Parkinson's medications
Starting and stopping
- Impulse control disorder - not a reason to stop
- Repetitive reward-based behaviour e.g. gambling, sexual behaviour, binge eating
- Requires secondary care review ± CBT
- Stopping suddenly can cause Neuroleptic malignant syndrome
pitfalls
- If NBM, convert to rotigitine/transdermal or give through NG tube
- Giving with a small sip of water/yoghurt - benefit > risk
- Conversion: https://pdmedcalc.co.uk/
- Ask your pharmacist if in doubt
- interactions - dopamine antagonists including many antipsychotics and antiemetics
PD meds are time critical!
| L-dopa | Dopamine agonists (ropinirole, bromocriptine, amantadine) | |
|---|---|---|
| Mechanism of action: | direct replacement of dopamine | Ergot-derived: bromocriptine, cabergoline |
| Indication: | First-line | Amantadine: drug-induced dyskinesias |
| Adverse effects | N+V (domperidone can help), dyskinesias, dystonias, unpredictable ‘off’ effects | nausea, orthostatic ↓ BP, psychosis, disinhibition/impulse ctrl disorders, excessive sleep |
| Administration: | ➥ Co-prescribed with co-careldopa (Sinemet) ➥ Efficacy ↓ over time |
Available in parenteral form (patches) |
| MAO-B inhibitors (selegiline) | COMT inhibitors (entacapone) | |
|---|---|---|
| Mechanism of action: | ? | ↓ peripheral breakdown ⇒ ↑ central delivery |
| Indication: | Adjunct to L-dopa | Lessen ‘off’ time |
| Adverse effects | Postural ↓BP, AF, psychosis | ↓ liver function |
| Administration: | PO | SC injection |