Emergency management of patients of parkinson's (pdf, 99kb)
Make sure they have enough
Only adjust prescribed medication
patient/carers where possible – dosages are individualised to each
person and may not coincide with drug round timings.
Temperature and respiratory rate.
Write up first dose as stat.
Blood pressure lying and standing.
If the patient/carers have brought
Mental test score (eg AMT, MMSE).
usual routine (including self-administration where able).
Consider placing tablets one
Therefore, put patients with Parkinson’s
Consider dispersible or liquid
continuation of usual medication routines)
AVOID metoclopramide (Maxalon)
Note cyclizine and ondansetron can
Consider posture for effective swallow
Check for history of cognitive
Check for underlying cause (eg
AVOID haloperidol (Serenace/Haldol)
Alert to Parkinson’s specialist
See page 12 for guide for estimating
– if necessary, consider a benzodiazepine.
oral dose, consider:
Administration via NG/NJ/PEG tube•
Assess for any contraindications.•
Insert as per local protocol.•
See page 8 for Preparing Parkinson’s
dispersible preparation4 – monitor as dose frequency may need
proprietary use of each medication.
For medication given in liquid form,
Return to usual medication routine
(and routes of administration) as soon as clinically possible.
Use Eldepryl (as also available in liquid
systems – can usually be safely omitted temporarily.
feeding systems. Therefore, consider rotigotine patches as
Use liquid (generic) version.
Use liquid (generic or Arpicolin) version.
Guide for estimating equivalent levodopa
1. Calculate Adjusted Levodopa Equivalent Daily Dose (LEDD):
(the above figures refer to each medication’s
NB (A) or (B) = 0 if not taking that type
2. Calculate dosage for rotigotine patch
This is a dopamine agonist
analgesic and is not a controlled drug.
Patients who are established on an
if increased stiffness/slowness
if increased confusion/
For further support, call the APO–
If adjusted LEDD >350mg, use
rotigotine 16mg and consult with specialist regarding administration of apomorphine.
For further support, contact the
This is co-careldopa (levodopa and
Patients who are established on
continued at the prescribed rate (providing gastric emptying is not
Delirium (acute confusion due
Chest infection, especially
Urinary tract infections.
This involves stimulation of target
or the subthalamic nucleus) through electrodes connected to a
Neuroleptic-like malignant syndrome.
neurostimulator placed under the skin around the chest or stomach area.
Patients who are established on
DBS need to be maintained on the same routine.
Dr J George, Dr S Manickam, Judith Graham (PDNS) (2007) Emergency assessment of
patients with Parkinson’s
. North Cumbria Acute Trust
Baxter K (2010) Stockley's Drug Interactions: A source book of interactions, their mechanisms, clinical importance and management
Pharmaceutical Press; 9th edition
British National Formulary – BNF
Preoperative fasting for adults to prevent perioperative complications
. Cochrane Database Syst Rev 2009; 7; CD005285
Madopar CR. Summary of product characteristics 2009. http://www.
Brennan, KA, Genever, RW, Managing Parkinson’s disease in surgery. BMJ
2010; 341: c5718
MacMahon, M.J MacMahon, DG Management of Parkinson’s Disease in the acute hospital environment. J R Coll Physicians, Edinb,
2012; 42: 157-62
We’re the Parkinson’s support and research charity. Help us find a cure and improve life for everyone affected by Parkinson’s.
the content of the material we produce.
Parkinson’s UK, November 2013 (RD1249) 2013. Parkinson’s
UK is the operating name of the Parkinson’s Disease Society of the
United Kingdom. A charity registered in England and Wales (258197)
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