesirable side effects from Sinemet. The
most frequent side effects are: abnormal movements including twitching
or spasms (which may or may not resemble your Parkinson's symptoms),
and nausea.
“Other possible side effects include: mental changes, dream
abnormalities, hair loss, diarrhea, increased sexual drive,
palpitations, feeling of lightheadedness when standing quickly,
dizziness, sleepiness, vomiting, loss of appetite, and slow movement.
Occasionally, dark color (red, brown or black) may appear in your
saliva, urine or sweat after you take Sinemet.
Hypersensitivity reactions may occur such as hives, itching, rash, and
swelling of the face, lips, tongue, and/or throat, which may cause
difficulty in breathing or swallowing: contact your physician
immediately if these symptoms occur.
Some people may have other reactions. If you notice any unusual
effect, check with your physician or pharmacist.”
SINEMET
http://www.rxcanadapharmacy.com/htmFiles/Sinemet.asp
In addition, some patients must have their dosages of the drug
adjusted to so that is can be taken concomitant (in conjunction with)
any medications they might be taking to treat high or low blood
pressure, heart disease or depression. Some studies have shown other
adverse reactions to Levodopa within the nervous system such as
numbness, increased hand tremor, muscle twitching, blepharospasm (an
involuntary blinking of the eyelids which may be taken as an early
sign of excessive dosage), trismus (a tonic contraction of the jaw
muscles), and activation of latent Horner's syndrome. Some known
psychiatric reactions in some patients include delusions and euphoria.
These are certainly some important issues to discuss with your
father’s doctor in great detail. When you meet with the physician keep
in mind that your father might:
* Be having a reaction to the drug
* Be having a reaction to the non-pharmaceutical ingredients in the
drug,
* That he might not be getting enough of the drug due to his diet,
stomach acid or other fundamental reason
* He might be getting too much of the drug due to an overdue dosage
adjustment, and...
* He might be experiencing a conflict with some other drug he is
taking.
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Now, as for the other drug you mentioned, it is actually called
“STALEVO”. The proper spelling of the drug’s name will be important to
note when you speak with the physician.
ABOUT STALEVO:
The drug Stalevo is actually much the same as Sinemet. Like Sinemet,
Stalevo contains the drugs Carbidopa and Levodopa but also contains a
third drug called “Entacapone” (in-TACK-a-pohn) aka brand name,
Comtan. It may be important to note that on Stalevo’s web site the
statement is made that Stalevo should be used INSTEAD of
Carbidopa/Levodopa and says nothing whatsoever about the drug being
used in conjunction with other Carbidopa/Levodopa therapies. If your
father was receiving both of these drugs (Stalevo and Sinemet) is
certainly plausible that he was being overmedicated and that some of
his symptoms might have actually been the result of too great a dosage
of Levodopa, Carbidopa or both. My research has often found that
whenever a Levodopa/Carbidopa therapy medication has been missed, it
should never be doubled up in order to make up for the missed dosage.
This in itself leads one to believe that a constant double dosage such
as Sinemet used with Stalevo is probably not a good thing.
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STALEVO INGREDIENTS:
Here is a description of the ingredients in the various forms of
Stalevo:
STALEVO 50, containing 12.5 mg Carbidopa, 50 mg Levodopa, and 200 mg
entacapone
STALEVO 100, containing 25 mg Carbidopa, 100 mg Levodopa, and 200 mg
entacapone
STALEVO 150, containing 37.5 mg Carbidopa, 150 mg Levodopa, and 200 mg
entacapone
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STALEVO SIDE EFFECTS:
“The most common side effects of STALEVO are unwanted or
uncontrollable movements (known as dyskinesia), nausea, diarrhea,
excessive muscle movements (known as hyperkinesia), harmless
discoloration of urine, sweat and/or saliva, diminished or slow
movements (known as hypokinesia), abdominal pain, dizziness,
constipation, fatigue, pain, and hallucinations. Some of the more
serious side effects may include severe diarrhea, severe dyskinesia,
hallucinations, other mental disturbances, orthostatic hypotension
(low blood pressure), rhabdomyolysis (a muscle disease) and symptoms
resembling neuroleptic malignant syndrome (a condition characterized
by fever and muscle stiffness).”
IMPORTANT SAFETY INFORMATION FOR STALEVO
http://www.stalevo.com/info/tools/product.jsp
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Frankly, (and again, keep in mind that I AM A RESEARCHER, NOT A
PHYSICIAN) I found nothing in my research that supports the use of the
drug Sinemet in conjunction with the drug Stalevo. In fact, RX
America’s New Drug Notification describes these an “alternatives” to
one another and mentions nothing whatsoever of concomitant use. I
should note though that in speaking with my own pharmacist (who by the
way says he has never heard of Stalevo) I learned that occasionally
two different forms of Levodopa/ Carbidopa therapies are sometimes
given to Parkinson’s patients but rarely of the same dosage and
delivery. That is to say one might be a time release version for
nighttime while another might be a scheduled dose intended for use
during the day. We have no way of knowing whether your father’s
physician(s) intended one or the other for specific purposes but I
would imaging this would be an important point to consider when you
meet with the physician as well.
As for the Parkinson’s disease versus Parkinsonism, Parkinson’s
disease is known condition caused by the lack of dopamine in the brain
(see above) while “Parkinsonism” is merely the term used to describe
the symptoms of Parkinson’s such as the stooped posture, shuffling
gait, palsy, and other obvious symptoms of the disease itself. The
term Parkinsonism is almost always used to describe symptoms suffered
by those diagnosed with Parkinson’s disease and does accurately
describe palsies and other problems that stem from other conditions
where a root cause for such disturbances are known (brain injury,
cerebral arteriosclerosis, encephalitis, syphilis, carbon monoxide
poisoning, etc). For the purposes of your question then, in your
father’s particular circumstance Parkinson’s and Parkinsonism are one
and the same.
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Now, to recap, here are some issues you should probably consider
discussing with your physician related to your fathers condition, his
continued use of certain medications and his unexplained recovery:
Is (was) my father…
…having a reaction to the drugs he is/was taking?
…is/was having a reaction to the non-pharmaceutical ingredients in
these drug?
…not be getting enough of the drug due to his diet, stomach acid or
other reason?
…getting the right dosage of the drug(s) was was prescribed?
…experiencing a conflict with some other drug he is/was taking?
Should my father…
…have been taking Sinemet and Stalevo at the same time?
…continue or discontinue one or more of these drugs, and why?
…have his dosage of one or more of these drugs adjusted?
How can we tell…
…if my father is allergic to one or more ingredients in these drugs?
…if the drugs are/were causing some of may father’s symptoms when the
same symptoms the drug is designed to treat are mentioned as possible
adverse reactions on the drug insert?
Are you certain beyond a reasonable doubt that my father actually HAS
Parkinson’s disease, and how did you come to that conclusion in
laymen’s terms?
Do you know for a fact, or is there any way to definitely determine
that other medications my father might be taking for his heart
ailments and other assorted medical problems are unquestionably
compatible with all the treatments he is/was receiving, before, during
and after his recent setback?
Why does research indicate that caution should be used to insure that
patients to not receive a double dose of drugs containing
Levodopa/Carbidopa, but my father was prescribed two different drugs
(Sinemet and Stalevo) containing these ingredients?
Is it possible that my father might have been having a reaction to the
Entacapone (Comtan) in Stalevo and when the drug was discontinued his
condition improved?
And finally, don’t beat around the bush. Be as forthcoming as possible
and express your concerns that there is some doubt in your mind as to
whether your father even HAS Parkinson’s disease. If he does have the
disease you suspect that his symptoms (or at least his recent symptoms
that led to his being referred to as "terminal") might have been
excerbated by the medication or combination of medications. Tell him
you wonder if his medication might very well have played a role in his
seemingly terminal state in the recent past. Come right out and ask
him, “Could my father have experienced this recent setback as a direct
result of his medication, his prescribed dosages or from the
combinations of drugs he was being given?” Ask him to explain this
miraculous recovery (if he can). I caution you though to be prepared
to confront the issue of end-stage Parkinson's if this is indeed what
the neurologist explains. Such is the tragic nature of this disease
and until something more develops in this field to help those
suffering from Parkinson's disease, it appears the situation will
ultimatley become more and more bleak as time goes by.
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I wish you well on your visit with your father’s neurologist and I
hope this better prepares you with information and possible questions
to consider. I hope you find that that my research exceeds your
expectations. If you have any questions about my research please post
a clarification request prior to rating the answer. I welcome your
rating and your final comments and I look forward to working with you
again in the near future. Thank you for bringing your question to us.
Best regards;
Tutuzdad-ga
INFORMATION SOURCES
SINEMET
http://www.rxcanadapharmacy.com/htmFiles/Sinemet.asp
PHARMACY NETWORK - SINEMENT
http://www.pharmacynetworkgroup.com/Sinemet-side-effects.htm
HOW STALEVO WORKS
http://www.stalevo.com/info/about/how_stalevo_works.jsp
IMPORTANT SAFETY INFORMATION FOR STALEVO
http://www.stalevo.com/info/tools/product.jsp
MEDLINE PLUS – ENTACAPONE
http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500103.html
RX AMERICA – NEW DRUG NOTIFICATION
http://www.rxamerica.com/media/pdf/jun20.pdf
BLEPHAROSPASM
http://www.blepharospasm.org/
PARKINSONISM
http://www.factmonster.com/ce6/sci/A0837674.html
SEARCH STRATEGY
SEARCH ENGINE USED:
Google ://www.google.com
SEARCH TERMS USED:
STALEVO
COMTAN
ENTACAPONE
SINEMET
DOPAMINE
LEVODOPA
CARBIDOPA
These search terms were used alone and also in conjunction with the
search terms: “CONTRAINDICATIONS”, “REACTIONS”, “ADVERSE”, “OVERDOSE”,
“OVERMEDICATED”, “OVER MEDICATED”, “EXCESSIVE”, “CONCOMITANT”,
“SYMPTOMS”, “PARKINSON’S”, and “PARKINSONISM”. |
