Dextromethorphan used for PD Protection

[reverett123]

First of all, there is more than one effect here. Symptomatic relief for Steve is a short term effect. Protection against further degeneration by quieting the immune system may be the case for Robert.

An additional possibility is endocrine effects on the HPA axis stress response resulting in Steve's sense calm at the podium.

Taking a "Multihit" viewpoint, these may be three entirely separate effects acting via independent mechanisms. And one or more may be dose dependent and there is a 50% spread between Steve and Robert. With endocrine affairs a little goes a long way as well.

Leaving Ashley out for now and just talking to the DM crew, have either of you tried either lower or larger doses?

And have either of you tried taking it at a different time of day?

-Rick

Originally Posted by stevem53

The only rational basis that I can think of for my symptomatic relief so far is this..Robert and yourself have had pd for appox the same amount of time as myself..You began LDN about 2.5 years ago, as did Robert with the DM..(2 yrs ago)....If we were to play the devils advocate and assume that both of your progressions have been halted as the study suggests..or if it has slowed the progressions or masked your symptoms, or a combination of the above..and myself on the other hand..I definately have 2 years of uninterrupted progression..I have more symptoms to treat, keeping in mind that you both were in the early stages of pd when you began the LDN/DM regimen..Then again it could be that you are both in fact on the Sinamet honeymoon and I am merely enjoying the dopamine reuptake inhibitor consequences of DM..I think now that a few more folks in our community are interested in trying DM we will know one thing for sure..We still wont know for a number of years if it has halted our progressions but we will have some comparisons on symptoms

[reverett123]

You seem to be doing well and are stable, so maybe you should be our "control" for now. Another week to let the MAO wash out and I will start low but then inch up a little above you to see what happens. So long as there are so few of us we can take it slow and easy. I did buy some of the local pharmacy's finest today. Did you know they had it in the five gallon size?

[stevem53]

Bucket o' DM..Wonder what the street value is?.. ..At 1/2 teaspoon per night that should last me for the rest of my life..

It will be interesting to compare results

[mrsD]

There are other forms of DM you can use.

Delsym is pure DM in sustained release dosage form. Most pharmacies carry
it:
http://www.delsym.com/

Some people get nausea from the guaifenesin in Robitussin DM. So if you prefer single dose DM the Delsym is for you. But it costs more.

There are tablets also, with guaifenesin and DM 30mg sustained acting:
Mucinex DM
http://www.mucinex.com/pdf/Mucinex_DM.pdf
Some stores now have a generic available for this.

Kids abuse DM so if you begin to use it in high amounts, you may attract
attention in the store. Some pharmacies may have it behind the counter because of this. Coricidin HBR recently was targeted by abusers and is
often behind the counter now.

Very high dosing of DM can cause dissociative CNS symptoms and a peculiar
"buzz"...but in the doses mentioned here, that should not be a problem.

Here is more information:
http://www.nhtsa.dot.gov/PEOPLE/inju...methorphan.htm

Drug Interactions: Should not be taken with Monoamine Oxide Inhibitors (MAOIs) and Selective Serotonin Reuptake Inhibitors (SSRIs) because of an apparent serotonin syndrome (fever, hypertension, arrhythmias). Should be used with caution in atopic children due to histamine release. Additive CNS depressant effects when co-administered with alcohol, antihistamines, psychotropics, and other CNS depressant drugs.

The serotonin reuptake is documented, but not common.

This is also interesting:

Pharmacodynamics: Dextromethorphan acts centrally to elevate the threshold for coughing, and has no significant analgesic or sedative properties at antitussive doses. It is proposed that dextromethorphan is a glutamate and NMDA antagonist, and blocks the dopamine reuptake site. It may also increase 5HT 1A activity possibly via NMDA antagonism.

[RLSmi]

MRSD, Delsym and some other long acting DM (aka DXM) preparations also contain polystiril, a substance that slows down the absorption of the drug. I was told by someone who is actively doing research on this class of drugs that using the long acting forms will defeat production of the "spike" of concentration of DM produced by the mini-dose that is needed.

Also, the time it is taken, just before bedtime, is important for producing a brief blocking of the opioid receptors just before the natural period of release of endorphins (2 to 4 am) the hormones that are beneficial in calming the over-active microglial cells in the PD midbrain. Too much drug, or taken at the wrong time, may cause prolongned receptor inhibition, or inhibition at a sub-optimal time for taking advantage of boosting the normal endorphin release.

This is my opinion, based on what I have learned from other scientists who have studied the process extensively in the laboratory for the last ten or twelve years.

Robert

[reverett123]

You brought up a good point about the psychological risks of habituation for those of us with the right personalities. The taste and the fact that it is a liquid, etc. When I was at CVS yesterday I also picked up the gel cap form as well for portability. You would lose the dose control (they're 15 mg) but it is a possibility to remember. Thank gawd you can't smoke it. ...can you?

[ashleyk]

Over the past week, all this discussion on DM has caused me to search the web for more info after I learned that DM and LDN are dopamine agonists as well as opioid agonists. According to the people who have done the research on DM and LDN (Dr's Bihari, Zagon, Hong), these drugs are neuro protective at very low doses, to use them at high doses negates their effectivness or worse.

My question is, would Mirapex at it's normal dosage override or defeat the low dose protection of DM or LDN since it is also a dopamine agonist? I did a search on "Pramipexole (mirapex) opioid antagonists" and did not come up with a match (that's good?) since I think DM and LDN work thru the opioid receptors for neuro protection. Since I take Mirapex, I wonder if it effects or negates the LDN I also take. If anyone works in this area, your comment would be appreciated.

As far as DM being addictive at only a half or one teaspoon a day, I'd be very surprised. I wouldn't think you'd feel a thing. In this case, a small dose is better then a big one.
Ashley

[reverett123]

I mentioned this question about DM and PD to Anne Frobert, the French MD and PWP who posted a few times on banding. She pointed out that levodopa has at least two effects. One is short term and helps us move. The other longterm one is dangerous and leaves us damaged.

It is possible that a similar dual action (thought hopefully with a better outcome) is at work here. What I mean is that the benefits that Steve is experiencing may be totally unrelated to what Robert is observing and I suppose that Dr. Hong could be looking at a third process. Short term symptom relief is something we can readily observe. Longterm effects, both good and bad, are beyond our capabilities to evaluate.

Something just wafted across my brain as I was thinking about the possibility of the higher dosage required for one negating the the other. There was something, and I think it was curcumin, that was effective at lower doses but lost some of its benefits as dosage increased. It might be acting on the same systems.

[made it up]

Hi Reverett,
Do you have a certain time when the one legged thingy is done?
The fluctuations in a PWP are many.... off, dyskinesic and of course on, a nice on.
What I'm getting at is how can you know its not the prescribed levodopa doing its job when you can stay on one leg longer but the cough syrup?
Regards,
Lee

[reverett123]

why, it's almost a zen koan

i do it in mid-afternoon when i am at my best. my goal is to detect change so the most important thing is consistency.

rick