My dad was diagnosed with Parkinson's in January 2012 (though he was showing symptoms long before then). He is currently on Madopar and Comtan. We also tried Mucuna Pruriens as well.

Two of the most difficult issues he faces is dizziness and fatigue. It seems to get worse after he takes his meds, which makes taking them during the day pretty problematic. He's tired without the meds, but after he takes them he's even more tired. We noticed that it is generally better at night.

I've researched some solutions for this, but they mostly point to more medication (ie. antidepressants, etc), which my dad is unwilling to take.

These issues are preventing him from getting enough exercise during the day. Any tips for managing the fatigue and dizziness, or getting more benefits from exercise would be much appreciated, thanks!

Just wondering if anyone has any useful tips...any help is appreciated!

pegasus4747,

I'm not a doctor, but ...

You mention "dizzyness". This may be orthostatic hypotension. Does this happen when he stands up quickly? I had this for a while when I was on both Parkinson's drugs and drugs to reduce my blood pressure. Together, they were lowering the blood pressure too much, I'd gone from hypertension to hypotension. In my case removing the blood pressure pill did the job. Get your dad to see his GP to see if this applies to him.

Watch out for dehydration. It's easier said than done, but make sure he's drinking enough.

See:
http://www.pdf.org/fall11_low_blood_pressure_pd

John

I had the exact same experience. Soon as I lowered the BP meds, I was better.

Great advice on hydration, especially this time of the year!

I don't think it's hypotension. He monitors blood pressure pretty closely. It's always after he takes his meds, so we're guessing it's some sort of reaction to dopamine. It also happens when he takes mucuna.

Moving is essential to being "moveable". If you decide to sit or lie down for a large part of your day, you will get "tired' when you do decide that it is time to get up. It can be horribly difficult to move at times, so the time that one has when they are able to move is important insofar as ones muscle tone is concerned. There are no great answers to your dad's dilemma. I'll bet that his weakness comes with inactivity, and that can be very frustrating. It is not easy to force oneself to move, when getting up and walking is a dreaded thing to perform. And that is what is all part of this disease. I take Dexedrine, in the morning, which sometimes works well to keep moving. Dexedrine is not for everyone, as it has it's side effects that many cannot tolerate. Are you sure that your day's BP is taken regularly and is not bottoming out, as anti parkinson drugs tend to have this effect on BP, fine one minute, low the next, and thus orthostatic hypotension , that makes you sometimes feel really dizzy. I have passed out on more than a few occasions, and have been so weak that I just hit the nearest chair or just get down on the ground "just in case" I were to go down and out. Rising slowly from ones sitting or lying positions is recommended, and a few deep breaths before attempting to do anything physical are also a good idea. That' all I have to offer, sorry.

taking sinemet, carbidopa/levodopa, lowers my blood pressure which is good for me since it's a little high. it goes from 140/90 to 120/80.
hypotension is a major side affect of sinemet.

Thanks for all the great replies! I will double-check that his BP is indeed stable. He does complain that he is REALLY tired in the morning, and I suspect that it has something to do with his meds wearing off.

Like one poster suggested, dexedrine works well, though these days I'd say that lisdexamfetamine, brand name Vyvanse, is a better option. It's a prodrug for dexamphetamine (dexedrine), making your body has to metabolize it before it's active. That means a slow steady onset and a slow wearing off, so it doesn't produce crashes the way plain dexedrine and adderall do.

Alternatively there is modafinil/armodafinil, provigil and nuvigil. They're the same drug only the latter is a single enantiomer, so it's roughly twice the potency of provigil. The price is the biggest difference.

I'm prescribed nuvigil, and it is crazy expensive. Without insurance a bottle of thirty 150mg tablets would be 500 something. Provigil is generic more though, and not very expensive afaik.

It increases wakefulness without making people jittery. Also, while it is a controlled substance like dexedrine (though in the lowest class, where dex is in the highest highest legally prescribe-able), to date there has not been a single case of abuse or addiction published in the literature. That's pretty good considering that there are reports of benadryl addiction

one thing that needs to be considered, too, is that dexedrine is known to be neurotoxic in higher doses, and has been implicated in causing Parkinson's Disease. Not a strong association, but it may play a role in disease development for some people. It causes dopamine to be released, along with norepinephrine, which cause wakefulness.

This leads to a decrease in dopamine levels, at least temporarily.

Modafinil, however, has a very complex and not entirely understood mechanism, but it is known to inhibit the reuptake of dopamine from the synapse. This is a far more gentle process. Also, reuptake inhibitors aren't known to cause neurotoxicity.

I think it's a better drug. You could look in PubMed for info on its use in Parkinson's patients. It may be helpful, even.