“ASK THE DOCTOR” with Dr. Rebecca Gilbert
Q. My husband has PD and he is on carbidopa/levodopa 10/100 taken three times a day. The medication makes him very nauseous. Is there anything that we can do?
A. Carbidopa is contained in the pill with levodopa primarily to control the nausea side effect of levodopa. There are different formulations of carbidopa/ levodopa. The 10/100 formulation contains 10mg of carbidopa and 100mg of levodopa. The 25/100 formulation contains 25mg of carbidopa and 100mg of levodopa.
If your husband’s doctor would consider changing the formulation from 10/100 to 25/100, that would increase the amount of carbidopa in the pill and could potentially help to decrease the nausea that the levodopa causes. Make sure the doctor is aware of the nausea issue so he/she can make any necessary adjustments.
In addition, I would recommend taking the carbidopa/levodopa (even the 25/100 formulation) with food such as crackers. Ginger ale can help as well. If these tricks are not enough, an antinausea medication such as Zofran may help (be careful, because there are antinausea medications that are contraindicated in PD and should not be used for this purpose).
Q. I’m 61 years old and I’ve had Parkinson’s for 15 years. Every day around the same time I get very depressed. Why is that, and what can I do?
A. This sounds like a non-motor OFF issue. After several years of living with Parkinson’s, it is common that a dose of carbidopa/levodopa does not last as long as it used to. In between doses, there is a dip in the levels of dopamine in the brain and symptoms of PD can return. For most people, the dip in dopamine leads to motor symptoms — slowness, stiffness, and balance problems. For other people however, the symptoms that occur are non-motor — depression, anxiety, pain. For you, it sounds like at a particular time of day, your dopamine levels are low and you get depressed.
There are a number of ways to deal with this. The simplest is to talk with your doctor about adjusting the timing of your doses to better cover the time of day that you feel depressed. You can read more about ways to deal with non-motor OFF episodes in Communicating About OFF Episodes and Dyskinesias With Your Doctor.
Q. I am a care partner for a wonderful lady who has been diagnosed with PD. She has been having a lot of urinary problems lately in which she feels like she constantly has to go to the bathroom, even if she’s just gone. Is there anything she can do to alleviate this problem?
A. Urinary problems are very common in Parkinson’s and many experience what you are describing — an urgency to go to the bathroom even if it seems like the bladder was just emptied. The first step would be to visit the urologist who can perform an ultrasound to determine if there is urine left in the bladder after the person with PD urinates. It could be that she is only sensing that there is urine left, but she actually empties her bladder completely. There are medications to decrease this annoying sensation if this is warranted. You may also want to check out Understanding Bladder Symptoms in PD.