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Questions and Answers
- Q
- I am caring for my elderly mother, who is diagnosed with Progressive
Supranuclear Palsy. At this time, she is undergoing physical therapy
for muscle tension, together with drugs. Because of depression, she
takes 10 mg of Paxil at night, she takes lorcet (actually generic
Hydrocodone/APAP) at night to relieve leg pain and cramping, also a 325
mg capsule of quinine sulfate, together with 25 mg of Sinemet. In the
morning, she takes 25 mg of Sinemet, 1 Skelaxin tab, and 1/2 of a 5mg
Methylphenidate (generic of ritalin) tablet. At lunch she gets a 3rd 25
mg of Sinemet. Together with all of this, she also takes over the
counter Legatrin, acetaminophen, and/or ibuprophen for the constant leg
pains (cramping and tense muscles) as well as rubbing them with
ointments such as BenGay, or the store brands of heating rubs. For a
while I was also getting her to take a selection of about 9 vitamin and
mineral supplements (calcium, magnesium, potassium, and zinc, and about
6 vitamin pills) For the last two weeks, I have discontinued the
vitamin supplements, and notice that she does not seem quite as alert as
with them, nor does she walk so well. At almost every meal she chokes,
and her eyesight is troublesome (we have been to eye doctors at least 8
times within the last two years for glasses changes, and she still
complains that she "can't see"). We have about 3-5 falls per day
regularly, and I am terribly concerned about her falling and breaking
bones. We have had two cuts to the head, many scrapes and skins of the
arms, but she does heal fairly well. Is there any hope? Is there any
danger of interactions between these drugs? Thank you for considering
these concerns.
- A
- ... sorry to learn of your mother's problems ...
First off, get in touch with:-
The Society for Progressive Supranuclear Palsy, Inc.,
Johns Hopkins Hospital,
5065 Outpatient Center,
601 N. Caroline Street,
Baltimore,
Maryland 21287.
They can be reached at 1-800-475-4777.
There is a small
newsletter sent out to members about every quarter with resource information
and discussion of medical conferences.
Now for your mother's drugs, divided into those used to try and
ameliorate the central condition, and those used to try and make things more
tolerable.
1. Sinemet (actually a combination of two drugs) is used in both
Parkinson's disease and PSP ... the dose used here is the usual starting
dose and may be increased gradually and cautiously according to the
patient's tolerance. In both Parkinson's and PSP, the effectiveness of
Sinemet has sometimes been augmented by adding the anti-viral drug,
amantidine. None of the other drugs you mention will interact with Sinemet.
2. Skelaxin ( metaxalone) is a drug very similar to Valium ... it is
used as a muscle relaxant although there is controversy about its
effectiveness ... some believe that whatever effect it has is due to
general depression of the central nervous system ... one of my texts claims
that this, and other such agents, are not useful in the treatment of
spasticity associated with chronic neurological disease. The usual single
dose is two, 400mg., tablets.
Methylphenidate is an amphetamine-like, mild central nervous
system stimulant producing psychomotor stimulation - alertness, feeling of
well-being. The usual adult dosage is 10mg twice or thrice daily. Its action
as a CNS stimulant will likely be impaired by the CNS depressant action of
Skelaxin.
Paxil (paroxetine) is one of the newer antidepressant serotonin
reuptake inhibitors - you may be more familiar with the name of the first
one used, Prozac. The initial dose in the elderly and debilitated is 10 mg.
per day - this may be increased if indicated. There are a wide variety of
side-effects; in world-wide clinical trials, twenty one percent of over
4,000 treated patients had to discontinue the treatment due to an adverse
effect. Its effectiveness has been cofirmed for periods of up to one year;
if used for extended periods, the physician should periodically re-evaluate
the long-term usefulness of the drug for the individual patient.
Hydrocodone (Lorcet when combined with other
analgesics/antipyretics - check which one your preparation has) is a mild
narcotic used to control pain and cough ... it lies about half-way between
codeine and morphine in efficacy ... older patients respond somewhat better
and longer ... the usual dose is 5 - 10 mg. given every 4 - 5 hours for the
continuous control of pain. You should determine which analgesic is combined
in the preparation, since it may be identical to whatever O.T.C. analgesic
your mother is using, with potential for inadvertent overdosage.
Quinine at this dosage has been used for a long time with
some success in relieving cramping of the leg muscles.
I can't comment on your mother's prognosis since I'm not a
physician, but if you have any other queries about her drug treatment,
please call me again.
Best wishes to you and your mother.