I have been caught in situations with caregivers and patients numerous times regarding Parkinson’s medication management. Patients can be VERY particular about getting their Parkinson’s medication on time. This is understandable if you acknowledge what happens in Parkinson’s when you run short of dopamine. In this post, I’ll discuss the kinetics of using carbidopa/levodopa and why patients care so much about their Parkinson’s medication timing.
Let’s get into some basics first about dopamine and Parkinson’s. Dopamine is one of the key neurotransmitters involved in the disease process so that is really where treatment is focused. There is a loss or depletion of dopamine in Parkinson’s and treatment involves the replacement of the dopamine. Sinemet is the primary treatment for Parkinson’s disease. The struggle in managing dopamine replacement therapy is that there is often a fine line between under-treatment and over-treatment. Concentrations can vary greatly, so the more frequent dosing you can have the more likely you are to have a steady state concentration in the body. The flip side is that dosing frequently is a huge burden if you want a normal life!
For patients who struggle with this balance and can’t be managed with a simple regimen, you may see a combination of Sinemet controlled release with immediate release. Combination therapy with dopamine agonists and other adjunctive medications is also seen in patients who require more complex medication regimens to manage Parkinson’s symptoms. I talk more about Sinemet on this episode of the Real Life Pharmacology Podcast.
Let’s get back to how Parkinson’s medication timing impacts our patients. When their Sinemet dose is delayed, they will likely start to display symptoms of Parkinson’s disease as the concentrations of dopamine will slowly dwindle over time. This can be incredibly stressful for the patient as their muscles may become more stiff and impair their ability to move as dopamine levels decline. If you are a caregiver or responsible for medication administration and education, this is why patients (and family members) can be so concerned about getting their carbidopa/levodopa on time. It is critical to have compassion when working with Parkinson’s patients and recognize that getting their medication on time is literally a matter of mobility or not.
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I want to stress this, as it is often missed by pharmacists. …it’s not unheard for patients who get their timing disrupted (like can easily happen in hospital) to experience degradation and never get back to that baseline before the disruption.
It’s why some neurologists and geriatrics go nuts over timing disruptions for patients.