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.
Where a patient does not have an individual supply of their PD medication, access supplies via the pharmacy or the local main holding areas of PD medications across NHSGGC. A full list of the PD medicines available in holding areas across NHSGGC sites is available on StaffNet, Clinical guideline electronic resource directory, search in the 'central nervous section' for "NHSGGC Parkinson's disease PD medication stock list across acute hospitals". It is important for PD medications to be administered at exact times. This should be clearly annotated on the prescription chart.
|Gartnavel General Hospital||Emergency drug cupboard|
|Glasgow Royal Infirmary||Ward 39|
|Inverclyde Royal Hospital||Larkfield Unit ward 2|
|Queen Elizabeth University Hospital||Ward 55 (Langlands) and emergency drug cupboard (based in ARU)|
|Royal Alexandra Hospital||Ward 5|
|Victoria Infirmary||NVH wards 1 and 2|
|Vale of Leven||Ward 14|
|Mental health sites||Contact pharmacy or on-call pharmacist for a supply (see Appendix 6 for contact details)|
If PD medicine is not available as above, contact pharmacy or on-call pharmacist (out of hours) for a supply.
Inform PD nurse specialist of all PD patient admissions (see Appendix 6 for contact details)
Refer to PD specialist (see Appendix 6 for contact details). If PD specialist is not available please refer to the 'Nil by mouth medicines for Parkinson's disease in the acute setting' guidance on StaffNet, Clinical Guideline Electronic Resource Directory, and search in the 'Central nervous system' section.
Advice can also be sought from a clinical pharmacist, Medicines Information (see Appendix 6 for contact details) or on-call pharmacist (out of hours) regarding alternative formulations.
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.