When travelling (long-haul) across time zones, you generally carry on as normal, i.e. you aim to stick to your usual day/night routine, but the length of the day is extended or shortened depending on the direction of travel. It is the intervals between daily doses that you maintain, adding or subtracting one or more doses as required.
For example, if you’re taking a long-acting agonist, an MAO-B inhibitor and L-dopa in the morning, with L-dopa at approximately 3-hour intervals until the evening/night, you should add further doses during the day extended by the time zone change if travelling westwards, and ‘make up for’ by taking fewer doses when travelling eastwards, as the day becomes shorter.
It is mainly the L-dopa doses that increase – long-acting MAO-I inhibitors (Azilect/rasagiline/Xadago/safinmamide) and dopamine agonists (ropinirole depot/ReQuip Depot/pramipexole depot/Sifrol Depot/ NeuPro patch) – there is no need to change the number of doses or make any other adjustments. The next dose is taken the following morning, for example. The patch is left in place for the extra hours.
If you are taking short-acting dopamine agonists, such as Sifrol 0.18/0.35 mg (non-depot) or ReQuip 0.5–2 mg – non-depot) – on a very long journey with a day extended by around 6–9 hours, an additional dose may be necessary. Similarly, it is the dosing intervals that are of interest – when travelling westwards, an extra dose may be required, which is then offset by taking one dose less on the return journey.
Try to keep track of what constitutes day and night, and extend or shorten the daytime hours if possible. It’s a bit more difficult to adjust to a longer or shorter night, but in principle the same approach to medication applies as ‘usual’.
It’s also important to maintain fluid balance during flights, as you lose fluids due to the dry air. Most airlines are good at serving drinks, and you should make the most of this.
Once you arrive at your destination, it is best to try to adapt to the local daily rhythm – and take your medication as usual, i.e. morning doses in the morning and stick to the usual intervals for subsequent doses. The usual medication schedule applies both before and after the trip.
When it comes to jet lag, there isn’t much you can do – some people may find it helpful to take melatonin temporarily to help them fall asleep, but it doesn’t work for everyone.
If you usually take medication to regulate your sleep pattern (the most common drugs are Mianserin or Mirtazapine), you can continue taking them. If you have previously taken Zopiclone or Zolpidem to help you fall asleep, you can continue taking them; however, if you have never taken these medicines before, it is not advisable to try them whilst travelling.
The temperature and humidity at the destination are often completely different.
It’s important to be mindful of your fluid balance. You usually need much larger volumes than you might imagine. If your destination is warmer than home, most people benefit from taking ‘fluid replacement solutions’ such as ReSorb (electrolytes and glucose in appropriate amounts), with 1 glass of ReSorb with meals (x 3 = 450 mL) in addition to what you would normally drink (at least 1½ L per day). This helps prevent much of the tiredness, mild nausea and headaches that dehydration can cause. Rule of thumb: if you feel thirsty, you need to replenish at least 1 L; if you feel thirsty first and then get a headache, you need at least 1½–2 L to compensate for the losses.
/Håkan Widner
Have a lovely trip!
E.g. Usual dosage 7 am 10 am 1 pm 4 pm 7 pm 9 pm Night-time medication
Xadago 50 mg 1
Pramipexole 1.05 mg 1
Stalevo 100 mg 1 1 1 1 1 1
Mianserin 10 mg ½
More doses on the ‘day of travel’
E.g. Travelling west 7 10 13 16 time time 19 21 Night-time medication
Xadago 50 mg 1
Pramipexole 1.05 mg 1
Stalevo 100 mg 1 1 1 1 1 1 1 1
Mianserin 10 mg ½
Fewer doses on the ‘day of travel’
E.g. Travelling east 7 10 13 time time Night-time medication
Xadago 50 mg 1
Pramipexole 1.05 mg 1
Stalevo 100 mg 1 1 1 1 1
Mianserin 10 mg ½