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.
Kindly advise.
Hello,
Welcome to icliniq.com.
I understand your concern.
I do not understand what you mean by 'I made a mistake'. You are right in saying that the 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's disease, it is important to continue treatment without any break unless there are otherwise serious side effects.
I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.
Thank you.
Patient's Query
Hello doctor,
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.
Hello,
Welcome back to iCliniq.com.
Thanks for your great feedback. I am really glad to receive your feedback and look forward to assisting you with all my capacity.
Thank you.
Patient's Query
Hello doctor,
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 will see a local psychiatrist soon. If he prescribes a 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 am with her each day and encourage the staff at NH to be patient and kind. That most often calms my wife without anxiolytics. I would appreciate any response or guidance you might be kind enough to provide.
Kindly advise.
Hello,
Welcome back to iCliniq.com.
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 you are satisfied with my answer. For further queries, you can consult me at iCliniq.
Thank you.
Patient's Query
Hello doctor,
It helps to think of what I do for my wife as loving. She liked your validation also. Yes, Seroquel should be the first choice according to a Dr. friend. She thought treating the neuro and psychiatrist might increase the seroquel dosage to see if that stopped hallucinations before switching to clozaril. Do you think raising the seroquel dose slowly upward would be wise?
Kindly advise.
Hello,
Welcome back to iCliniq.com.
I am glad to know that my words are helpful in caring for your wife. Regarding seroquel, as per my experience, we have a target dose of 200 to 400 milligrams (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 the next best choice, but unfortunately, the dose range is very limited. In case they decide to opt for Clozaril, the dose range for hallucinations is 25 to 75 mg per day, and side effects are much more common with Clozaril in comparison to seroquel.
I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.
Thank you.
Patient's Query
Hello doctor,
I agree. I hope to convince a local psychiatrist that what you say is exactly what to do. The Seroquel dose is now 150 milligrams 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 Seroquel or Clozaril? I hope you have a good evening. I sleep now.
Kindly advise.
Hello,
Welcome back to iCliniq.com,
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 the two of the mentioned medications. I may be wrong, as I 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 you are satisfied with my answer. For further queries, you can consult me at iCliniq.
Thank you.
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Answered byDr. Ashok Kumar Budaniya
Medically reviewed byiCliniq medical review team
Same symptoms don't mean you have the same problem. Consult a doctor now!
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