Managing Parkinson's Disease medication: advice for Community Pharmacists

Parkinson's Disease (PD) in the UK and the role of medication in treatment

In the UK approximately 1 in 37 people are diagnosed with Parkinson’s Disease (PD), which is caused by the loss of dopamine-containing cells in the substantia nigra (the part of your brain that helps control your movements). There is currently no cure for PD, so medication is an important part of a wider treatment plan.

Motor symptoms and treatment for PD

The three main motor symptoms (related to movement) of PD are stiffness, slowness of movement and tremor, although the condition is also associated with several significant non-motor symptoms too such as fatigue, constipation and low blood pressure.

Levodopa remains the gold standard treatment for people experiencing motor symptoms (NG71) but ensuring that medication is taken on time, every time, allows patients to control their symptoms and avoid 'off times'. ‘Off times’ occur when medication is no longer effective and can cause the patient’s symptoms to return which could include ‘freezing’. 

Guidelines for community pharmacists to support patients with PD medication management

PD is now included in the New Medicines Service, and it is important for Community Pharmacists to give appropriate advice to patients prescribed PD medicines for the first time and to follow this up with two further consultations. 

• Parkinson’s medicines are ‘Time Critical’ so ask GPs to put exact timings on prescriptions eg. 7.30am; 10am; 12.30pm; 3pm; 5.30pm; 8pm instead of ‘six times per day’. 
• Discuss timings with the patient so that any lifestyle issues are not compromised, and they can continue work or social activities. 
• Remind patients about taking medicine before food to increase absorption and make any minor adjustments to timings to help with this.  
• Advise patients about protein intake affecting absorption and to eat their high protein meal later in the day i.e. redistribute protein intake but do not reduce it.
• Ask patients if they need help to remind them of dosage timings (offer a monitored dose system or suggest an alarm or app). 
• Remind patients to discuss their over-the-counter medication with their pharmacist to prevent drug interactions. 
• Mention possible side effects eg. nausea (Levodopa can be taken after a low protein snack eg. cracker, biscuit, or toast if medication causes nausea) 
• Hospitalised patients should request self-medication to avoid missing doses. 
• Signpost patients to Parkinson’s UK’s website for access to information and resources about PD. 

Medication consultation and follow-up

At the intervention consultation, ask whether the patient has started the medication, if they think it is working and how they are feeling. Are there any side effects which can be easily resolved, or do they need a referral? Remember that the patient may need to be referred to their Specialist Parkinson’s Team (Consultant/Pharmacist/Nurse) if any changes are required (the GP should not initiate medication changes). 

At the follow-up appointment again check for compliance, side effects or other issues and remind the patient to request a repeat prescription so that there is no break in treatment. 

Professional development opportunities for Pharmacists in PD

Pharmacists who want to improve their knowledge of PD can access Parkinson’s Learning Pathway for Pharmacy Professionals which is free online on the Parkinson’s Excellence Network website. 

To join the award-winning Parkinson's Disease Specialist Pharmacy Network (PDSPN) with access to a network of over 350 colleagues with an interest in Parkinson's (specialist experience not required), and news of conferences and events, contact [email protected].

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