February 29, 2012

Bell Curve Thinking Saves Me Big $$ on Azilect and Other Meds

As I recently mentioned, I've been on a new kick. (Friends and family no doubt are saying "there he goes again!"). This time, it's thinking about my health issues from the perspective of the Bell Curve, used in statistics to show normal distribution of a variable.

One of the first issues that came to mind is my gut feeling (actually emanating from my gut) that I'm over-medicated or that I'm having adverse reactions from the mix of meds I'm taking. Looking at the Bell Curve got me thinking that health researchers (and my doctors) are probably looking at the experience of the average patient (think the 68.2% in the dark blue in the above picture) when they come up with the recommendations for the amount and timing of the prescribed meds.

But of course I'm convinced I'm not your average patient. So I decided to see what would happen if I deviated a bit from my doctors' recommendations. Not surprisingly, the first med I looked at was my Azilect (rasagiline), commonly prescribed, with levodopa/carbidopa, for those of us with Parkinson's. My neurologist gave me the standard prescription of 1mg, once a day. Azilect was first on my test list because I had just renewed my 90-day prescription . . . at a cost of $1,100! Although my insurance paid the lion's share, the tariff on this drug is the main reason I ended up in Medicare's Donut Hole last year, which meant I had to purchase meds from my own pocket for the balance of the year.

So, I decided to see what would happen if I split my 1mg pill in half and took only O.5 mg a day. I couldn't detect any problems. But ever cautious, I decided on a routine of a full 1mg one day, followed by the split pill (0.5mg) the next two days.

Apparently successful with this routine, I looked next at levodopa/carbidopa, another standard prescription -- at least for those in the early years of  PD -- of 25/100 taken at six hour intervals three times during the day, but with a double dose (50/200) at bedtime.

The first thing I tried was using the standard, not double, dose at bedtime. After a few days, I couldn't detect any difference.

Then, I thought I'd stretch the timing to three pills at eight-hour intervals, rather than the prescribed four pills at six-hour intervals. This time I COULD tell this made a difference:  I felt fairly shaky toward the end of eight hours.

One reason I was comfortable with these experiments: I knew my regular appointment with my neurologist was coming up soon. I met with him yesterday.

He had no problem with my cutting back on the Azilect or with my taking the standard 25/100 levodopa/carbidopa at bedtime rather than the ER (extended release). But he recommended that I stick with the 6-hours, four times a day for the levodopa/carbidopa, since this drug only has a six-hour lifetime in the brain.

Actually, I just checked Azilect on the Mayo Clinic's website and found that some doctors prescribe only the smaller 0.5mg dose. But from the pocketbook perspective, I'm glad I have the 1mg prescription, since I can save a hell of a lot of money by cutting this pill in half.

Pill-splitting is not advisable with some meds, but my neurologist said it wasn't a problem with Azilect.

I've also been experimenting with halving my blood pressure. I have a bp monitor at home and I check my numbers regularly. I have an appointment with a blood pressure specialist in April, since I've had a gut feeling that this med is causing my gut unease.

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