Why is it important to take anti-Parkinson’s medications on time and not 20 minutes before or 20 minutes after?
Anti-Parkinson’s are generally classified in several categories but the most effective are those who play on Dopamine. The dopaminergic agents can be classified as Dopamine precursors or L-Dopa (Sinemet or Prolopa) and dopamine agonists that is to say drugs that play on cerebral Dopamine.
The principle of the treatment that aims to supplement the brain deficient in dopamine and to add a dopaminergic agent to the brain in the most stable way possible by avoiding stimulation peaks by too fast entry of the dopamineergic agent and avoiding cavities of stimulation by a too rapid drop in the effective Dopamine or dopaminergic agent inside the brain.
These peaks and troughs can come very quickly with L. Dopa but more slowly with Dopamine agonists such as Permax or Mirapex or Requip.
Why should L-Dopa (Sinemet or Prolopa) be given at fixed times?
<The Sinemet CR 100/25 has a duration of action of only 2 hours and after 3 hours, one finds oneself in a hollow of stimulation.
<The Sinemet CR 200/50 has a duration of 3 hours and after 4 hours, one finds oneself in a hollow of stimulation.
The Sinemet CR 100/25 must be taken every 3 hours and the Sinemet CR 200/50 must be taken every 4 hours to ensure the most physiological dopaminergic stimulation possible being as continuous as possible.
Dopaminergic agonists have half lives ranging from 3 hours to 6 hours. The intake can be more spaced and be done at meals to facilitate their tolerance by mixing with food and then can be done at bedtime to have an efficiency on the stiffness of the night and allow the patient a better mobility to get up the night. Agonists can be given at each meal and at bedtime but if they complement the work of L. Dopa it is important to also respect regular intervals taken during the day.
Finally, a third medication can be important to take to facilitate the accession and improve the tolerance of L. Dopa, it is the Domperidone or Motillium which is recommended in general to take at the dose of 10 mg, 1 tablet, to hour before the Sinemet or at the time before meals if we want to eliminate the effects of dopamino stimulation on the stomach or on the vessels, which would give nausea or hypotension. Here again the schedule of Domperidone is important to respect. In conclusion, if the patient starts his day at 6:00 am,
Finally, it is preferable to cover the Dopamine requirements of the night with a Dopamine agonist such as Mirapex rather than with Levo-Dopa to reduce motor impatience and end-of-effect dystonic cramps of Levo-Dopa. .