References
Prescribing considerations in the use of oral medication in Parkinson's disease
Abstract
The aim of this article is to consider and support the rationale for prescribing decisions throughout the Parkinson's disease trajectory. The authors will discuss the challenges of managing both motor and non-motor features of Parkinson's disease mindful of potential complications attributable to both progression and medications used. This will include motor fluctuations and impulse control behaviours, which can adversely affect quality of life. The Parkinson's specialist will need to consider a treatment regimen that optimises symptom control while limiting the potential adverse effects of medications. This article will provide an overview of oral medications used throughout the recognised stages of Parkinson's disease.
Parkinson's disease (PD) is a progressive neurological condition resulting from loss of dopamine producing cells, and the main treatment approach is therefore dopamine replacement therapy. While there is currently no known cure for this condition, effective medication management can significantly reduce the symptoms of PD and consequently improve quality of life. At the time of diagnosis the presenting features often relate to motor symptoms, namely bradykinesia, rigidity and resting tremor, as outlined in the PD Society Brain Bank criteria (Hughes et al, 1992). There is now greater understanding about the numerous PD non-motor features categorised as autonomic, neuropsychiatric, sleep and sensory symptoms, which can fluctuate and also respond to dopamine replacement therapy (Chaudhuri and Fung, 2016). Treatment options, for both motor and non-motor symptoms (NMS, Figure 1), should be discussed at diagnosis and feature in newly diagnosed patient education programmes. There are recognised stages of PD and the treatment approaches will vary in each, but the aim should be to optimise medication for maximum symptom control, while minimising the potential for any adverse side effects. It is acknowledged that treatment of NMS should also be considered throughout the disease trajectory and there is a growing evidence base to support treatment options across the spectrum (Seppi et al, 2020).
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