Alty Jane, Robson Jeremy, Duggan-Carter Philippa, Jamieson Stuart
Department of Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK University of Leeds Hull York Medical School, University of York.
Department of Pharmacy, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK.
Pract Neurol. 2016 Apr;16(2):122-8. doi: 10.1136/practneurol-2015-001267. Epub 2015 Dec 30.
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.
