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Topic Medication Go to previous topic Go to next topic Go to higher level

By Claude Henderso On 2010.11.03 12:13
Hi. I am care giver for my wife of 50+ years who was diagnosed with Parkinsonís disease in 2001. This terrible relentless disease (or LBD) has taken a talented wife who raised four kids and could do just about anything and turned her into someone who can do almost nothing (but still wants to).
I am new to this forum and this is my first post. I would really like your input concerning her medication. I had (have) the gut level feeling that she is over medicated. I requested her neurologist to do a review of her medication. The only change he recommended was to reduce her amantadine from twice per day to once per day and changed her Exelon from a 1.5mg tab twice per day to a 4.5mg patch.
I go regularly to a local PD support group. Yesterday I read to them her med list. There was a collectively jaw dropping. It was a small group due to lousy weather. There were 4 PDrs their spouses and the facilitator. They all felt she was taking too much medication. It will probably make this post way too long but I am going to copy her med list here.
10/20/10
Normaís med list

OMEPRAZOLE 20MG 30 MIN BEFORE BREAKFAST
SERTRALINE 150MG EACH MORNING AFTER BREAKFAST
NAMENDA 10MG BID
CARABIDOPA LEVODOPA 10/100 1 AT NIGHT DC 7/6/10 DR. CONWAY RESTARTED 10/6/10 DR. CHURCH DC AGAIN BY DR CONWY 10/12/10
METANX 2 -2.8 25 MG 1 PER DAY
NITROFURANTOIN (MACROCRYSTALS) 50 MG ONE AT BEDTIME
OXYTROL TWICE A WEEK (SUN & THURSDAY)
HYDROCODONE 5/500 ONE TAB 4 TO 6 HRS PRN
EXELON 1.5MG BID 7/6/10 DR CONWAY
AMANTADINE 100MG 1 TABLITS BID 7/6/10 DR CONWAY
SIMVASTATIN 40MG TABLET (ZOCOR) 1 EACH EVENING DR. CHURCH DC 10/4/10
SEREQUEL 25MG ONE TAB AT BED TIME DR CONWAY 6/12/10 CHANGED TO 12.5MG 10/19/10
CLONAZEPAM 1 MG ONE TAB AT BEDTIME DR. CONWAY 6/12/10
MIRAPEX 0.125MG TID DR. CONWAY 10/19/10
MELATONIN 3MG OTC DR CHURCH
CITRUCEL TWO TABLETS EACH EVENING
OTC STOOL SOFTENER BID
MIRILAX AND SENNA-LAX PRN
Please give me the benefit of your collective wisdom. Thanks Claude

By karolinakitty On 2010.11.03 23:31
[deleted]

By Emma On 2010.11.04 04:15
Welcome to the forum Claude. That's quite a list! I noticed that you have one doctor starting the carb/levo then another one dc's it, the other one starts it. It looks like your wife is also taking two dementia meds and a lot of stuff for constipation and sleeping. Along with karolinakitty I wonder if each of your doctors knows what the other is prescribing. I think you were right to ask the neuro to review them all, what response did you get? It's important with PD to have doctors who communicate with each other to coordinate care. Our family doctor is my husband's primary care physician/team leader and does an extraordinary job of coordinating care and seeing that information is shared with his other doctors, including the neurologist. The neurologist in turn regularly reviews his medications and confers with the primary care doc about that. It's a well oiled machine with all of his doctors sharing information through the primary care physician who then passes it on to the rest of my husbands medical team. As a result every hand knows what the other is doing. Another thought ... do you use the same pharmacy for all of your wife's meds? The pharmacist can review them for you too.

Keep us posted on what you find out.

By susger8 On 2010.11.04 08:51
Wow, that is an amazing list. I see quite a few treatments for things other than PD, but a couple of items puzzle me. I am assuming that your wife is maybe in her 70s at least? And has had PD for some years? She is on three meds for PD -- but taking only one Sinemet per day. Current thinking is that older patients do better on Sinemet only, because the other meds for PD don't do much at that stage, and only cause side effects. I would especially wonder about amantadine in an elderly patient as it tends to cause or increase delusions and hallucinations. Mirapex also can cause confusion. When I "fired" my dad's garden-variety neurologist and switched to a movement disorder specialist, the first thing the new doc did was take him off everything but Sinemet, and increase the dose of Sinemet, which is what I was trying to convince the old doc to do.

I am guessing that she does have problems with memory and thought process, since she is on two dementia meds. I am wondering if part of that might be due to the above PD meds, and/or some of her other psychoactive meds. She's on an antidepressant, and an antianxiety agent, plus Seroquel -- all of which might be appropriate for her condition, but could impact her mental status. Most of all I am wondering about the hydrocodone. Most people with PD do not react at all well to opiates. This can really affect mental status! Is she in a great deal of pain from something? PDers have to be really careful with pain meds.

Does she have an ongoing urinary tract infection? (I'm guessing that from the nitrofuantoin.) UTIs can often cause confusion.

Why is she taking the Metanx? It's usually for diabetic neuropathy, but you haven't mentioned any meds for diabetes. I see that it increases levels of folic acid, B12 and B6, so maybe that's for a B vitamin deficiency, which can also cause confusion.

I'm not a doctor, but I have the impression that she is being given a lot of meds for her mental status, when maybe she is experiencing confusion due to some of her other meds.

Sue

By Claude Henderso On 2010.11.04 11:08
Thanks to all for your input. My wife is 71. She has scoliosis and has had back surgery. The pain med is for her back pain. She had brest cancer in 2000 and had a double mastectomy, chemo and radiation. Her doctors do talk. They only seem to disagree on the carabidopa/levidopa. We have never been to a movement specialst. I will look into that. Again thanks, you have given me lots to think about.

By MJ-Camano On 2010.11.04 11:29
My husband's medication list is about this long also, I have taken him to several doctors and they all seem to review the list and accept that he needs all of these medications. (they are for PD, sleep, diabetes, gout, heart, blood pressure, thyroid, anti-depressent, memory.) I have 15 perscription medications along with various vitamins and melatonin. He tolerates this current list very well, but he has had problems with pain medications and incontinence medications. He now goes to an internist and a neurologist at the same clinic which is working very well - they use the same computer system and review all the notes on file. I recently took him to have a skin cancer removed and the dermatologist at the same clinic, he was able to review the notes and medications and proceed accordingly.

Yes, you should probably have the list of medications reviewed; but I thought I would let you know that my husband is there also so this may not be so unusual......

By MonaL On 2010.11.13 06:59
I am new to the list also, and just a couple of thoughts.

Long term OMEPRAZOLE can make some digestive problems worse, as well as conditions like osteoporosis. Making sure that she is on a minimal dose, or using an H2 inhibitor like Zantac (if it's effective) can be safer in the long run and also not have as many interactions with other drugs.

The NITROFURANTOIN is a very bad drug for my Mom (non-PD'er). It makes her extremely weak and disoriented, both physically and mentally. The confusion that she has on that drug is profound - she is a different person on it. Thank goodness she is on it only for short periods of time. She has recurring urinary problems, so we are now trying cranberry/mannose capsules, trying to avoid that medicine again. She is sensitive to most other antibiotics, I don't know if that's related, but in anyone having mental impairment of any sort, I might first suspect that drug.

By parkinit On 2010.11.14 22:57
Having the disease for so long, I am surprised at the low dosage of Sinemet. Actually, my spouse has been diagnosed for going on 11 years and he takes sinemet 7 times a day - every 3 hours and wakes and takes it at night. I'm not sure about many of the meds that are non-PD.


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