NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Prescribing
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4 Central nervous system

4.9 Drugs used in parkinsonism and related disorders

4.9.1 Dopaminergic drugs used in Parkinson’s disease

Preferred list
CO-BENELDOPA

Prescribing Notes:

This medicine commonly causes confusion and is best avoided (especially in the elderly).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3636.htm

CO-CARELDOPA (tablets, modified-release tablets)

Prescribing Notes:

The BNF notes that the total daily dose of the carbidopa proportion of these products should be at least 70mg.

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP3098-co-careldopa.htm#PHP47533-indicationsAndDose-topic

Total Formulary
PRAMIPEXOLE

Restrictions: The use in Parkinson’s disease is restricted to use on the advice of consultants with a special interest in Parkinson’s disease or movement disorders. The use of pramipexole in restless legs syndrome (RLS) is restricted to those patients with severe RLS (symptoms resulting in significant disruption to sleep and impairment of daily living.

Prescribing Notes:

Pramipexole dosing can be expressed as either base or salt and this should be clearly documented when prescribing.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/77550.htm

ROPINIROLE

Restrictions:

Restricted to use on the advice of consultants with a special interest in Parkinson’s disease or movement disorders. Use in restless legs syndrome is restricted to those patients with severe RLS symptoms resulting in significant disruption to sleep and impairment of daily living.

Prescribing Notes:

The preferred brand of modified-release ropinerole in NHSGGC is Ipinnia XL®

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/57171.htm

ROTIGOTINE (TRANSDERMAL PATCH)

Restrictions: Restricted to specialist initiation for patients where the transdermal route would facilitate treatment. Treatment for moderate to severe idiopathic Restless Leg Syndrome (RLS) in adults is restricted to patients with a baseline score of 15 points on the International Restless Legs Scale (IRLS) and who do not respond to or tolerate oral preparations.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129661.htm

SELEGILINE

Restrictions: Restricted to specialist initiation only.

Prescribing Notes:

The selegiline melt formulation remains non-formulary.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3652.htm

AMANTADINE

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3644.htm

APOMORPHINE

Restrictions: Restricted to specialist initiation. Apomorphine is restricted to use in patients with mid/late stage Parkinson’s disease under consultant supervision only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/10071.htm

CO-CARELDOPA (intestinal gel)

Restrictions: Restricted to specialist use only for the treatment of advanced levodopa-responsive Parkinson's disease with severe motor fluctuations and hyper-/dyskinesia when available combinations of Parkinson medicinal products have not given satisfactory results.

CO-CARELDOPA WITH ENTACAPONE (tablets)

Prescribing Notes:

The current preferred brand of carbidopa with entacapone and levodopa is Stanek®

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/128294.htm#_128294

4.9.2 Antimuscarinic drugs used in parkinsonism

Total Formulary
PROCYCLIDINE HYDROCHLORIDE

Restrictions: Restricted to specialist initiation

4.9.3 Drugs used in essential tremor, chorea, tics, and related disorders

Total Formulary
PRIMIDONE

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3592.htm

RILUZOLE

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/40688.htm

SULPIRIDE

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3250.htm

TETRABENAZINE

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3677.htm

BOTULINUM TOXIN A

Restrictions: Restricted to specialist use only. It remains non-formulary for the indications detailed in the prescribing notes below.

Prescribing Notes:

Three brands available (Dysport®, Xeomin® and Botox®). The doses are specific to the preparations and they are not interchangeable. Prescribe by brand name.

For uses in urology, see the entry in section 7.4.2 and for use in migraine see section 4.7.4.2

 

The following indications are not recommended for use in NHS Scotland by the SMC and remain non-Formulary:

  • Treatment of focal lower limb spascticity associated with stroke 
  • For cosmetic reasons (e.g. temporary improvement in the appearance of moderate to severe vertical lines between the eyebrows seen at frown)

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3680.htm

BOTULINUM TOXIN B

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/106097.htm

CHLORPROMAZINE

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3211.htm#_3211

HALOPERIDOL

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3224.htm

PIMOZIDE

Restrictions: Restricted to specialist initiation only.