madopar cr and madopar

[Msocpharm]

anyone heard of pts recieving both. I am aware that cr sometimes given at in combination with normal release to cover tremor period at night but is this routine practice. Anyone seen both more frequntly?

[Nik]

Both forms are commonly co-prescribed, but it's not to do with tremor symptoms. With the immediate release levodopa patients may eventually develop complications. These include end of dose deteriorations where essentially the benefit of a levodopa dose is "lost" and symptoms return. This commonly happens first thing in the morning (after a long period of not having any levodopa) or just before the next dose is due.
"On-off" effects can also occur, where pt's suddenly can become stiff and immobile, before their normal motor function returns. CR preps provide a more constant plasma level but will still need to be taken more frequently during the day, and an extra dose at night might be needed for off periods. The alternative option is to reduce the dose and increase the frequency of administration.
Essentially what is happening is that the brain becomes more reliant on exogenous dopamine as the disease progresses, because of loss of dopamine neurones and loss of the ability to synthesize dopamine. Duration of action of individual doses therefore become progressively shorter.

[Msocpharm]

Both forms are commonly co-prescribed, but it's not to do with tremor symptoms. With the immediate release levodopa patients may eventually develop complications. These include end of dose deteriorations where essentially the benefit of a levodopa dose is "lost" and symptoms return. This commonly happens first thing in the morning (after a long period of not having any levodopa) or just before the next dose is due.
"On-off" effects can also occur, where pt's suddenly can become stiff and immobile, before their normal motor function returns. CR preps provide a more constant plasma level but will still need to be taken more frequently during the day, and an extra dose at night might be needed for off periods. The alternative option is to reduce the dose and increase the frequency of administration.
Essentially what is happening is that the brain becomes more reliant on exogenous dopamine as the disease progresses, because of loss of dopamine neurones and loss of the ability to synthesize dopamine. Duration of action of individual doses therefore become progressively shorter.

I assume it is the same for sinemet. what abot dispersible madopar combined with normal madopar.

[Msocpharm]

Both forms are commonly co-prescribed, but it's not to do with tremor symptoms. With the immediate release levodopa patients may eventually develop complications. These include end of dose deteriorations where essentially the benefit of a levodopa dose is "lost" and symptoms return. This commonly happens first thing in the morning (after a long period of not having any levodopa) or just before the next dose is due.
"On-off" effects can also occur, where pt's suddenly can become stiff and immobile, before their normal motor function returns. CR preps provide a more constant plasma level but will still need to be taken more frequently during the day, and an extra dose at night might be needed for off periods. The alternative option is to reduce the dose and increase the frequency of administration.
Essentially what is happening is that the brain becomes more reliant on exogenous dopamine as the disease progresses, because of loss of dopamine neurones and loss of the ability to synthesize dopamine. Duration of action of individual doses therefore become progressively shorter.

are you referring to normal levodopa + decarboxylase inhbitior

[Nik]

are you referring to normal levodopa + decarboxylase inhbitior

Yes

No issues with switching between disp and normal release co-beneldopa, often done in hospital where swallowing becomes an issue.

[Msocpharm]

Yes

No issues with switching between disp and normal release co-beneldopa, often done in hospital where swallowing becomes an issue.

so have you ever seen madopar cr after each dose of release madopar

[Nik]

Not off the top of my head but then PD drug regimes can get horribly complicated.

[laurabuk]

Often see the dispersible formulations for the AM dose taken with or just before a CR prep - quick acting, gives patients the oopmf to get up and go whilst the CR prep kicks in.

Did have to have words with my wards for putting a CR prep down an NG tube last week

[bobbin]

What about dispersible madopar combined with normal madopar.

I've seen dispersible Madopar used with normal Madopar. The dispersible product was given first thing in the morning to 'get the patient going'. I suppose the doctor was thinking that it might be absorbed a bit quicker.

[Msocpharm]

Often see the dispersible formulations for the AM dose taken with or just before a CR prep - quick acting, gives patients the oopmf to get up and go whilst the CR prep kicks in.

Did have to have words with my wards for putting a CR prep down an NG tube last week

nurses common sense lacking there I think.

I wonder if disp formulation can be given at night, cr prep might 'run out' by night?