My father is 68 years old and has been diagnosed with PD for about 6
years. He has also had a triple bypass about 16 years ago. He is
currently on a 25/100 Carbidopa/Levodopa dosage x3 times a day and the
CR version once a day.

For the last one month or so he has been getting steadily less mobile.
He had a fever for a few days. Aroudn the same time his difficulty in
changing positions increased very significantly. His eyes glaze over,
pupils dilate and he blacks out for a bit - especially when getting up
from lying down or in the shower or getting up from sitting down. This
more or less fits with the description of 'Orthostatic Hypotension'
that I found online, except that he also gets spasms (like electric
shocks) while he is unconscious. Is this also part of the 'Orthostatic
Hypotension' symptoms or is it something else?

His doctor seems to have no clue (my parents live in India) and even
suggested that it might be due to an old back problem. What then are
the different options for treating 'Orthostatic Hypotension? (I
understand that this is not the place to get treatment plans - but it
would be nice to be able to give the doctor some specific questions
etc.) Thanks so much for reading the question.

Hi jhinks!!


After research for answer your question I think that your father are
suffering side effects of Carbidopa/Levodopa and also he is showing
symptoms of an overdose.

Please read carefully the following documents:

"Medication-Induced Orthostatic Hypotension in the Elderly" from
Consultant Pharmacist/Forum @ American Society of Consultant
Pharmacists website:
This article explains how some drugs induce Orthostatic Hypotension in
the geriatric patient, one of the types of medications capable of
causing Orthostatic Hypotension are Antiparkinsonian agents!!
http://www.ascp.com/public/pubs/tcp/1998/jul/forum.shtml


This explains the Orthostatic Hypotension symptoms but not the spasms.
But if you read the pages that give info related to Carbidopa/Levodopa
all of them say that the list of symptoms of side effects include
uncontrolled movements of a part of your body and back and neck muscle
spasms.
Sometimes this symptoms are part of overdose symptoms. These symtoms
normally dissapear when the offending medications are removed.

"Sinemet - Sinemet Side Effects - Sinemet Information - Canadian Pharmacy":
'The most frequent side effects are: abnormal movements including
twitching or spasms (which may or may not resemble your Parkinson's
symptoms), and nausea.'
http://www.rxcanadapharmacy.com/htmfiles/Sinemet.asp

"LEVODOPA and CARBIDOPA - Medicomm Drugs Reference Center":
http://www.medicomm.net/Consumer%20Site/dh/dh_l4.htm

"MedlinePlus Drug Information: Levodopa and Carbidopa":
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601068.html

"levodopa-carbidopa" page from MedicineNet.com:
http://www.medicinenet.com/levodopa-carbidopa/article.htm


In one page I found the following advice:
"Do not take this medication if you have...Any kind of heart disease,
including high blood pressure, arteriosclerosis, hardening of the
arteries, a previous heart attack, or an irregular heartbeat...", this
could be applicable to your father in some way.
"Carbidopa, Levodopa, Atamet, Sinemet, Sinemet CR, Parkinson's
disease, dopamine, Treatment of Parkinson's disease":
http://www.holistic-online.com/Remedies/Parkinson/pd_cardidopa.htm


Additional info related can be found after the following links:
First of all I strongly suggest you to read this excelent answer from
my felow researcher kevinmd-ga:
"Google Answers: Levodopa/Carbidopy":
http://answers.google.com/answers/threadview?id=175084

"Carbidopa/Levodopa":
http://www.mycustompak.com/healthNotes/Drug/Carbidopa_Levodopa.htm

"levodopa-carbidopa Main Index" from MedicineNet.com:
http://www.medicinenet.com/levodopa-carbidopa/index.htm

"Carbidopa and Levodopa Side Effects, Interactions and Information - Drugs.com":
http://web1.drugs.com/xq/cfm/pageid_0/htm_202326/tgid_15/type_cons/bn_Carbidopa%20and%20Levodopa/micr_medex/qx/index.htm


For info related to Orthostatic Hypotension follow the links at this
Google results page:
://www.google.com/search?q=Orthostatic+Hypotension

Search strategy:
Levodopa carbidopa spasms
Orthostatic Hypotension spasms
Levodopa spasms


I hope that this helps you. Please do not consider this answer ended
until your entire satisfaction. Before rate this answer, ask for a
clarification if you have a question or if you would need further
information.

Best regards.
livioflores-ga

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Request for Answer Clarification by jhinks-ga on 30 May 2004 22:14 PDT

Thanks so much livioflores for the detailed answer. All the links were
very helpful, especially the
http://www.aafp.org/afp/971001ap/engstrm.html one - as it talks of
possible tests and treatments. Thank you very much again!
-jhinks

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Clarification of Answer by livioflores-ga on 31 May 2004 04:39 PDT

Thank you so much for the good rating and for the generous tip. I am
so glad for knowing that my research gives you the help needed and I
hope also that this help your father to get more healthy.

Regards.
livioflores-ga

Very helpful and got to the exact things I needed to know.