4.9 Drugs used in parkinsonism and related disorders

General Notes

  • Refer to NICE NG71 Parkinson’s disease in adults and BMJ visual summary
  • Refer to COMPASS therapeutic notes on the management of Parkinson’s disease
  • Refer to Parkinson’s UK for patient information and support
  • Specialist advice should precede initiation and adjustment of drug therapy
  • Could this be drug-induced parkinsonism? Most common causative agents are antipsychotics (typical e.g. haloperidol more likely than atypical to cause parkinsonism) and anti-emetics (prochlorperazine, metoclopramide, cyclizine)
  • Tailor treatment to optimise patients’ functional goals
  • It is not possible to identify a universal first choice drug therapy for either early Parkinson’s Disease (PD) or for adjuvant drug therapy for later PD
  • Levodopa, non-ergot derived dopamine agonists, or monoamine-oxididase-B inhibitors can be prescribed for initial treatment in early PD. Therapy with two or more anti-parkinsonian drugs may be necessary as the disease progresses
  • Patients with PD should be supported to get their medication ‘on time’, and this is particularly relevant in situations where they are not self-medicating (e.g. hospital admission).See Parkinson’s UK ‘Get It On Time’ campaign for further details and resources
  • Dopamine replacement therapy should not be stopped suddenly, e.g. on admission to hospital. These medications are not optional and are essential for the patients’ wellbeing
  • Dopamine agonists, and less commonly levodopa, may cause impulse control disorders (pathological gambling/shopping, hypersexuality). Patients and carers should be advised in advance of these potential adverse effects (see MHRA and Parkinson’s UK patient information leaflet )
  • Patients who drive must inform the DVA

Cautions

  • Patients who have suffered excessive sedation or sudden onset of sleep with dopaminergic drugs (levodopa and dopamine agonists) should refrain from driving or operating machines until those effects have stopped recurring. In some individuals, these drugs may cause wakefulness and should be avoided in the evening