[lou_lou]

Columbia University psychiatrist Richard Brown and Baylor University
neuropharmacologist Teodoro Bottiglieri recommend that all psychiatric patients take a daily megadose of 1 mg of oral B12.



--------------------------------------------------------------------------

In 1973, in a double-blind trial by F. R. Ellis and S. Nasser, B12 shots boosted the energy and lifted the moods of chronically fatigued patients significantly more than shots of water.
Sixteen years later, in a less formal single-blind study, orthomolecular psychiatrist Herbert Newbold reported that his B12-responsive patients "invariably" were able to tell whether they had received B12 or an injection of water.
Newbold also noted that B12 is not a simple stimulant, but a "normalizer" that helps some of his patients sleep better and even made one less manic. (Mania is a symptom of B12 deficiency.)

Newbold's suggestion that B12 is a mood stabilizer is echoed by recent research in which oral megadoses of methylcobalamin – the most bioactive form of B12 – has shown promise as a regulator of disturbed sleep-wake rhythms.

Methylcobalamin has been particularly well-studied in Japan as a treatment for delayed sleep phase syndrome; that is, not being able to fall asleep until very late at night and needing to sleep in every morning. Because sleep-wake disturbances are part and parcel of most mood disorders, B12's apparent sleep-wake regulatory effect could help account for its mood-stabilizing benefits. In a 1996 study by G. Mayer et al.,

three grams a day of methylcobalamin,
but not cyanocobalamin (the form of B12 in most supplements), managed to decrease sleep time yet improve sleep quality and daytime alertness in a small group of healthy men and women.

There is an intriguing reason why some people with normal blood levels of B12 may need megadoses of the vitamin. They may have a B12 deficiency that is confined to the brain.

While most doctors would never consider such a possibility, studies have documented local cerebral deficiencies of B12 (using cerebrospinal fluid levels as a measure) in people with Alzheimer's disease, postpartum depression, and toxic neuropsychiatric disorders, including toxic depression. Cees van Tiggelen and associates suspect this cryptic condition may also commonly afflict people with histories of nitrous oxide or Agent Orange intoxication, alcoholics (including those with alcohol-related dementia), long-term users of dilantin, and people with brain atrophy.

B12 has its mainstream advocates too. In 1975, psychiatrists K. Geagea and Jambur Ananth, then at McGill University, remarked that "astonishing results can be obtained in some cases with B12 therapy, even if B12 levels are within normal range." They had just described one such case.

Their young patient's two year depression had landed him in Montreal's Jewish General Hospital after a suicide attempt. Because the man had had a total gastrectomy nine years earlier – a risk factor for B12 deficiency – and because his treatment-resistant symptoms had become progressively more psychotic and neurologic in quality, Geagea and Ananth took a leap of faith. The man's B12 levels were normal, but they gave him B12 shots anyway.

"The response to this therapeutic trial," they wrote, "was dramatic. The patient was discharged eight days later with complete remission." He was still well three years later.

In 1999, in their book Stop Depression Now, Columbia University psychiatrist Richard Brown and Baylor University neuropharmacologist Teodoro Bottiglieri (a leader in vitamin/depression research) recommend that all psychiatric patients take a daily megadose of 1 mg of oral B12. In The Way Up From Down, UCLA psychiatrist Priscilla Slagle suggests:

"If you are over fifty-five, vegetarian or alcoholic, have extreme fatigue, poor memory, low thyroid or weight loss, I recommend you take 1000 to 2000 mcg of the sublingual form [of B12] every morning."



--------------------------------------------------------------------------

Using Vitamin B12
(cobalamin, cyanocobalamin, hydroxocobalamin, methylcobalamin)
Recommended Daily Intake: 6 mcg.

Dosage (therapeutic): By injection: from 1000 mcg every few days up to 10,000 to 25,000 mcg/day. Oral (including sublingual) and nasal gel: probably 500-25,000 mcg/day. Sublingual and (especially) nasal gel products may rival B12 shots in their ability to increase blood levels. Studies like that of Mayer et al. suggest the cyanocobalamin form of B12 typically used in supplements isn't as clinically effective as methylcobalamin. Cost: moderate.

Side effects, cautions, contraindications:
Evidently none.

http://www.mts.net/~baumel/B12.html

--------------------------------------------------------------------------------

Syd Baumel is a writer and Editor of The Aquarian in Winnipeg, Canada.

[rd42]

Thanks for the info.

It also gives you vivid dreams when taken before bed time. The only problem I find is that I wake up ready to go at 3:30 or 4 AM instead of say 6 or 7 AM.

Does B6 or B12 mess with PD meds containing Dompamine?

[lou_lou]

Originally Posted by rd42

Thanks for the info.

It also gives you vivid dreams when taken before bed time. The only problem I find is that I wake up ready to go at 3:30 or 4 AM instead of say 6 or 7 AM.

Does B6 or B12 mess with PD meds containing Dompamine?

dearest rd42,
No the methylcobalamine actually helps my medicine work better, because I was experiences alot off off's!?
and when I take the methycolbalamine it makes the Sinemet even out the imbalance -
sinemet, can be overdosed, and it causes dykenesias...

ps: did you ever read the reactions to Sinemet - one of the many is nightmares. -

[lou_lou]

Sinemet - Sinemet Side Effects - Sinemet Information


Pharmacology: The symptoms of Parkinson's disease are related to depletion of dopamine in the corpus striatum. Administration of dopamine is ineffective in the treatment of Parkinson's disease because it does not cross the blood-brain barrier. However, levodopa, the metabolic precursor of dopamine, does cross the blood-brain barrier, and is converted to dopamine in the basal ganglia. This is thought to be the mechanism whereby levodopa relieves the symptoms of Parkinson's disease.

When levodopa is administered orally it is rapidly converted to dopamine by decarboxylation in extracerebral tissues so that only a small portion of a given dose is transported unchanged to the CNS. For this reason, large doses of levodopa are required for adequate therapeutic effect and these may often be attended by nausea and other adverse reactions, some of which are attributable to dopamine formed in extracerebral tissues.

Since levodopa competes with certain aminoacids, the absorption of levodopa may be impaired in some patients on a high protein diet.

Carbidopa inhibits decarboxylation of peripheral levodopa. It does not cross the blood-brain barrier and does not affect the metabolism of levodopa within the CNS. Since its decarboxylase inhibiting activity is limited to extracerebral tissues, administration of carbidopa with levodopa makes more levodopa available for transport to the brain. Combined therapy with levodopa and carbidopa reduces the amount of levodopa required for optimum therapeutic benefit by about 75 to 80%, permits an earlier response to therapy, and also reduces the incidence of nausea, vomiting and cardiac arrhythmias. Combined therapy, however, does not decrease adverse reactions due to central effects of levodopa.

Following simultaneous administration of carbidopa and levodopa in man, both plasma levels and plasma half-life of levodopa are markedly increased over those found when the same dosage of levodopa is given alone, while plasma levels of dopamine and homovanillic acid are reduced or do not change. Nevertheless, the plasma levels vary greatly between patients.

Pyridoxine HCl (vitamin B 6), in oral doses of 10 to 25 mg, may reverse the effects of levodopa by increasing the rate of aromatic amino acid decarboxylation. Carbidopa inhibits this action of pyridoxine.


Indications: For the treatment of Parkinson's disease.

Sinemet is not recommended for the treatment of drug-induced extrapyramidal reactions.

Although the administration of carbidopa permits control of Parkinson's disease with much lower doses of levodopa, there is no conclusive evidence at present that this is beneficial other than reducing nausea and vomiting, permitting more rapid titration, and providing a somewhat smoother response to levodopa. Carbidopa does not decrease adverse reactions due to central effects of levodopa. By permitting more levodopa to reach the brain, particularly when nausea and vomiting is not a dose-limiting factor, certain adverse CNS effects, e.g., dyskinesias, may occur at lower dosages and sooner during therapy with Sinemet than with levodopa.

Contraindications: Nonselective monoamine oxidase (MAO) inhibitors are contraindicated for use with Sinemet. These inhibitors must be discontinued at least 2 weeks prior to initiating therapy with Sinemet. Sinemet may be administered concomitantly with a MAOI with selectivity for MAO type B (e.g., selegiline HCl) (see Precautions, Drug Interactions, Psychoactive Drugs) at the manufacturer's recommended dose which maintains selectivity for MAO type B.

Sinemet should not be administered to patients with clinical or laboratory evidence of uncompensated cardiovascular, endocrine, hematologic, hepatic, pulmonary (including bronchial asthma), or renal disease; or to patients with narrow-angle glaucoma.

As with levodopa, Sinemet should not be given when administration of a sympathomimetic amine is contraindicated.

Sinemet is contraindicated in patients with known hypersensitivity to any component of this medication.

Because levodopa may activate a malignant melanoma, Sinemet should not be used in patients with suspicious, undiagnosed skin lesions or a history of melanoma.


Warnings: When patients already receiving levodopa are switched to Sinemet, levodopa must be discontinued for at least 12 hours or more before Sinemet is started. Sinemet should be substituted at a dosage that will provide approximately 20% of the previous levodopa dosage (see Dosage).

Patients who are taking Sinemet should be instructed not to take additional levodopa unless it is prescribed by the physician.

The levodopa induced involuntary movements and on-and-off phenomenon may appear earlier with combination therapy.

As with levodopa, Sinemet may cause involuntary movements and mental disturbances. These reactions are thought to be due to increased brain dopamine following administration of levodopa. Because carbidopa permits more levodopa to reach the brain and thus more dopamine to be formed, dyskinesias may occur at lower dosages and sooner with Sinemet than with levodopa. The occurrence of dyskinesias may require dosage reduction.

Patients should be monitored carefully for the development of depression with suicidal tendencies. Patients with past or current psychoses should be treated with caution.

Care should be exercised in administering Sinemet to patients with a history of myocardial infarction or who have atrial, nodal, or ventricular arrhythmias. In such patients, cardiac function should be monitored with particular care during the period of initial dosage adjustment in a facility with provisions for intensive cardiac care.

Neuroleptic Malignant Syndrome: A symptom complex resembling the neuroleptic malignant syndrome including muscular rigidity, elevated body temperature, mental changes, and increased serum creatine phosphokinase has been reported when antiparkinsonian agents were withdrawn abruptly. Therefore, patients should be observed carefully when the dosage of Sinemet is reduced abruptly or discontinued, especially if the patient is receiving neuroleptics.

Sinemet should be used cautiously in patients who have a history of seizures or have conditions associated with seizure or have a lowered seizure threshold.

Precautions: General: Periodic evaluations of hepatic, hematopoietic, cardiovascular and renal function are recommended during extended therapy in all patients with Sinemet.

Since levodopa competes with certain amino acids, the absorption of levodopa may be impaired in some patients on a high protein diet.

Children: The safety of Sinemet in patients under 18 years of age has not been established.

Pregnancy and Lactation: Although the effects of Sinemet on human pregnancy and lactation are unknown, both levodopa and combinations of carbidopa and levodopa have caused visceral and skeletal malformations in rabbits. Therefore, use of Sinemet in women of childbearing potential requires that the anticipated benefits of the drug be weighed against possible hazards to the mother and to the fetus. Sinemet should not be given to nursing mothers.

Physical Activity: Patients who improve while on therapy with Sinemet should increase physical activities gradually, with caution, consistent with other medical considerations such as the presence of osteoporosis or phlebothrombosis.

Glaucoma: Pupillary dilatation and activation of latent Horner's syndrome have been reported during levodopa treatment. Patients with chronic wide angle glaucoma should therefore be treated cautiously with Sinemet. The intraocular pressure should be well controlled and the patient monitored carefully for changes in intraocular pressure during therapy.

Laboratory Tests: Sinemet may cause a false-positive reaction for urinary ketone bodies when a tape test is used for determination of ketonuria. This reaction will not be altered by boiling the urine specimen. False-negative tests may result with the use of glucose-oxidase methods of testing for glucosuria.

Cases of falsely diagnosed pheochromocytoma in patients with levodopa-carbidopa therapy have been reported very rarely. Caution should be exercised when interpreting the plasma and urine levels of catecholamines and their metabolites in patients on levodopa or levodopa-carbidopa therapy.

Drug Interactions : Caution should be exercised when the following drugs are administered concomitantly with Sinemet.

Antihypertensive Drugs: Symptomatic postural hypotension can occur when Sinemet is added to the treatment of a patient receiving antihypertensive drugs. Therefore, when therapy with Sinemet is started, dosage adjustment of the antihypertensive drug may be required.

Psychoactive Drugs: Dopamine D 2 receptor antagonists (e.g., phenothiazines, butyrophenones and risperidone) may reduce the therapeutic effects of levodopa. The beneficial effects of levodopa in Parkinson's disease have been reported to be reversed by phenytoin and papaverine. Patients taking these drugs with Sinemet should be carefully observed for loss of antiparkinsonian effect.

Concomitant therapy with selegiline and levodopa-carbidopa preparations may be associated with severe orthostatic hypotension not attributable to levodopa-carbidopa alone (see Contraindications).

There have been rare reports of adverse reactions, including hypertension and dyskinesia, resulting from the concomitant use of tricylic antidepressants and Sinemet. (For patients receiving MAOI, see Contraindications).

Isoniazid: Isoniazid may reduce the therapeutic effects of levodopa.

Anesthetics: When general anesthesia is required, Sinemet should be discontinued the night before. Therapy with Sinemet may be continued as soon as the patient is able to take medication by mouth.

Iron Salts: Iron salts may reduce the bioavailability of levodopa and carbidopa. The clinical relevance is unclear.

Metoclopramide: Although metoclopramide may increase the bioavailability of levodopa by increasing gastric emptying, metoclopramide may also adversely affect disease control by its dopamine receptor antagonistic properties.

Adverse Effects: The most common serious adverse reactions occurring with Sinemet (levodopa and carbidopa) are dyskinesias, including choreiform, dystonic and other involuntary movements, and nausea. Other serious adverse reactions are mental changes including paranoid ideation and psychotic episodes, depression with or without development of suicidal tendencies, and dementia. Convulsions also have occurred; however, a causal relationship with Sinemet has not been established.

Other adverse reactions reported in clinical trials or in post-marketing experience include:

Body as a Whole: syncope, chest pain, anorexia, asthenia.

Cardiovascular: cardiac irregularities and/or palpitation, hypotension, orthostatic effects including hypotensive episodes, hypertension, phlebitis.

Gastrointestinal: vomiting, gastrointestinal bleeding, development of duodenal ulcer, diarrhea, dark saliva, constipation, dyspepsia, dry mouth, taste alterations.

Hematologic: leukopenia, hemolytic and nonhemolytic anemia, thrombocytopenia, agranulocytosis.

Hypersensitivity: angioedema, urticaria, pruritus, Henoch-Schönlein purpura, bullous lesions (including pemphigus-like reactions).

Musculoskeletal: back pain, shoulder pain, muscle cramps.

Nervous System/Psychiatric: neuroleptic malignant syndrome (see Warnings), bradykinetic episodes (the on-off phenomenon), dizziness, somnolence, paresthesia, psychotic episodes including delusions, hallucinations and paranoid ideation, dream abnormalities including nightmares, insomnia, headache, depression with or without development of suicidal tendencies, dementia, agitation, confusion, increased libido.

Respiratory: dyspnea, upper respiratory infection.

Skin: alopecia, rash, increased sweating, dark sweat.

Urogenital: dark urine, urinary frequency, urinary tract infection.

Other adverse reactions that have been reported with levodopa alone and with various levodopa-carbidopa formulations, and may occur with Sinemet are:

Body as a Whole: fatigue.

Cardiovascular: myocardial infarction.

Gastrointestinal: sialorrhea, dysphagia, bruxism, hiccups,abdominal pain and distress, flatulence, burning sensation of tongue, gastrointestinal pain, heartburn.

Metabolic: weight gain or loss, edema.

Musculoskeletal: leg pain.

Nervous System/Psychiatric: decreased mental acuity, disorientation, ataxia, numbness, increased hand tremor, muscle twitching, blepharospasm (which may be taken as an early sign of excess dosage, consideration of dosage reduction may be made at this time), trismus, activation of latent Horner's syndrome, anxiety, euphoria, falling and gait abnormalities, extrapyramidal disorder, nervousness, memory impairment, peripheral neuropathy.

Respiratory: pharyngeal pain, cough.

Skin: flushing, malignant melanoma (see Contraindications).

Special Senses: diplopia, blurred vision, dilated pupils, and oculogyric crises.

Urogenital: urinary retention, urinary incontinence, priapism.

Miscellaneous: faintness, hoarseness, malaise, hot flashes, sense of stimulation, bizarre breathing patterns.

Laboratory Tests: Laboratory tests which have been reported to be abnormal are alkaline phosphatase, AST, ALT, lactic dehydrogenase, bilirubin, blood urea nitrogen, creatinine, uric acid, and positive Coomb's test.

Decreased hemoglobin, hematocrit, elevated serum glucose, and white blood cells, bacteria and blood in the urine have been reported.

Decreased white blood cell count and serum potassium; protein and glucose in urine have been reported with levodopa alone and with various levodopa-carbidopa formulations, and may occur with Sinemet.

Overdose: Symptoms and Treatment: Management of acute overdosage with Sinemet is basically the same as management of acute overdosage with levodopa alone. However, pyridoxine is not effective in reversing the actions of Sinemet.

General supportive measures should be employed, along with immediate gastric lavage. I.V. fluids should be administered judiciously and an adequate airway maintained. ECG monitoring should be instituted and the patient carefully observed for the possible development of arrhythmias; if required, appropriate antiarrhythmic therapy should be given. The possibility that the patient may have taken other drugs as well as Sinemet should be taken into consideration. To date, no experience has been reported with dialysis; hence, its value in overdosage is not known.

Dosage: In order to reduce the incidence of adverse reactions and achieve maximal benefit, therapy with Sinemet must be individualized and drug administration must be continuously matched to the needs and tolerance of the patient. It should be borne in mind that the therapeutic range of Sinemet is narrower than that of levodopa alone because of its greater milligram potency. Therefore, titration and adjustment of dosage should be made in small steps and the dosage ranges recommended should usually not be exceeded. The appearance of involuntary movements should be regarded as a sign of levodopa toxicity and as an indication of overdosage, requiring dose reduction. Treatment should, therefore, aim at maximal benefit without dyskinesias.

If a patient being treated with levodopa is switched to therapy with Sinemet, levodopa must be discontinued at least 12 hours or more before therapy with Sinemet is initiated.

Sinemet tablets are available in a 4:1 ratio (Sinemet 100/25) and in a 10:1 ratio of levodopa to carbidopa (Sinemet 100/10 and Sinemet 250/25). Tablets of the 2 ratios may be given separately or combined as needed to provide the optimal dosage.

Studies have shown that peripheral dopa decarboxylase is saturated by carbidopa at doses between 70 to 150 mg/day. Patients receiving less than 70 mg per day of carbidopa are more likely to experience nausea and vomiting. Experience with total daily dosages of carbidopa greater than 200 mg is limited.

For patients who require only low doses of levodopa, e.g., less than 700 mg, Sinemet 100/25 may be helpful.

Induction of Therapy in Patients Not Receiving Levodopa: Dosage is best initiated with 1 tablet of Sinemet 100/25 three times a day. This dosage schedule provides 75 mg of carbidopa/day. Dosage may be carefully increased by 1 tablet every 3 days until the optimal dosage has been reached which does not produce dyskinesias.

While increasing the dosage during the induction period, the doses should be divided, aiming at a frequency of dosing of at least 4 times a day. If further titration is necessary after a daily dosage level of 6 tablets of Sinemet 100/25 has been reached, tablets of Sinemet 100/10 or Sinemet 250/25 may be used as needed to provide the optimal dosage.

Usually no patient should receive more than 1500 mg of levodopa a day. Some patients, including those with postencephalitic parkinsonism, are more sensitive to levodopa and require specially careful dosage adjustment.

Induction of Therapy in Patients Receiving Levodopa: Levodopa must be discontinued at least 12 hours or more before Sinemet is started. A dosage of Sinemet should be used that will provide approximately 20% of the previous levodopa daily dosage; this can be started in the morning after the day in which the treatment with levodopa has been stopped. For example, if a patient is receiving 4000 mg of levodopa per day, the dosage of Sinemet should not provide more than 750 mg of levodopa per day divided into 4 to 6 doses.

Tablets of Sinemet 100/25 should be used to start medication for patients requiring lower dosages of levodopa.

Adjustment and Maintenance of Therapy: Therapy should be individualized and adjusted according to the desired therapeutic response. At least 70 to 100 mg of carbidopa per day should be provided. When a greater proportion of carbidopa is required, 1 tablet of Sinemet 100/25 may be substituted for each tablet of Sinemet 100/10. When more levodopa is required, Sinemet 250/25 should be substituted for Sinemet 100/25 or 100/10. If necessary, the dosage of Sinemet 250/25 may be increased by 1/2 or 1 tablet every day or every other day to a maximum of 8 tablets a day. Experience with total daily dosages of carbidopa greater than 200 mg is limited.

Because both therapeutic and adverse responses occur more rapidly with Sinemet than with levodopa alone, patients should be monitored closely during the dose adjustment period. Specifically, involuntary movements will occur more rapidly with Sinemet than with levodopa. The occurrence of involuntary movements may require dosage reduction. Blepharospasm may be a useful early sign of excess dosage in some patients.

Current evidence indicates that other standard antiparkinsonian drugs may be continued while Sinemet is being administered although their dosage may have to be adjusted.

If general anesthesia is required, therapy with Sinemet may be continued as long as the patient is permitted to take fluids and medication by mouth. If therapy is interrupted temporarily, the usual daily dosage may be administered as soon as the patient is able to take oral medication.

Information for the Patient: See Blue Section--Information for the Patient Sinemet.


Supplied: Sinemet 100/10: Each dark dapple-blue, oval, uncoated tablet, engraved 100/10 on one side and SINEMET on the other, contains: levodopa 100 mg and carbidopa 10 mg expressed as anhydrous carbidopa. Nonmedicinal ingredients: cornstarch, indigotine, magnesium stearate, microcrystalline cellulose and pregelatinized starch. Bottles of 100.

Sinemet 100/25: Each yellow, oval, scored, uncoated tablet, coded Sinemet 650, contains: levodopa 100 mg and carbidopa 25 mg expressed as anhydrous carbidopa. Nonmedicinal ingredients: cornstarch, magnesium stearate, microcrystalline cellulose, pregelatinized starch and quinoline yellow. Bottles of 100 and 500.

Sinemet 250/25: Each light dapple-blue, oval, scored, uncoated tablet, coded Sinemet 654, contains: levodopa 250 mg and carbidopa 25 mg expressed as anhydrous carbidopa. Nonmedicinal ingredients: cornstarch, indigotine, magnesium stearate, microcrystalline cellulose and pregelatinized starch. Bottles of 100.


All strengths gluten-, lactose- and tartrazine-free. Store at 15 to 30°C in a tightly closed container. Protect from sunlight.

http://www.rxcarecanada.com/Sinemet....1588#backtotop