Warning

Specialist assessment should always precede initiation of drug therapy, to exclude alternative diagnoses and to plan an optimal treatment programme. Lifelong specialist follow-up is also extremely important, particularly in advanced disease when dosage schedules are often very complex.

It is not possible to identify a universal first choice drug therapy for either early Parkinson’s Disease (PD) or for adjuvant drug therapy for later PD. The optimal regimen depends on several factors such as age, cognitive state, nature and stage of disease. Medication regimens should only be adjusted after discussion with a specialist.

Drugs used in parkinsonism are particularly prone to give side-effects in older patients. Treatment should be initiated with low doses and be increased with caution.

Antiparkinsonian drug therapy should never be stopped abruptly as this carries a small risk of neuroleptic malignant syndrome. Patients should be supported to get their medication ‘on time’, and this is particularly relevant in situations where they are not self-medicating (e.g. hospital admission).

Useful links

NICE Clinical Knowledge Summaries - Parkinson's disease

NICE Guideline (NG71) - Parkinson’s Disease in Adults

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.