title: What to do when people with Parkinson's disease cannot take their usual oral medications.
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.
authors.affiliation: Department of Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK University of Leeds Hull York Medical School, University of York.
authors.forename: Jane
authors.initials: J
authors.lastname: Alty
authors.affiliation: Department of Pharmacy, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Robson
authors.affiliation: Department of Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK.
authors.forename: Philippa
authors.initials: P
authors.lastname: Duggan-Carter
authors.affiliation: Department of Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK University of Leeds Hull York Medical School, University of York.
authors.forename: Stuart
authors.initials: S
authors.lastname: Jamieson
mesh_terms: D000978:Antiparkinson Agents / Q000008:administration & dosage*; D004304:Dosage Forms; D004333:Drug Administration Routes; D006801:Humans; D010300:Parkinson Disease / Q000188:drug therapy*
chemical_list: D000978:Antiparkinson Agents; D004304:Dosage Forms
keywords: DYSPHAGIA; MOVEMENT DISORDERS; NEUROPHARMACOLOGY; PARKINSON-S DISEASE; PHARMACOLOGY