Pharmacotherapeutic Management of Parkinson Disease in a Hospital

Parkinson disease (PD) is 1 of the fastest growing neurological disorders in the world. The number of patients with PD doubled to over 6 million, from 1990 to 2015. Due to aging, this number is estimated to be more than 12 million by 2040.¹

Studies have shown that patients with PD admitted to the hospital experience longer hospital stays and increased mortality than age matched control groups. One risk factor resulting in deterioration during hospital admission is the incorrect timing of levodopa administration,¹ which is defined as administering levodopa more than 60 minutes before or after the scheduled administration time or failure to administer an ordered dose.²

Another risk factor was incorrect prescription administration of antidopaminergic drugs.¹ Most antidopaminergic drugs are antipsychotics used to treat delirium, such as haloperidol, olanzapine, risperidone, and aripiprazole.³

These findings show that involving hospital pharmacists in the decision-making process of PD patient’s medication management has room for improvement.

A national Spanish study was conducted using surveys to analyze hospital pharmacists’ perspectives on identifying key issues in the pharmacy management of inpatients with PD. The information collected included medication compliance, reconciliation, protocols, contraindicated medications, and areas for improvement.¹

Results from the survey identified weaknesses such as pharmacy services closing at certain times, low variety of antiparkinsonian drugs, delay in antiparkinsonian drug administration, and lack of flexibility in administration times. Within the survey, participants highly ranked 2 improvement needs: designing specific protocols for patients with PD; and implementing concrete actions to optimize PD pharmacotherapy.¹

The participants detected improvement opportunities and proposed recommendations to enhance the safety of patients with PD. Protocols for antiparkinsonian drug interchange, administration timing and nothing by mouth (NPO) status, medication reconciliation, and handling nausea/vomiting or psychotic symptoms were the main improvement areas.¹

This study shows that hospital pharmacists should be actively involved in the management of PD patients to decrease longer hospital stays and mortality.

Raquel S. Mateus is a 2021 PharmD Candidate at the University of Connecticut in Storrs.

REFERENCES

• Lertxundi Etxebarria U, Palacios-Zabalza I, Ibarrondo I, Domingo-Echaburu S, Hernandez R, Isla A, Solinis M. Pharmacotherapeutic management of Parkinson's disease inpatients: how about asking hospital pharmacists? Eur J Hosp Pharm. 2020 Dec 22:ejhpharm-2020-002461. doi: 10.1136/ejhpharm-2020-002461. Epub ahead of print.
• Martinez-Ramirez D, Giugni JC, Little CS, Chapman JP, Ahmed B, Monari E, Wagle Shukla A, Hess CW, Okun MS. Missing dosages and neuroleptic usage may prolong length of stay in hospitalized Parkinson's disease patients. PLoS One. 2015 Apr 17;10(4):e0124356. doi: 10.1371/journal.pone.0124356.
• Ebersbach G, Ip CW, Klebe S, Koschel J, Lorenzl S, Schrader C, Winkler C, Franke C. Management of delirium in Parkinson's disease. J Neural Transm (Vienna). 2019 Jul;126(7):905-912. doi: 10.1007/s00702-019-01980-7.