PD Pearls

If levodopa is any higher than a low starting dose, it should never be stopped abruptly, but tapered slowly over at least 3 days to minimize risk of very rare, but still very severe, and even possibly life-threatening side effects of rapid withdrawal.

All PD meds should ideally be tapered off, not stopped abruptly, if it is time to stop.

The word Sinemet is a portmanteau built from Latin roots which mean “without vomiting.” Levodopa given without carbidopa may cause nausea and vomiting.   

 Carbidopa can be prescribed alone if needed to decrease nausea when the amount in Sinemet is not strong enough.  It is known by the brand name Lodosyn.

PD Pearls

pearl NYPL digital image

Manganese toxicity does not cause PD, but may cause a static, unchanging parkinsonism.

The “Parkinson personality” is one of avoiding risk, caffeine, nicotine, and alcoholism, and is often present for many years prior to the onset of the motor symptoms of PD.  

PD can occur at any age, but is most common in older people.  Based on U.S. Census Bureau count of the number of Mainers over 65 and over 80 in 2015, along with the incidence of PD as people age, one can estimate at least 3500 elderly Mainers currently have PD.

“ON” time is when medications are working and symptoms are lessened.  

“OFF” time is when medications are not working and symptoms are present or worse.

PD Pearls

pearl NYPL digital imageExcessive stomach acidity delays stomach emptying, thus delaying the absorption of levodopa.   Patients with gastritis, reflux, or chronic heartburn are at risk of other medical conditions as well, and should seek medical help.

Iron salts (such as in multivitamin tablets or ferrous sulfate tablets) may reduce the amount of levodopa available to the body. Iron salts can chelate levodopa and carbidopa, and therefore reduce the bioavailability and effectiveness of carbidopa/levodopa (Sinemet). If iron must be taken, it should not be given at the same time as carbidopa/levodopa.

Restless Leg syndrome (RLS) is a little more common among PD patients than the general population and tends to be worse at night.  Symptoms typically include a deep, uncomfortable sensation in the legs (not the feet), the urge to move, stretch, or walk, and at least partial relief with movement.  Some patients confuse these symptoms with wearing off of PD medications. Adding to the confusion, PD medications can relieve the symptoms, and therefore, wearing off might exacerbate RLS.

The incidence of PD: 1% over age 60, 4% over age 80.  In 2012, the U.S. Census Report estimated about 43,000,000 people over 65 in the U.S.  The Parkinson Disease Foundation estimates up to a million U.S. citizens have PD.

PD Pearls

Take levodopa one hour before, or two hours after meals containing protein. Levodopa and proteins are absorbed in the first part of your small intestine and if consumed together may compete to get into the bloodstream like passengers trying to get through a turnstile before a train leaves. If you eat a cheeseburger for example, and take levodopa at the same time, you may not absorb your medication. And, the problem does not stop there. Proteins are broken down into amino acids that will compete with levodopa to get through the blood brain barrier, a two-hit problem. If you have to eat something when you take levodopa, have crackers or a piece of fruit.

Many people with PD will have hyposmia (loss of sense of smell), constipation, and/R.E.M. sleep behavior disorder (RBD) for years before motor symptoms of tremor, stiffness, and slowness develop.

A third of all PD patients don’t have tremor. The most important diagnostic sign of PD is actually bradykinesia, or slowness of movement.

Work on balance daily, even if it is not yet a problem. Balance will almost certainly be a problem later on, and the more you do now, the better off you are likely to be.

Melanoma is a little more common among PD patients than the general population and regular skin exams with a doctor should take place, along with heightened concern for any new unusual lesions.