Sinemet has been the “Gold Standard” of Parkinson’s medication for over 50 years. But it can be like walking on a tight rope. You must balance in many factors when trying to get Levodopa to work to the best of its ability. This can include communication, timing, body functions and even how you eat. As you can see that being on that wire in the sky, it can be pretty tricky trying to figure out how to get the most out of your Levodopa. Well, fear no more my fellow Parkies. Here is a list of ways to Optimize your Levodopa intake.
- Neurologist Visit: Doctors and patients often have a communication problem during the office visit. Maybe the doctor has the pressure of the clock on him (the next patient is already waiting in another examination room), You, on the other hand, could be distracted by discomfort, pain, or “white coat” anxiety, which can lead the inability of addressing your main concerns. Try making a list, weeks before your scheduled visit of things that you would like your Neurologist to focus on. This will allow you to feel heard and have all your concerns addressed.
- Expectations: PD doctors are not only treating a patient’s condition… they are also managing a patient’s ‘outcome expectation.’ PD is a chronic disease, and many people have an idea of what Parkinson’s looks like and a certain belief of its progression, but is that realistic? Make sure to address what you can expect at each stage of the disease. I mean, really, wouldn’t you want to know if you should expect a carrot growing out of your ear? I know I would.
- Remembering to take Meds: Remembering, each day, to take your medication at the perfect time can be tricky, especially when you have multiple medications that are taken during the day. Maybe try setting an alarm on your phone to help keep all those dose times straight. Just make sure you hit the snooze button instead of just turning the alarm off if you can’t take your medicine cocktail at that exact moment.
- Timing: Even a levodopa regimen as simple as “1 pill every 6 hours” might need to consider the instructions for other medications being taken simultaneously. Drug dispenser labels instruct users when the best time of day (morning, mid-day, evening, or overnight) is, and when, relative to meals (1hour prior, 1hour after, ½ hour before) meds should be taken. You might also feel that you need to take a pill every 5 hours. Your Neurologist can help you make that decision if you feel that your medication isn’t lasting long enough. Remember, timing is everything! I think someone really famous said that once…
- Protein Interference: The performance of Levodopa can be diminished when taken with protein. This is due to the fact that protein is an amino acid, as is Levodopa. This leaves the steak that you just annihilated competing with your Sinemet for absorption. To avoid dose failure, use the “1-2 hour rule.” Don’t eat high protein meals within one hour of dosing or wait until 2 hours after your intake of protein.
- Interactions: Many Parkies not only take levodopa/carbidopa (Sinemet), but they also take other medications or supplements which can interfere with a peak performance of levodopa. Alcohol is another substance that interacts negatively with Levodopa. Sorry, I know how you like to booze it up on the weekends, but those days are over.
- Constipation: Slow bowel movement can slow the effect of medication. Medication is its own worst enemy because it very often slows gut movement. That’s why if a Parkie tells me they are just having a horrible day and their medications aren’t “kicking in”. I always ask, “Have you pooped?” Not only does that help with figuring our why your Levodopa isn’t working efficiently… This also is a really great way to get to know someone… and I mean really know them.
- Metabolism: Patients who metabolize too quickly can lose the full potential of the medication, whereas people who metabolize too slowly can experience toxicity problems from the build-up.
- Exercise: Vigorous exercise not only pumps oxygen into the heart and lungs, and strengthens muscles, it will also aid in moving constipated bowels. And get this it’s the only thing that has been scientifically proven to slow the progression of Parkinson’s. It’s just as important as taking your medications.
- Rest: Getting adequate bed rest, and REM sleep, can improve medication performance. Plus, if you get your beauty rest, you just feel better all overall.
- Blood-Brain Barrier: Assuming your medications get taken on time, and enough dopamine molecules get through your gut into the digestive system successfully, the released molecule must get through the blood-brain barrier.
- Duration: How long dopamine stays present in the synaptic gap, which will be drawn in by dopamine specific receptors. This process is completed by consuming another medicine. This is the combination of Levodopa and Carbidopa which makes up the medication Sinemet. Without Carbidopa, the Levodopa wouldn’t stay in your system long enough to have any benefit.
- Patient Age: As a Parkie ages, the number of dopamine-producing neurons is diminished, making it necessary to take more frequent or higher doses of Levodopa. That is one more reason it sucks to get old…
- False positives: With assessing medicine optimization, you may wrongly attribute a stretch of good days to the medicine, when in actuality, it may be that you limited your protein intake that morning, or took a great Zumba class.
- Adrenaline: Have you ever noticed that if you got angry at a person that cut you off on the road, or you get into an altercation with your neighbor letting his dog poop on your lawn, or maybe you got mad at the cable company for charging too much, your Parkinson’s symptoms will get worse… this is due to Adrenaline. It can make your tremor more prominent, make your speech worse, your rigidity off the charts. Adrenaline is not your friend. Sorry, no more roller coasters for you.
Hormones, hormones, hormones!! and everything that effects them — the environment, food etc. i wish I could find a good study on the relationship between symptoms and hormonal changes.
Kirstin,
There is such a huge gap between available information about hormones and Parkinson’s. It’s differently a topic that needs so attention!
Thank you so much for this< i was never told or took the time to read that protein intake can affect my meds. I will say that exercise has been a godsend. I have retired form my position as a law Enforcement officer so i could leave that profession om my terms and not PD's terms. Have fallen into a new career that I love and allows tome sleep more regular, which seems to be helping as well. There are still bad days but take those with a smile and move forward.
Curtis, What a great adventure you’ve had. Left law enforcement on your own terms, which has ultimately helped your condition by lower your stress levels… and you even found a new career! Bravo! Keep up the good work and thank you for sharing your journey!
I’M CONFUSED, carbidopa doesn’t pass thru the BBB, if it did it would stop any l-dopa passing thru the BBB being converted to dopamine in the brain. so i assume the slowing down of l-dopa to dopamine conversion outside the brain is what you are referring to. when you think about how little dopamine the brain must use it is so sad that a more effective agonist hasn’t been developed. assuming an agonist is about the same molecular weight as l-dopa or even significantly different, with an effective dose of requip being 18mg, that implies the brain doesn’t need much dopamine and it is truly amazing that eating a steak with all it’s amino acids doesn’t just drive us mad, i.e., there isn’t a huge increase of amino acids in the brain. an conversely, people who fast for weeks don’t show symptoms of pd, their body is still supplying enough amino acids. there is a very effective system controlling our neurotransmitter production and unfortunately you can’t buy a replacement off the shelf.
and what a sad statement that oral l-dopa delivery is still the gold standard after 50 years and even then i think the generic versions were’re getting, most manufactured in INDIA from chinese ingredients are nowhere as effective as the brand name. and i don’t think the original brand name is even obtainable. i think C/L generic mfg’s should have to pass a test of the effectiveness of their generic vs brand name ON PEOPLE WHO HAVE PD, not just testing blood levels of active ingredients in healthy volunteers. i hate to depend on such a fragile supply chain, teva sold off their C/L generic to MAYNE, an indian manufacture, and they also sold them their ACTIVIS brand. So we lost the TEVA quality and that leave us with how many manufacturers? i couldn’t get the MYLAN 50/200 for almost 2 years and MYLAN never explained why except couldn’t get some ingredient.
fwiw, here’s 2 articles suggesting methods to speed up getting l-dopa to your brain. some hopefully’ useful statements:
1. laying down slows digestion
2. milk proteins interfere the most with l-dopa absorption.
3. drinking warm water speeds up digestion, cold water slows it down,
4. some exercises done after eating might decrease constipation.
https://www.thecut.com/2018/11/the-best-ways-to-digest-a-big-meal.html
https://www.nutritionucanlivewith.com/levodopa-and-protein-what-about-it/
Gordon,
Thank you for sharing your knowledge.
Spot on ! much of the time my symptoms are about slowing a bit. Non-motor symptoms are unpredictable, but expect the unexpected.
Thanks so much! I have a question. How do you manage working with timing of sentiment? I am 10 years Since diagnosis and I am working as a professor. Any ideas on being on during my three hour teaching periods?
And an idea for communicating with neurologists. If you forget a question when you see her or him in person, use the portal that is available in most practices. Right? (although I’m always afraid of being a pain in the____ if I use it too often with my neurologist!) 😟
Garrett,
Great questions! You gave to a topic for working with PD… I will touch on your question then.
As for communicating with your Neurologist, yes the portal is the best. You can also write down your questions to be answered at a future appointment. Also, don’t forget your Wolfpack! Support groups are a great source of information! Hope this helps!
Thank you for these great reminders. I am grateful to you for sharing your knowledge.
Brian,
Happy to hear my blog has helped! Thanks for reading!
Thanks for the reminders of what affects sinemet. Happy new year 🎈
Only you could find humor in stool. Very comprehensive,. Makes you wanna just crawl inside a synaptic gap and play wack-a-mo with those receptors.
Ha! So true Pete!
Hello Allison my name is Bob Williams I’ve had Parkinson’s for 20 years I still enjoy reading your column because I learn something every time or I could at least laugh a little bit I think the hardest thing with this disease is learning how to dispense the levodopa . I still struggle with that specially when you’re feeling good one day and then you just totally forget to take it for an hour or so . Then I get stuck somewhere without being able to move oh well fun and games every day smile it could be worse
Robert, I feel you! That’s very frustrating!
Something must have been inadvertently omitted.
What did you really mean to say with this sentence on this website?
“Duration: How long dopamine stays present in the synaptic gap, which will be drawn in by dopamine specific receptors.”
https://www.perkyparkie.com/2020/01/optimizing-your-levodopa/
Bill,
I hope that wasn’t too confusing… but in short, When (and if) levodopa is properly, metabolized the released molecule is substantially released into the gap that exists between the axion of one neutron and the dendrite of another, otherwise known as the synaptic gap. The axion releases the molecule into the gap caused by another dendrite which has receptors reaching out to ‘swallow’ the passing molecule. If the molecules get through the gap without being received by the dendrite there is no dopamine created by the neuron. Carbidopa slows the process down, so more levodopa molecules are consumed. I hope that helps explain the concept in more detail.
So many moving parts to consider. I like carrots.
Allison,
In addition to protein, fat affects the absorption of Levodopa. So, the bacon you mentioned in a previous post has two “whammies” against it.
I must add that I’ve enjoyed your insights and positive spin. I have found that laughing beats crying (I’ll admit a good cry is sometimes needed too.)
Doug
Good point Doug!
Well done Alison, great summary and things to take into consideration. I had my DBS am doing ok. Still,in de middle of programming.
Casey,
DBS programming is important and can take some time to figure it out, but hopefully, they do soon!