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What to do when people with Parkinson's disease cannot take their usual oral medications
  1. Jane Alty1,2,3,
  2. Jeremy Robson4,
  3. Philippa Duggan-Carter1,
  4. Stuart Jamieson1,2,3
  1. 1Department of Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
  2. 2University of Leeds
  3. 3Hull York Medical School, University of York
  4. 4Department of Pharmacy, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
  1. Correspondence to Dr Jane Alty, Consultant Neurologist, Department of Neurosciences, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, West Yorkshire LS1 3EX, UK; Jane.alty{at}nhs.net, jane.alty{at}hyms.ac.uk

Abstract

People with Parkinson's disease have limited brain reserves of endogenous dopamine; thus, their medications must not be omitted or delayed as this may lead to a significant drop in brain dopamine levels. This has two main clinical consequences: first, a deterioration in disease control, with distressing symptoms such as tremor, pain, rigidity, dysphagia and immobility, and second, an increased risk of developing the life-threatening complication of neuroleptic malignant-like syndrome. Common reasons for people with Parkinson's disease being unable to take their oral medications are neurogenic dysphagia from progressive disease or concurrent illness, gastroenteritis, iatrogenic ‘nil by mouth’ status especially perioperatively, and impaired consciousness level. Here we outline alternative methods to give dopaminergic drugs in the acute setting to people with Parkinson's disease who cannot take their usual oral treatment, namely using dispersible preparations in thickened fluids, an enteral tube, a transdermal patch or subcutaneous injections.

  • PARKINSON-S DISEASE
  • DYSPHAGIA
  • NEUROPHARMACOLOGY
  • MOVEMENT DISORDERS
  • PHARMACOLOGY

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  • Editors' commentary
    Phil Smith Geraint N Fuller