Tips for Better Management of Parkinson Disease (PD) | Pharmacy QI | Jan 2020

January 2020 | Practical Tips for Quality Improvement | View PDF

  • Resident-Centred Care
    When selecting therapy, consider the need to control motor symptoms and improve the resident’s quality of life without causing adverse effects.
  • Educate
    Educate residents and their families about the side effects of therapy and what to expect.
  • To treat or not to treat?
    The resident’s choice. If PD symptoms are very mild, the resident may choose not to begin therapy.
  • Manage Wearing Off
    • Increase levodopa daily dose and maintain dose interval.
    • Maintain levodopa dose and increase dose interval.
    • Add another antiparkinsonian medication to levodopa.
  • Manage Peak-Dose Dyskinesia
    • Reduce dose of carbidopa/levodopa while maintaining dose frequency.
    • Switch IR carbidopa/levodopa to extended-release capsule or intestinal gel.
    • Add amantadine.
  • Manage On & Off/Freezing
    • Switch IR* carbidopa/levodopa to extended-release capsule or intestinal gel.
    • Add other antiparkinsonian medication to levodopa.
    • Intermittent use of subcutaneous apomorphine.
Best Therapeutic Outcome

• Give levodopa on empty stomach.
• Reduce protein intake during the day for higher efficacy of therapy.

Dose omission is the most common medication error!

Avoid abrupt withdrawal of therapy, as it might lead to acute akinesia or neuroleptic malignant syndrome.

*IR: Instant Release


References:
Grimes D, Fitzpatrick M, Gordon J, et al. Canadian guideline for Parkinson disease. CMAJ 2019;191:E989-1004. Doi:10.1503/cmaj.181504.
Parkinson’s Foundation. Diagnosis. https://www.parkinson.org/Understanding-Parkinsons/Diagnosis. Accessed Nov. 29, 2019.
Pahwa R, Factor SA, Lyons KE, et al. Practice parameter: treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based
review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2006;66:983-95.

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