Ask the Doctor” with Rebecca Gilbert
Q. I cannot sleep due to tremors in my right arm and my big toe curling inwards involuntary. What can I do about this?
A. When people have difficulty at night, sometimes it is because their medication has worn off. If this is the case for you, talk to your doctor about taking a long-acting formulation of the medication before bed, which can be helpful. Long-acting formulations include Carbidopa/levodopa extended release, Rytary®, and Crexont®.
Q. After 18 years with PD, I recently developed bothersome episodes when my face twists. Could this be due to my Parkinson’s?
A. Yes, it is possible to develop facial movements after years of PD treatment. These are likely levodopa-induced dyskinesias, a side effect of the PD medication carbidopa/levodopa. Talk with your neurologist about possibly changing the timing or dose of your medication to see if this can help to decrease the facial movements. There are also medications that can be added to your regimen (amantadine or Gocovri®) that could help if changing your carbidopa/levodopa regimen does not solve the problem.
Q. I was just prescribed carbidopa/ levodopa for the first time and I was told to take it three times a day. What are the best times to take it?
A. I would defer to your neurologist, but typically, we recommend that carbidopa/levodopa be taken in even intervals during waking hours — so that often corresponds to 1) upon waking, 2) middle of the day, and 3) early evening (potential timing could possibly be 8AM, 1PM, and 6PM).
You may hear a lot of contradictory information about whether the medication needs to be taken with or without food. When carbidopa/levodopa is first started, nausea can be an issue for some people. If this is a problem, the medication can be taken with a simple food like plain crackers, which tends to help with nausea. As PD advances, some people find that dietary protein (such as chicken, beef, pork, or fish) interferes with medication absorption and that the medication is less effective when taken with protein. This is not the case for everyone, even with advanced disease, and would be unusual for anyone early in the disease course.
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