Medications and Hospital Stays

In the hospital, 3 out of 4 people with Parkinson's don't get their medications on time. Hospital stays for people with PD require special consideration, especially when it comes to medication. Before your hospital visit, make sure you have a complete, updated list of your medications, dosages, and the times of day that you take them. Write down the exact times of day medications are to be administered so that doses are given on the same schedule you follow at home.

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Keeping an accurate, up-to-date list decreases the likelihood of an unwanted medication interaction. Studies have found that one in three people with PD have been prescribed contraindicated drugs while they were hospitalized, which highlights the importance of always having an up-to-date list of medications available.

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Be sure your hospital care team understands that all Parkinson's medications must be given on time. You and your care partners should strongly advocate on your behalf for this important point. To avoid serious side effects, Parkinson's patients need their medication on time, every time - do not skip or postpone doses.

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Do not substitute Parkinson's medications or stop levodopa therapy abruptly. Doing so may cause a life-threatening condition called neuroleptic malignant syndrome (NMS).

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While you are hospitalized, the nursing staff must control your medications. This is a safety issue and is standard hospital policy. in some cases, your medications may not be stocked in the hospital pharmacy. In such situations, your hospital physician might want to prescribe substitute medications. If possible, do not agree to any changes made without a consultation with your primary Parkinson's neurologist or movement disorder specialist.

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It is ideal that you continue to take your prescribed medications, but for the hospital to allow this they need to be in their original bottles, and they cannot be expired. You can expect to give them to the nursing staff, who will then dispense your medications -without need for substitutions while you are hospitalized. If you are enrolled in an experimental drug protocol, it is even more important that you follow this practice.

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Take your own medication to the hospital with you and discuss being able to administer it yourself to stay on schedule -especially if the hospital pharmacy doesn't have your specific medication. In some hospitals and outpatient surgical facilities, the doctor can write an order to allow patients to take their own medicines; however, the doses and times must be written in the chart and the pill ingestion must be supervised and documented.

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In addition to your list of medications, bring with you a list of your current symptoms. This will help your hospital care team recognize these symptoms, as they may not be familiar with such problems as dyskinesia, ON-OFF fluctuations, and freezing of gait. Be sure to let them know how your movement and abilities change during ON and OFF times. This also helps the hospital care team understand why it is so important for you to get your medication on time every time.

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Some medications can worsen motor symptoms of Parkinson's. These drugs, listed below, are often used to treat psychiatric problems such as hallucinations, confusion, or gastrointestinal problems such as nausea. It's important that your hospital team is aware that many common anti-hallucination medications must be avoided in people with Parkinson's, since they might otherwise prescribe these medications. It is common that the stress of your illness, hospital stay, or new medications causes hallucinations or delirium while you are hospitalized. New onset delusions, paranoia, and agitation signal to the medical team that a longer hospital stay or skilled nursing is required before going home.

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Resume medications immediately following procedures unless vomiting or severely incapacitated. Be alert for symptoms of dysphagia (trouble swallowing) and risk of pneumonia. Consulting with a Speech Language Pathologist is recommended. Ambulate as soon as medically safe. Patients may require assistance. Consulting with a Physical Therapist is also recommended.

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Medications That May Be Contraindicated in Parkinson's Disease

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You can download this chart to make sure you have it available and printed out for hospital stays at the below link:

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Anti-Hallucination Medications

The anti-hallucination medications quetiapine (Seroquel), clozapine (Clozaril), and pimavanserin (Nuplazid) can be used with Parkinson's. Of these, Nuplazid is the only anti-hallucination medication approved for Parkinson's. Avoid the following anti-hallucination medications:

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• Aripiprazole (Abilify)

• Chlorpromazine (Thorazine)

• Fluefenazine (Prolixin)

• Haloperidol (Haldol)

• Molindone (Moban)

• Perphenazine (Trilafon)

• Perphenazine and amitriptyline (Triavil)

• Riperidone (Risperdol)

• Thioridazine (Mellaril)

• Thiothixene (Navane)

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Anti-Nausea Medications

Serotonin (5-HT3) antagonists work to block the effects of serotonin in order to reduce nausea and vomiting and do not worsen symptoms of Parkinson's. Ondansetron (Zofran), dolaseton (Anzemet), and granisetron (Granisol) are acceptable alternatives to the list below. Older and cheaper anti-nausea medications block dopamine, therefore worsening Parkinson's symptoms. The following should be avoided:

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• Metoclopramide (Reglan)

• Phenothiazine (Compazine)

• Promethazine (Phenergan)

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Rasagiline (Azilect) or Selegiline (Eldepryl)

If you are currently taking Rasagiline (Azilect) or Selegiline (Eldepryl) you should avoid the following medications:

• Pain Medications: Meperidine (Demerol, tramadol [Ultram] and methadone)

• Antispasmodic medication (Flexeril)

• Dextromethorphan (cold medication) and ciprofloxacin (antibiotic)

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