Makindo Medical Notes

Missed doses of PD meds can impair patients’ swallow, increase their risk of aspiration, render them immobile and prone to falls and fractures, and – at worst – lead to Neuroleptic Malignant-Like Syndrome, which can lead to coma and death

There are several dose conversion calculators here pdmedcalc.co.uk and parkinsonscalculator.com

About: Always check the BNF link here

• Check BNF or equivalent for UpToDate prescribing advice
• Rotigotine is a dopamine agonist delivered transdermally by a continuous 24-hour patch
• Useful when patients with Parkinson disease cannot use the enteral route

Mode of action

• Dopamine agonists

Costs

• Neupro 8mg patch £150 (28 days)

Indication/Dose

• If unable to tolerate meds PO/NG/ NJ/PEG tube
• Start dose is 2 mg/day.
• The maximum dose is 16mg/24hrs.
• The patch must never be cut.
• 2 patches can be used simultaneously

Dose range:You must check with BNF or drug datasheet

Interactions

• See BNF

Cautions

• When using doses > 8mg/24hrs, it is advised that the initial dose is 2mg lower than suggested in the tables, and review the next day.
• If the patient is stiff or drowsy increase dose by 2mg.

Contraindications

• See BNF

Side effects

• Dopamine agonists may cause compulsive/addictive behaviours such as gambling, compulsive shopping and hypersexuality. Patients rarely recognise such changes as side effects and rarely report them unless specifically asked.
• Nausea and vomiting: Unless very minor, prescribe Domperidone 10mg tds
• Sedation: often transient
• Confusion/hallucinations develop

References