IMPORTANT INFORMATION ABOUT LEVODOPA USE IN PARKINSON’S DISEASE

IMPORTANT INFORMATION ABOUT LEVODOPA USE IN PARKINSON’S DISEASE

Levodopa is one of the most important medicines used for treating Parkinson’s disease (PD). It is sold in combination of levodopa and carbidopa. The commonly used brand names for this medicine are syndopa, sinemet, tidomet and duodopa. Levodopa is very useful in ameliorating the symptoms of PD, especially the tremors and rigidity. However, there are several important points of note regarding its use. The current article highlights a few of them.

1. Try to avoid levodopa use in early PD: Though levodopa is very effective in controlling symptoms of PD even in early stage, it is better to avoid using it in early PD. This is because the risk of dyskinesia (abnormal movements as a side effect of levodopa) and rapid wearing off (reduced efficacy of levodopa) are more common, if levodopa is started early in the course of disease. Also, levodopa loses the efficacy after longer use, so, it makes sense to start it later.

2. Use the lowest effective dose of levodopa: It may be tempting to use levodopa at a higher dose or more frequently, as the symptom control would be better with that. However, for the same reason mentioned above, it is better to use levodopa at the lowest possible dose, and as less frequently as possible.

3. Take levodopa on empty stomach: Presence of food in stomach may interfere with the absorption of levodopa; so, it is better to take levodopa on empty stomach. In the initial days of starting levodopa, there may be nausea or vomiting, so, it may be taken after food or snacks.

4. Reduce or evenly space the amount of protein intake: High protein diet prevents proper absorption of levodopa. So, the protein intake should be evenly spaced out in the day; or better, it can be shifted to dinner time (as most doses of levodopa are taken before dinner time).

5. Avoid pyridoxine (vitamin B6) intake: Pyridoxine can reduce the effects of levodopa, if taken alone. However, pyridoxine does not interfere with the effects, if levodopa is taken along with carbidopa (as in most cases).

6. Hallucinations and psychosis can be a side effect of levodopa: Use of levodopa does increase the risk of visual and auditory hallucinations, and other psychotic reactions (agitation, anger, irritability, etc). However, it is not a simple relationship. The severity & duration of PD, presence of cognitive impairment and daytime somnolence, all increase the risk of psychotic reactions with levodopa use.

7. Avoid using levodopa in late evenings: The risk of hallucinations and other psychotic reactions are higher if levodopa is used in late evenings or nights. So, avoid it at those times, as much as possible.

8. Avoid breaking, crushing or chewing the controlled release (CR) tablets: Those taking medicines such as syndopa CR, tidomet CR, etc should swallow the entire tablet, without breaking or crushing (which would reduce its efficacy).

9. There is a risk of dependence and abuse with levodopa: Levodopa increases the dopamine levels in brain and may cause effects such as euphoria (feeling of extreme happiness) and other positive mental effects. Therefore, a small group of patients with PD may increase the dose of levodopa by self and take upto 1500-2000 mg per day. These patients accept the side effects of high dose levodopa (such as hallucinations, nausea, loss of appetite), in order to experience the positive mental effects. This behavior (of dependence and abuse of levodopa) should be recognised and treated.

10. Other side effects of levodopa to watch for:

a.     Dizziness or fainting sensation on standing up (may occur due to fall in BP on standing),

b.     Feeling of nausea, vomiting, loss of appetite

c.      Sudden sleep episodes: Patients taking levodopa may fall asleep without any drowsiness or warning. It can occur while driving or doing other activities needing full concentration, which can be potentially harmful.

d.     Sleep disturbance or insomnia at nights. 

DR SUDHIR KUMAR MD (Medicine) DM (Neurology)

Senior Consultant Neurologist

Apollo Hospitals, Hyderabad, India

Phone: 0091-40-23607777/60601066

Email: drsudhirkumar@yahoo.com

Online consultation: https://www.doctorspring.com/doctors/sudhir-kumar

MEDICINES FOR TREATING ACIDITY COULD INCREASE THE RISK OF DEMENTIA

COMMONLY USED MEDICINES FOR ACIDITY INCREASE THE RISK OF DEMENTIA

Dementia is a condition, characterised by progressive loss of memory and other higher brain functions. It is a common cause of disability and dependence on others in older people. 

Alzheimer's disease and brain stroke are the two most common causes of dementia.

1. In a recent research, medicines commonly used for treating acidity, were found to increase the risk of developing dementia in older people.

2. The effect of medicines belonging to the group of proton pump inhibitors (PPIs) such as omeprazole (omez), pantoprazole (pantodac, pantocid), rabeprazole (razo) were studied.

3. The study population included about 74,000 people from Germany, aged 75 or more.

4. People on regular prescriptions of PPIs (anti-acidity medications) had a significantly higher risk of developing dementia.

5. The possible mechanism is an increase in beta-amyloid in brain (which are involved in causing Alzheimer's disease).

This study was published in JAMA Neurology (April 2016), and those interested in reading further details of the study can access it at the following link:

http://archneur.jamanetwork.com/article.aspx?articleid=2487379

DR SUDHIR KUMAR MD DM (Neurology)
Senior Consultant Neurologist
Apollo Health City, Hyderabad
Ph- 04023607777/60601066
Email: drsudhirkumar@yahoo.com

Frequent Coffee Breaks Keep You Healthy Too!

Coffee Breaks Make You Healthier

Coffee drinking is quite popular all across the world. There are many, who have coffee first thing in morning, referred to as bed coffee. Bed coffee is supposed to energize people and get them out of sleepiness. Many others take “coffee breaks” while at work, which relaxes them. Who would have forgotten the student days, when numerous coffee cups kept them awake until late nights just before examinations? Coffee drinking is supposed to increase alertness and concentration. The effects are mainly related to caffeine contained in the coffee.

Health-Related Benefits of Drinking Coffee

1. Lower risk of diabetes: In a Dutch study done on 40,000 people, it was found that drinking at least 3 cups of coffee or tea per day reduced the risk of developing diabetes by 42%. (Diabetologia 2009). The anti-diabetic effects are related to polyphenols found in coffee.

2. Lower risk of coronary heart disease: Moderate habitual coffee consumption (3-4 cups per day) lowers the risk of coronary heart disease, especially in women. (International Journal of Cardiology)

3. Coffee improves headaches and migraine, if taken alone or along with other painkillers.

4. Lower risk of brain stroke: Middle aged people in Japan, who drank 3 or more cups of coffee per day had lower rates of silent brain infarctions (strokes without symptoms, picked up on MRI scan of brain). Lesser brain infarctions would also lead to lesser incidence of dementia. (Journal of Stroke and Cerebrovascular Diseases, 2016)

3 or more cups of coffee intake per day reduced the risk of brain stroke (despite smoking tendency in coffee drinkers). A lower incidence of heart failure, diabetes and hypertension was also observed. (Nutritional Neuroscience, 2015)

5. Reduced risk of Alzheimer’s disease: Alzheimer’s disease is the commonest cause of dementia (memory loss and loss of other higher mental functions) in the world. Based on the meta-analysis of 11 research studies, it was found that higher coffee consumption reduced the risk of Alzheimer’s disease. (Nutrition, 2015)

6. Reduced risk of Parkinson’s disease: Parkinson’s disease is the commonest cause of movement disorder, characterized by tremors, rigidity and slowness of movements. Based on meta-analysis of 26 studies, increased caffeine/coffee consumption was associated with reduced risk of Parkinson’s disease. (Journal of Alzheimer’s Disease, 2010)

7. Reduced risk of multiple sclerosis: Researchers in USA and Sweden have found that drinking at least 900 ml (six cups) of coffee per day has protective effects against multiple sclerosis. Caffeine has neuroprotective properties and suppresses inflammation. (JNNP, 2016)

8. Reduced risk of depression and suicide: A meta-analysis of 11 studies showed a protective effect of coffee against depression. The relationship between coffee intake and depression was linear; for each cup/day increase in coffee intake, the risk of depression reduced by 8%. (Australia NZ Journal of Psychiatry 2016)

In addition, increased coffee consumption was also associated with reduction in incidence of completed suicides. (World Journal of Biol Psychiatry, 2014)

9. Reduced risk of cancer: Various studies have shown that regular coffee consumption is associated with lower risk of cancers. 5 or more cups per day reduced the risk of colorectal cancer (Oncotarget, 2016). Other studies have shown reduced risk of cancers of oral cavity, pancreas, urinary bladder, breast, uterus, and liver among regular coffee drinkers.

10. Lesser incidence of erectile dysfunction: Coffee can provide a boost to sexual health too. Men with coffee intakes of 2-3 cups of coffee/ day reported significantly lesser incidence of erectile dysfunction, as compared to those with no coffee intake or only 1 cup/day. (PLos One, 2015)

11. Lower death rates: Regular intake of coffee can increase longevity and prevent deaths too. Recent research has shown that people drinking 2-5 cups of coffee/day had significantly lower deaths from heart disease, chronic lung diseases, diabetes, pneumonia and influenza, and intentional self-harm. Coffee may reduce mortality risk by favorably affecting inflammation, lung function, insulin sensitivity, and depression. (American Journal of Epidemiology,

Possible Health Hazards of Coffee Drinking

1. Poor control of BP in patients with hypertension:  A recent study showed that older people with hypertension, who consumed 3 or more cups of coffee per day, had higher BP (systolic and diastolic). Coffee drinking, however, does not lead to an increased risk of developing hypertension (in people with normal BP).

2. Increased cholesterol levels: Drinking unfiltered or boiled coffee may cause an increase in the levels of LDL cholesterol and triglycerides.

3. Increased risk of coronary heart disease: Drinking 3 or more cups of Italian-style coffee (espresso or mocha) is associated with increased risk of coronary heart disease. (PLoS One, 2015). This effect was independent of cholesterol levels, as the cholesterol levels did not increase in this study.

4. Sleep problems: Caffeine is a brain stimulant and after consuming it, people feel alert. People sensitive to the stimulant effects of caffeine may not get proper sleep, if they drink coffee close to bedtime. Since, the effect of coffee may last for 5-6 hours, people sensitive to it should avoid coffee after 6 PM.

5. Not recommended for children: Coffee suppresses appetite, and may cause children to eat less. Also, after having coffee, children feel full, and avoid nutritious foods such as milk.

6. Pregnant and nursing women should have coffee in moderation: There is no restriction of coffee in pregnant or nursing mothers. However, they should restrict the coffee intake to 2-3 cups per day.

So, what is the final take home message?

1. Coffee is good for health, and can be safely consumed by adults.

2. For optimum benefits, it should be restricted to 2-5 cups per day.

3. The maximum safe limits for caffeine/coffee intake is 200 mg in one sitting (around 2½ cups of coffee) or 400 mg daily (around 5 cups of coffee). 

4. Coffee (without sugar and milk) has zero calories; and hence, people on strict diet too can freely have coffee.

DR SUDHIR KUMAR MD (Internal Medicine) DM (Neurology)

Senior Consultant Neurologist

Apollo Health City, Jubilee Hills, Hyderabad

Phone: 040-23607777/60601066

Email: drsudhirkumar@yahoo.com

Online Consultation: http://bit.ly/Dr-Sudhir-kumar

OPTIMUM DURATION OF OPD CONSULTATION

WHAT IS THE OPTIMUM DURATION OF OPD CONSULTATION?

Almost all doctors see patients in OPD and it is the most important aspect of patient care for a physician. For a surgeon, OPD consultation is important to counsel patients regarding surgery after discussing the pros and cons of the procedure.

What factors determine the success of OPD consultation?

There are several aspects of OPD consultation that determine whether it was successful or not. These include: 1. Whether doctor carefully listened to patient’s problems or not? 2. Whether the doctor was pleasant or not? 3. Whether adequate time was allotted for the consultation or not? 4. Whether adequate information was given regarding diagnosis, investigations, medications, treatment, prognosis, etc or not? Of all of these, the duration is consultation is probably one of the most important factors.

How long should an ideal OPD consultation last?

There is no uniform guideline regarding the optimum duration for an OPD consultation. Doctors complete an OPD consultation in as little as 3-4 minutes, and some doctors spend almost an hour per patient in the OPDs. Spending more time would increase patient’s satisfaction, however, that is not the only criteria ensuring patient’s satisfaction.

Longer duration of OPD consultation would limit the number of patients a doctor can see per day. This would lead to long waiting periods. Is it advisable, when there are so few doctors seeing so many patients?

Duration of OPD consultation can increase without necessarily increasing the efficiency of diagnosis and treatment. For example, patient may try to discuss in detail certain irrelevant history (symptoms or past treatment) or he may bring volumes of old documents, which may not be relevant. He may discuss certain facts that he “half-learned” from the Internet, which may not be relevant to the case. Some patients are very talkative and it is difficult to stop them.

What is the best strategy?

Most experienced doctors know the relevant factors in history taking and examination. Doctors should guide the discussion in OPD, and politely point out if the patients are drifting away. Most important points can be discussed in 8-10 minutes. In any case, patients on average remember only three points from an outpatient consultation. So, there is no real point in overloading patients with too much information in a single consultation. Also, not all patients require the same amount of time. For example, a regular patient coming for diabetes or hypertension medications may not take more than 3 minutes, if sugar and BP are normal. On the other hand, an elderly patient with multiple comorbidities on multiple medications may take 15 minutes. So, the duration can be tailored as per the needs of the patient. On an average, 8-10 minutes per consultation would suffice.

This article was first published in www.docplexus.in Can be accessed at the following link-

https://www.docplexus.in/#/app/posts/5cdf6cab-03fe-4e12-934a-cd4d472fbc23

Image above is for representational purpose only

Dr SUDHIR KUMAR MD (Internal Medicine), DM (Neurology)

Senior Consultant Neurologist

Apollo Health City, Jubilee Hills, Hyderabad

Phone: 040-23607777/60601066

Email: drsudhirkumar@yahoo.com

HIGH STRAIN JOBS LEAD TO A HIGHER RISK OF STROKE

HIGH STRAIN JOBS LEAD TO A HIGHER RISK OF STROKE

Today's job requires working long hours, often stretching into late nights. Several jobs also require doing night shift duties. With increased internet connectivity, there is a boon to communication. However, it has also blurred the boundaries of "work time" and "leisure time". It is common to see people bringing work to home. At home, instead of relaxing, they remain busy on "business calls" on their smartphones, or work on "projects" on their laptops. While all these long and unearthly hours of work have increased their productivity making these employees "valuable assets" to the company; it has also taken a big toll on their health.

A recent study, published in NEUROLOGY Journal (Nov 2015) has shown a significantly higher risk of brain stroke in people with high strain jobs. The risk was higher for ischemic stroke (where the blood supply to a part of brain gets blocked), resulting in paralysis, impaired speech, blindness, and so on. The risk of brain stroke due to high strain jobs was found to be higher in women as compared to men.

Several reasons may be involved in increasing the risk of brain stroke in high strain jobs:

1. Work strain may lead to unhealthy lifestyles such as increased smoking, reduced physical activity, unhealthy eating habits, untimely meals, reduced sleep, lack of health check ups, etc. All of them are risk factors for stroke.

2. Work stress is often associated with certain cardiovascular risk factors, such as metabolic syndrome, high body mass index (obesity), impaired glucose metabolism (diabetes), and dyslipidemia (high cholesterol), which are also known to be risk factors for stroke.

3. Work stress can also lead to neuro-endocrine disturbances, leading to increased inflammation and plaque destabilization, leading to ischemic brain stroke.

Therefore, one needs to maintain a good work-leisure balance. Maintaining good work out put and efficiency are important, however, it should not be at the cost of strain and stress.

1. Working hours should be restricted to 8-10 hours per day.

2. Work should not be brought home.

3. There should be adequate time left (after work) to spend with family; and exercise on a regular basis.

4. Smartphones and laptops should be in silent mode during sleep, so that sleep is not disturbed.

5. Avoid night shift duties as much as possible.

6. Avoid excess travel, as it leads to disturbed sleep rhythm, as well as increased strain.

7. Periodic breaks and vacations with family are advisable, to get relaxed and recharged.

DR SUDHIR KUMAR MD (Medicine) DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Jubilee Hills, Hyderabad
Email: drsudhirkumar@yahoo.com
Phone: 040-23607777/60601066

Online Consultation: http://bit.ly/Dr-Sudhir-kumar