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Patient's Query
Hello doctor,
I made a mistake. Since carbidopa levodopa can precipitate or exacerbate hallucinations, I need to correct myself, My wife takes 2 x 0.5 tabs 25/100 carbidopa daily.
Thanks for using Icliniq. I do not understand what you mean by 'I made a mistake'. You are right in saying that carbidopa and levodopa combination may precipitate psychosis but it does not mean that it occurs in all. I also like to tell you that studies have revealed that almost 40% of individuals with Parkinson's disease develop some form of psychosis irrespective of their treatment or the nature of medications. So I mean to say that if she is suffering from Parkinson disease it is important to continue treatment without any break unless otherwise there are serious side effects. I hope this helps you. Thanks again.
Patient's Query
Thank you! yes, your response is most helpful indeed. You have encouraged me and renewed my spirit of determination to continue seeking and insisting upon the best medical and environmental treatment for my wife who is in a long-term care facility. Most appreciated.
Thanks for your great feedback. I am really glad to receive your feedback and look forward to assisting you with all my capacity. Thanks, sir.
Patient's Query
My feedback is true. I have a question about the use of benzodiazepines as anxiolytics for patients with Lewy body type of dementia. My concerns are worsening cognition, interpose withdrawal "cravings", dependence, and development of tolerance. We see a local psychiatrist soon. If he prescribes benzo, such as lorazepam, would you advise having my wife take it?
She never wanted psychotropics but she needs her antipsychotics. I wonder if risperidone was added to the Seroquelif hallucinations would abate. I work in her environment. I'm with her each day and encourage the staff at NH to be patient and kind. That most often calms my wife without anxiolytics. I'd appreciate any response or guidance you might be kind enough to provide. Thank you. All the best.
Thanks for the follow-up. I am not convinced about the use of BZDs (benzodiazepines) in Lewy body dementia other than on a need basis. In my last five years of experience with the geriatric population, I have seen more detrimental effects of BZDs in LBD( lewy body dementia) than benefits. For a person who has a loving husband and makes her calm the need for anxiolytics goes down and you have proved it again and again. Regarding hallucinations n my opinion seroquel is a better option when it comes to parkinnson's disease and related disorders. I hope this helps you further. Thanks and regards.
Patient's Query
It helps to think of what I do for my wife as loving. She liked your validation also. Yes, Seroquel should be first choice according to a Dr. friend. She thought treating neuro and psychiatrist might increase seroquel dosage to see if that stopped hallucinations before switching to clozaril. Do you think raising seroquel dose slowly upward would be wise. Thank you. Best regards,
Thanks for follow up and your encouraging feedback. I am glad to know that my words are helpful in care of your wife. Regarding seroquel as per my experience have a target dose of 200-400 mg when she is having parkinson disease. I am not aware of her current dose but it will be ideal to increase 25 mg per week till we get maximum response or get limiting side effects. I agree that Clozaril is next best choice but unfortunately the dose range is very much limited. In case they decide to opt for Clozaril the dose range for hallucinations is 25-75 mg per day and side effects are much more common with clozaril in compare to seroquel. I hope this helps you further. Thanks again.
Patient's Query
I agree. I hope to convince a local psychiatrist that what you say is exactly what to do. Seroquel dose now 150 mg per day. I would like to see it raised slowly to 300 if needed. Yes, Clozaril is scary but so are hallucinations. I think I read about serotonin syndrome with it but I think agranulocytosis can be kept to a low possibility (at least of mortality) if watched weekly. Have you heard of serotonin syndrome resulting from either or both Seroquel or clozaril? I hope you have a good evening. I sleep now. Thanks
Thanks for the follow-up. I am yet to see a person with serotonin syndrome after the use of either Clozaril or Seroquel. As per my knowledge, there is no relation between serotonin syndrome and two of the mentioned medications. I may be wrong as may not have updated about this but the mechanism of action does not indicate any possibility of serotonin syndrome with these two wonderful molecules. I hope this clarifies. Thanks again.
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