Q&A: Pharmacist’s Impact on Optimizing Complex Regimens in Parkinson Disease

Eduardo Martinez Sanchez, PharmD, CPh, BCPS, BCACP, an ambulatory care pharmacist at Baptist Health South Florida, discusses the gradual and often subtle onset of Parkinson disease, including both motor and nonmotor symptoms, and emphasizes that treatment must evolve as the disease progresses and remain highly individualized. He highlights the essential role of ambulatory care pharmacists in ensuring safe and effective medication use, optimizing complex regimens, supporting adherence, and helping manage comorbid conditions.

Key counseling points include strict medication timing, symptom tracking, healthy lifestyle habits, and caregiver involvement. Martinez Sanchez also describes Baptist Health South Florida’s advanced capabilities in Parkinson disease management and points to a promising pipeline of emerging therapies, encouraging patients to stay engaged with their care teams and remain hopeful as treatment options continue to expand.

Pharmacy Times: Please introduce yourself.

Eduardo Martinez Sanchez, PharmD, CPh, BCPS, BCACP: So first of all, thank you so much for inviting me to talk about a topic that I’m very passionate about. My name is Eduardo Martinez Sanchez, and I’m a board-certified ambulatory care pharmacist specialist working with the Baptist Health Specialty Pharmacy and Baptist Health Miami Neuroscience Institute.

Pharmacy Times: What are some early signs and symptoms of Parkinson disease, and how might progression influence treatment decisions over time?

Martinez Sanchez: Yes,…that’s a great question. Early signs of Parkinson disease often develop gradually, and they could be quite subtle. Common symptoms, or what we call main symptoms, of Parkinson disease include a resting tremor. They often start with one hand. Also, we have slow movement, which in medical terms we call bradykinesia, and then third, it will be muscle stiffness and mild to moderate changes in postural balance. I would say, though, that some patients…do tend to develop nonmovement or what we call nonmotor symptoms very early on in their disease, such as loss of smell, sleep disturbances, constipation, or mood changes [such as] depression. Unfortunately, as the disease develops, symptoms typically become more visible, and they may begin to affect both sides of the body.

And to answer the second part of your question, treatment decisions evolve over time based on symptom severity, impact on quality of life, [and] individual responses to medications. So, early [on] in the disease, providers may start with medications that help manage mild symptoms or delay more complications. And as symptoms advance, therapy often shifts completely to include a stronger combination of treatments, adjustments in dosing and frequency, management of [adverse] effects…that we call fluctuations or on-and-off periods or ambulatory movements. But overall, each [patient with Parkinson disease] will need to be tailored for the treatment.

Pharmacy Times: What role do pharmacists, particularly ambulatory care pharmacists, play in the management of Parkinson disease?

Martinez Sanchez: ….So pharmacists, especially ambulatory care pharmacists,…do play an important role in helping manage Parkinson disease over time. We work very closely with patients and the health care team to ensure medications are used safely and effectively, which is critical in a condition where timing, dosing, and adjustment can significantly impact symptom control. We can also provide education on how and when to take the medications; for example, coordinating the medications with meals, in particular certain doses; support[ing] adherence, and helping patients and caregivers understand what to expect as the disease develops. In addition, we can also support [patients] with symptom management. As I mentioned in [response to] the first question, a lot of these patients…have other comorbidities like sleep issues, mood changes, [and] constipation, so we can also recommend appropriate treatment for them. But at the end of the day, our main goal is to serve as an accessible resource for both the patients and the health care professionals throughout the course of the disease.

Pharmacy Times: How can pharmacists help optimize medication regimens for patients with complex treatment plans?

Martinez Sanchez: So this is very exciting, right? To have an ambulatory care pharmacist be part of the Parkinson disease management team is something that, you know, we at Baptist were very eager to start. But how can we…optimize [the] medication regimen? Well, we can start by performing comprehensive medication reconciliations with the patient and then make recommendations to simplify these complicated schedules. For example, when we take a look at the pharmacokinetics and pharmacodynamics parameters of each individual medication, and we align dosing with the meals and daily routines. All of this ultimately translates into better health outcomes for our patients. And in other ways, we can also optimize medication regimens for patients by completing polypharmacy reviews and helping managing transitions between these complicated therapies.

Pharmacy Times: What counseling points are most important to emphasize when working with patients who are newly diagnosed with Parkinson disease?

Martinez Sanchez: There are a lot of key points that I like to review with newly diagnosed patients, but if I would have to summarize, my top 5 counseling points [would] be, first, take your medication exactly as prescribed. Timing is essential for this medication, so make sure you follow your directions to the point. Second, know your medication, and that means what benefits to expect, and watch out for [adverse] effects to report. No. 3, track your symptoms, both motor and nonmotor, and communicate those changes very early on to your providers. No. 4, maintain regular exercise, nutrition, and a consistent daily routine. And No. 5, involve your family and caregivers in your health. I think if you follow these 5 key points, [you’re] definitely on the [right] track for managing your Parkinson disease.

Pharmacy Times: In the Parkinson space, is there anything that Baptist Health South Florida is doing or contributing that stands out compared with other institutions and health systems?

Martinez Sanchez: There’s a lot that I’d like to share on this…. So, in the Parkinson space,…Baptist Health South Florida truly stands out in several meaningful ways compared with other institutions.

Just to name quite a few, our neurology team here at MNI, which is the Miami Neuroscience Institute, has 5 fellowship-trained movement disorder specialists, which gives our program one of the largest concentrations of subspecialty-trained physicians in the region. These providers…all have access to the full spectrum of modern diagnostic tools in Parkinson disease, including DaTSPECT [dopamine transporter SPECT] imaging, MRI evaluation, [and] Syn-One skin biopsy testing, and this broad capability is uncommon and allows the providers to deliver highly precise evaluation. Also, multiple members of our team are active and participants in the Parkinson Study Group, which is the premier academic network for Parkinson clinical research.

We also offer the most advanced therapies available for this condition, including high-intensity focused ultrasound and deep brain stimulation. And we were also the first site in Florida, which we’re very excited to mention,…that initiated the new subcutaneous infusion pump therapy for Parkinson disease. And finally, of course, we have an outstanding team of people working at the Baptist Health Specialty Pharmacy to ensure the Parkinson patients that we serve have financial assistance support, timely home delivery of medications, monthly adherence calls, and multiple assessments for clinical progress,…drug monitoring, and longer treatment.

Pharmacy Times: Is anything new or innovative regarding clinical trials or treatments coming down the pipeline?

Martinez Sanchez: Absolutely. There are quite a few agents in the pipeline. Just to name a few, we have prasinezumab (Roche), which is an investigational anti–alpha-synuclein antibody for early-stage patients. There’s also a lot of ongoing research with precision gene therapy and cell replacement. And even, if you believe it, with GLP-1 agents; there is this agent called lixisenatide (Adlyxin; Sanofi-Aventis US LLC), which shows an impressive 40% reduction in motor decline compared [with] placebo. So this opens up the question to the other GLP-1 agents in the market, and their place in Parkinson disease.

Also,…to share an example of our very own providers, [Diego] Torres-Russotto, MD, recently served [on] an international research team that published the second-largest dopamine agonist trial in Parkinson disease in JAMA Neurology. And this investigational therapy called tavapadon (AbbVie), which is a selective D1/D5 agonist, is assigned to reduce some of the typical [adverse] effects associated with this drug class. So there [are] a lot of promising therapies that are coming our way.

Pharmacy Times: Any final or closing thoughts?

Martinez Sanchez: Well, more like a kind of a final statement that I wanted to give to the patients. I like to encourage the patients to feel hopeful, right? There are…many promising therapies in the treatment of Parkinson disease, and care continues to improve. So I want to emphasize also the importance of working closely with a movement disorder specialist and staying engaged with the health care team. The key thing to remember today is that each person’s journey with Parkinson is unique, so treatment should always be individualized, and that, of course, involving an ambulatory care pharmacist will help patients navigate their care with more confidence.