Parkinson’s disease is one of the fastest-growing neurological conditions in the world, according to WHO, and people with Parkinson’s are admitted to hospital more often than people of the same age without it. In hospital, one problem stands out: Parkinson’s medicines given late or missed. Even short delays can cause patients to stiffen, become unable to move, swallow or speak, fall, or develop complications. Patient charities have campaigned for years under the banner “Get It On Time.”
Why timing matters
Parkinson’s results from loss of dopamine-producing brain cells. Medicines such as levodopa (co-careldopa, co-beneldopa) replace dopamine but wear off quickly. Many patients have individualised schedules, sometimes five or more doses a day at precise times, that keep symptoms controlled. Ward drug rounds at fixed times often don’t match these schedules.
What happens when doses are missed
- Increased stiffness, tremor and slowness; inability to get out of bed.
- Falls.
- Swallowing difficulty, which increases the risk of aspiration and makes taking further doses harder.
- Confusion, agitation, hallucinations.
- Longer hospital stays.
- Parkinsonism-hyperpyrexia syndrome (similar to neuroleptic malignant syndrome): a rare but life-threatening reaction to sudden withdrawal, with fever, rigidity, confusion and instability.
How nurses can get it right
- Identify patients with Parkinson’s at admission and flag them.
- Get the exact home regimen: drug, dose, formulation (immediate or modified release) and times. Patients and carers are the experts.
- Give doses at the patient’s usual times, ideally within 30 minutes. Use alarms or timers if needed.
- Support self-administration when the patient is able and policy allows.
- Check stock: many wards don’t stock Parkinson’s medicines. Ask the patient to bring their own and know where emergency supplies are.
- Don’t substitute brands or formulations without pharmacist advice.
Nil by mouth? Don’t just stop
If a patient is nil by mouth for surgery or can’t swallow, urgent alternatives are needed: dispersible levodopa via a nasogastric tube, or a rotigotine skin patch as a temporary substitute, as advised by a pharmacist or specialist. Patients having surgery should be scheduled early on the list and take their medicine as close as possible to the procedure, per anaesthetic advice.
Medicines to avoid
Some commonly used medicines block dopamine and can severely worsen Parkinson’s:
- Antiemetics: metoclopramide and prochlorperazine. Safer alternatives such as domperidone (with cautions) or ondansetron may be used, per pharmacist advice.
- Typical antipsychotics such as haloperidol. If antipsychotics are needed for severe agitation or psychosis, specialists may consider quetiapine or clozapine.
Other nursing priorities
- Swallow assessment and safe eating. See dysphagia screening.
- Falls prevention: postural hypotension, freezing, and “off” periods increase risk. See falls prevention.
- Constipation is very common.
- Delirium and hallucinations; look for infections and medication causes.
- Communication: soft voice and reduced facial expression don’t mean the person doesn’t understand or care. Give time.
- Involve the patient’s Parkinson’s nurse specialist where available.
Based on NICE NG71 (Parkinson’s disease in adults), Parkinson’s UK “Get It On Time” guidance and WHO’s technical brief on Parkinson’s disease. Educational content: follow local policies and pharmacist advice.