Today, for the first time, I experienced the effects of protein interference with L Dopa absorption. I usually make an effort to refrain from eating protein at least 30-45 minutes before or after I've taken Stalevo (L Dopa and carbidopa + entacapone), but today I was out and didn't pay attention to the timing. I ate an egg and then took my medication a few minutes later. About a half hour later I was shopping in the local bead store, holding a small basket in my right hand and became aware that my tremor was acting up and the basket was shaking in a very distracting way. I realized that it had been weeks since my tremor had been noticeable and wondered why it was a problem today, but I didn't put two and two together until a little later. I realized that I had not waited the requisite interval between eating protein and taking my medication. In the past I had been skeptical about the reports that protein was truly a problem, but here very clearly was the confirmation that in fact it was.
For those who don't know, Stalevo is a fairly new medication that is equivalent to Sinnemet (L Dopa and carbidopa) plus a 3rd ingredient called entacapone which is supposed to even out the on/off periods and make them less noticeable and problematic. "Entacapone is an inhibitor of catechol-O-methyltransferase (COMT). It is used in combination with levodopa and carbidopa (Sinemet) to treat the end-of-dose 'wearing-off' symptoms of Parkinson's disease. Entacapone helps the levodopa and carbidopa work better by allowing more of it to reach the brain..."
Stalevo is more expensive than Sinnemet and many doctors do not believe that the cost differential is worth the benefits to PD patients. I cannot give an opinion on the difference because I have never taken Sinnemet so have no comparison. Stalevo was recommended by the PD specialist, a neurologist, at NIH and by my own local neurologist. If I take it regularly it seems to work well and I have few on/off symptoms.
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Stalevo is my friend. As well as mirapex and sinemet. I seem to repond well and I'm taking a lot more mirapex than is recommended, but it works. A little sleepiness at the wrong times and sleeplessness at night.
ReplyDeleteI don't have tremor, but if I've worked very hard or not slept well, I have some wearing off in the form of stutter-stepping around the house. Where I can walk with long strides, there is rarely a gait problem. Often, I forget my meds, especially mid-day, but now, the delta between forgetting and taking the meds is harder to disguise.
I feel like I do very well, then the lady at the check out stand in the grocery store will ask me if I need some help with my bags. That happened more before I was on meds. We're so lucky to have such a huge drug arsenal for our neurological disease.