4.9.1. Dopaminergic drugs used in Parkinson’s disease
Prescribing Notes:
This medicine commonly causes confusion and is best avoided (especially in the elderly).
Prescribing Notes:
The BNF notes that the total daily dose of the carbidopa proportion of these products should be at least 70mg.
Restrictions:
Restricted to specialist initiation. Apomorphine is restricted to use in patients with mid/late stage Parkinson’s disease under consultant supervision only.
Restrictions:
The Commission on Human Medicines (CHM) has advised that bromocriptine and cabergoline have been associated with pulmonary, retroperitoneal and pericardial fibrotic reactions. Refer to BNF for details.
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.
Restrictions:
Restricted to specialist use only in patients not eligible for deep brain stimulation
Prescribing Notes:
For the treatment of advanced levodopa-responsive Parkinson’s disease with severe motor fluctuations and hyperkinesia or dyskinesia when available combinations of Parkinson medicinal products have not given satisfactory results.
To be used in preference to Duodopa.
Prescribing Notes:
The current preferred brand of carbidopa with entacapone and levodopa is Stanek®
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.
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 ropinirole in NHSGGC is Ipinnia XL®
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.