These are specific questions that cannot be answered with individual advice. The treating doctor bears medical responsibility for the treatment, and any discussion of different treatments must take place with them.
Dose gaps can manifest in many different ways, with worry and anxiety being common symptoms; if these are linked to a dopamine deficiency and dose gaps, they should improve and become less distressing if the dose gaps are addressed in some way. Anxiety can manifest as ‘nausea’, but this can be difficult to interpret, as there should be some form of general discomfort during the dose gap. Dose gaps can manifest in many ways – motor symptoms such as tremors, stiffness and slow movements, but also non-motor symptoms, with restlessness, anxiety or indecisiveness being key symptoms. It is important to be aware that these dose gaps often occur in different stages – first motor symptoms and later non-motor symptoms, or vice versa, and not always both types.
There are many different mechanisms and contributing factors to nausea – apart from anxiety. If it is genuine gastrointestinal discomfort, the adjunctive medication in Madopark/Sinemet may be a contributing factor. The active ingredient in Madopark is benserazide and in Sinemet it is carbidopa, and they have different effects on the gastrointestinal tract. It may be worth switching from one medication to the other for a period to assess whether there is a difference – the switch can usually be made straight away and should be for a couple of weeks to allow for evaluation.
/Håkan Widner