The need to monitor carefully the anti-parkinson’s medications that are currently the mainstay of treatment for Parkinson’s disease, assuring that they are taken in the correct dosages at the right times. These medications have numerous potential side effects and interactions with each other or with medications taken to treat other health conditions such as heart disease. As well, timing of dosages often is key to maximizing benefit from the medication. Effective medication management provides optimal symptom control.
Dosing is particularly crucial with lEvodopa, the cornerstone of Parkinson’s pharmacotherapy. Because of this drug’s tendency to cause nausea at the beginning of levodopa therapy, some pharmacists and doctors recommend taking it with food. Although this arrangement slightly reduces nausea, it also interferes with the way the body absorbs the levodopa. One common error that many nonneurologists and even some neurologists make is not dosing sufficient carbidopa to avoid levodopa associated nausea; Sinemet 10/100 tablets in particular should not be used as initial therapy (too little daily carbidopa unless at least five to 10 of them are taken in one day), and additional carbidopa (Lodosyn) can be prescribed if necessary. In the disease’s early stages the decreased absorption from taking medications with food that contains protein is not so much of a problem as the dosage can be increased to compensate. In later stages, however, increasingly higher dosages are required to relieve symptoms, there is a point at which the person cannot tolerate the dosage and it is necessary to take smaller amounts more frequently and on an empty stomach to maximize absorption. As well, levodopa is most effective within the first hour or two of administration. Many people with Parkinson’s find themselves managing dosages to provide the maximal effect for times when they need it most, such as when going out in public or having visitors.
It also is important to accommodate other medications taken to treat Parkinson’s as well as other health conditions. As Parkinson’s progresses and the person moves from monothErapy (use of a single drug, usually levodopa, to control symptoms) to adjunct therapies (addition of different drugs to the medication regimen), coordinating the timing of all medications becomes crucial. Some medications must be taken with meals and others on an empty stomach. Some are better taken in the evening or at bedtime. It often becomes necessary to create a schedule of medication dosages and times. The person with Parkinson’s should always have a copy of this schedule and enough medication to cover the next few dosages whenever leaving home, even when he or she intends to be out for a short time.
Medication management can become a challenge in situations such as traveling to different time zones; whether it makes sense to adjust dosage to accommodate time changes depends on how long the person will be in the new time zone. Medication management also becomes challenging if the person needs to be hospitalized for any reason, and in particular for surgery or diagnostic procedures in which preparation requires temporarily withholding food and water. In general most “nothing by mouth” orders before surgeries or procedures make an exception that allows important medications to be taken as usual with water; however, this should be clarified with the physician or dentist who will perform the procedure. If the practitioner performing the procedure demands no medications, communication between that practitioner and the neurologist managing the Parkinson’s disease should be facilitated to ensure that no unnecessary harm comes to the person who has Parkinson’s. When anti-Parkinson’s medications must be interrupted, it is important to make the interruption as brief as possible and to resume the schedule quickly. If one is hospitalized, it is important to carefully review all of the current medications especially anti-Parkinson’s medications with the admitting physician and remind both the admitting physician and the nursing staff of the importance of receiving anti-Parkinson’s medications on schedule. For planned admissions, it may be worthwhile for the person with Parkinson’s to bring his or her medications to the hospital and ask the admitting physician to authorize self-administration of the usual anti-Parkinson’s medications as a way to avoid the potential delays of relying on a busy nursing staff.
When the person who has Parkinson’s disease has cognitive difficulties, a caregiver must oversee or take over medication management. It is always a good idea for someone other than the person with Parkinson’s to know the medication schedule. There are numerous aids for managing medications, from simple date- and time-organized pill dispensers to more sophisticated alarm-notification systems. Some people set a wristwatch alarm clock or timer to help them keep track of dosage times.