This guidance highlights the importance of continuing Parkinson's disease (PD) medication and covers the first-line management of PD patients who have:
It is crucial not to stop PD drugs for any significant length of time i.e. >2 hours or to miss any doses as there is a risk of Neuroleptic Malignant-Like Syndrome (Parkinson hyperpyrexia syndrome, PHS) which may be fatal. Symptoms include rigidity, pyrexia, and reduced conscious level. There may be features of autonomic instability, and serum creatine kinase (CK) may be elevated. Complications of PHS include acute renal failure, aspiration pneumonia, deep venous thrombosis / pulmonary embolism and disseminated intravascular coagulation.
It is important for PD medications to be administered at exact times. Annotate dose timings clearly on the prescription chart. It is recommended that levodopa should be taken within 30 minutes of its prescribed administration time (NICE guidance - Parkinson's disease 2018 [QS164]).
If the patient does not have an individual supply of their PD medication, access supplies via pharmacy or the local main holding areas of PD medications across NHSGGC. See the Parkinson's Disease Medication Stocklist, Acute Hospitals guideline for details.
If PD medicine is not available as above, contact pharmacy (see Appendix 6 for contact details) during working hours, or the on-call pharmacist outwith working hours, for supply.
Inform PD nurse specialist of all PD patient admissions.
During working hours contact the PD specialist immediately, and a speech and language therapist if the patient has swallowing difficulties.
Outwith working hours, or if a PD specialist is not available, refer to the NBM algorithm. Additional information is provided in:
Note: Exercise clinical judgement on the applicability of this guidance to individual PD patients depending on their characteristics. Both risk and benefit should be considered, seek advice from senior if unsure.
Guideline reviewed: July 2022
Page updated: September 2022