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Suggest Treatment For Hallucinations In A Parkinson's Patient
Question: Hello Doctor,
My father is a patient of Parkinson and takes only Parkin tablet three times a day. Earlier around 3-4 years back he used to take Rasalect also. But he discontinued it. Now it is almost 3+ years since he took it. His tremors have increased a bit now and he has also developed some problem in his speech also (not serious). I am thinking of starting Rasalect again and want to know your guidelines on the same. I have learnt that it should be started with very minimum and increased gradually in weeks. Earlier also when he had restarted, by mistake he took 2mg straight, 3 times a day, which caused hallucination in him and we stopped it. He recovered. Probably we should have just reduced the dose instead of stopping.
As we want to start it again, can you please suggest how much dose should he start with and will it be safe?
my father is 76 years old. his left arm tremors the most in the whole body, some problem in speech. other parts of the body do not shake so much.
Regards and thanks in advance.
My father is a patient of Parkinson and takes only Parkin tablet three times a day. Earlier around 3-4 years back he used to take Rasalect also. But he discontinued it. Now it is almost 3+ years since he took it. His tremors have increased a bit now and he has also developed some problem in his speech also (not serious). I am thinking of starting Rasalect again and want to know your guidelines on the same. I have learnt that it should be started with very minimum and increased gradually in weeks. Earlier also when he had restarted, by mistake he took 2mg straight, 3 times a day, which caused hallucination in him and we stopped it. He recovered. Probably we should have just reduced the dose instead of stopping.
As we want to start it again, can you please suggest how much dose should he start with and will it be safe?
my father is 76 years old. his left arm tremors the most in the whole body, some problem in speech. other parts of the body do not shake so much.
Regards and thanks in advance.
Brief Answer:
Strongly recommend doctors visit before initiation
Detailed Answer:
Hello and welcome.
Thank you for writing to us.
I have gone through your query with diligence and would like you to know that I am here to help. I would first like to mention that Rasalect (rasagiline) requires an elaborate evaluation before being initiated, and so I would recommend a visit to your doctors office before you can restart this medication.
There are various other medications and conditions that need to be addressed with precaution before starting rasalect, and so I emphasize on visiting your doctor before restarting this medication for your father yourself.
The instructions of use for rasagiline are:
-If used alone, then the minimum dose is 1 mg to be taken orally once a day; but if used in combination with other drugs (Eg. levodopa) then the dosage should be 0.5 mg to be taken orally once a day
-If a desired response is achieved with this minimum dosage, then please continue with the same dosage; but if the desired results are not achieved the dosage can be increased gradually - for example: If your father started off with 1 mg a day orally, he can then start taking 1 mg twice a day orally. To observe the response after a duration of 2 weeks. During this time, if your father experiences any undesired side effects please do not discontinue the medication, but either write back to me or visit your doctor; and make sure the dosage is reduced.
I would also request you to discuss the option of initiating a drug in combination with the rasalect (eg. levodopa, as mentioned earlier). I hope you find my response helpful and informative. Please feel free to write back to me for any further clarifications, I would be more than happy to help you.
Best wishes.
Strongly recommend doctors visit before initiation
Detailed Answer:
Hello and welcome.
Thank you for writing to us.
I have gone through your query with diligence and would like you to know that I am here to help. I would first like to mention that Rasalect (rasagiline) requires an elaborate evaluation before being initiated, and so I would recommend a visit to your doctors office before you can restart this medication.
There are various other medications and conditions that need to be addressed with precaution before starting rasalect, and so I emphasize on visiting your doctor before restarting this medication for your father yourself.
The instructions of use for rasagiline are:
-If used alone, then the minimum dose is 1 mg to be taken orally once a day; but if used in combination with other drugs (Eg. levodopa) then the dosage should be 0.5 mg to be taken orally once a day
-If a desired response is achieved with this minimum dosage, then please continue with the same dosage; but if the desired results are not achieved the dosage can be increased gradually - for example: If your father started off with 1 mg a day orally, he can then start taking 1 mg twice a day orally. To observe the response after a duration of 2 weeks. During this time, if your father experiences any undesired side effects please do not discontinue the medication, but either write back to me or visit your doctor; and make sure the dosage is reduced.
I would also request you to discuss the option of initiating a drug in combination with the rasalect (eg. levodopa, as mentioned earlier). I hope you find my response helpful and informative. Please feel free to write back to me for any further clarifications, I would be more than happy to help you.
Best wishes.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Shoaib,
Thank you very much for your reply to my query.
When my father's doctor had started the parkinson medicine for my father around 4 years back, he prescribed only two medicines, PARKIN and RASALECT. My father continued with PARKIN all this while but discontinued RASALECT. He took RASALECT for only couple of months. My father's doctor did not prescribe any Levodopa medicine as you have mentioned in your reply. The doctor that time said that he will have to take PARKIN for life long. Unfortunately, that doctor has now left that hospital. And, i am trying to find his own clinic or will take my father to another doctor.
Is "Parkin" medicine like levodopa?
Also, should my father start with 0.5 mg Rasalect with Parkin tablet? I was rather thinking to start with 0.25 mg (if available). Please suggest doctor.
Doctor, what are the side-effects that we should be worried about and stop Rasalect? can he feel hallucinations or such symptoms with 0.25 or 0.5 mg Rasalect also?
Regards and thanks.
XXXX
Thank you very much for your reply to my query.
When my father's doctor had started the parkinson medicine for my father around 4 years back, he prescribed only two medicines, PARKIN and RASALECT. My father continued with PARKIN all this while but discontinued RASALECT. He took RASALECT for only couple of months. My father's doctor did not prescribe any Levodopa medicine as you have mentioned in your reply. The doctor that time said that he will have to take PARKIN for life long. Unfortunately, that doctor has now left that hospital. And, i am trying to find his own clinic or will take my father to another doctor.
Is "Parkin" medicine like levodopa?
Also, should my father start with 0.5 mg Rasalect with Parkin tablet? I was rather thinking to start with 0.25 mg (if available). Please suggest doctor.
Doctor, what are the side-effects that we should be worried about and stop Rasalect? can he feel hallucinations or such symptoms with 0.25 or 0.5 mg Rasalect also?
Regards and thanks.
XXXX
Brief Answer:
All queries addressed sir
Detailed Answer:
Hello once again XXXXXXX
Yes sir, Parkin is a medication which can be used in combination with rasalect (like levodopa) and your doctor was right to prescribe it for the rest of your fathers life. What dosage of parkin does sir take? Is it around 6 mg a day?
As mentioned earlier XXXXXXX I would really be comfortable if your father could be thoroughly examined by a doctor before we start rasalect for him. But if we do indeed plan on starting rasalect for him, the usual minimum effective dose is 0.5 mg and so all preparations available in the market are of a minimum of 0.5 mg.
But if you wish to start him off with 0.25 mg then there is no harm with this. You might not get 0.25 mg preparations and so you can just cut the 0.5 mg tablet into half and give it to him.
Side effects from use of rasalect or when a high dose is given include the following:
-Nausea
-Dizziness
-Joint pain
-Heartburn
-Dry mouth
-Abdominal pain
-Muscle pain
-Fever
and a few others. And yes, if the patient is not responding well to the given dosage then at times disorientation can result sir.
I hope you find my response helpful. Please do not hesitate to write back to me for any further assistance, I am always here to help.
Best wishes.
All queries addressed sir
Detailed Answer:
Hello once again XXXXXXX
Yes sir, Parkin is a medication which can be used in combination with rasalect (like levodopa) and your doctor was right to prescribe it for the rest of your fathers life. What dosage of parkin does sir take? Is it around 6 mg a day?
As mentioned earlier XXXXXXX I would really be comfortable if your father could be thoroughly examined by a doctor before we start rasalect for him. But if we do indeed plan on starting rasalect for him, the usual minimum effective dose is 0.5 mg and so all preparations available in the market are of a minimum of 0.5 mg.
But if you wish to start him off with 0.25 mg then there is no harm with this. You might not get 0.25 mg preparations and so you can just cut the 0.5 mg tablet into half and give it to him.
Side effects from use of rasalect or when a high dose is given include the following:
-Nausea
-Dizziness
-Joint pain
-Heartburn
-Dry mouth
-Abdominal pain
-Muscle pain
-Fever
and a few others. And yes, if the patient is not responding well to the given dosage then at times disorientation can result sir.
I hope you find my response helpful. Please do not hesitate to write back to me for any further assistance, I am always here to help.
Best wishes.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Shoaib,
My father is taking PARKIN 2mg three times a day.
Doctor, how much chances are there that a patient like my father can get the symptoms of hallucinations by having just RASALECT 0.5 mg once in a day?
Best Regards
XXXX
My father is taking PARKIN 2mg three times a day.
Doctor, how much chances are there that a patient like my father can get the symptoms of hallucinations by having just RASALECT 0.5 mg once in a day?
Best Regards
XXXX
Brief Answer:
Chances are quite less, but not non-existant
Detailed Answer:
Hello once again XXXXXXX
So the total dose of Parkin per day is 6 mg, which is the correct dose, I am happy with this.
As for the chances of hallucinations/disorientation, this varies sir and is not easily predictable. There have been cases wherein, an individual has been started off with 1 mg per day and rapidly increased to higher doses and has not experienced any side effects; and on the other hand there have been individuals who have been started off with 0.5 mg per day for almost 4 weeks and have yet experienced side effects.
So it is not easy to predict whether or not an individual will react to rasalect, whether on a small or much larger dose. But taking into consideratio the odds, and the small dosage I am guessing and hoping that he does not and should not react to rasalect.
Your father is in my prayers, and I sincerely hope he only improves from here on. Please feel free to write to me anytime and about anything XXXXXXX I am always here to help.
Take care.
Chances are quite less, but not non-existant
Detailed Answer:
Hello once again XXXXXXX
So the total dose of Parkin per day is 6 mg, which is the correct dose, I am happy with this.
As for the chances of hallucinations/disorientation, this varies sir and is not easily predictable. There have been cases wherein, an individual has been started off with 1 mg per day and rapidly increased to higher doses and has not experienced any side effects; and on the other hand there have been individuals who have been started off with 0.5 mg per day for almost 4 weeks and have yet experienced side effects.
So it is not easy to predict whether or not an individual will react to rasalect, whether on a small or much larger dose. But taking into consideratio the odds, and the small dosage I am guessing and hoping that he does not and should not react to rasalect.
Your father is in my prayers, and I sincerely hope he only improves from here on. Please feel free to write to me anytime and about anything XXXXXXX I am always here to help.
Take care.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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