When a patient with Parkinson's disease is admitted, keep their levodopa and dopamine-agonist schedule running on time, including nil-by-mouth and perioperative periods, using enteral or alternative routes rather than omitting doses. Abrupt withdrawal, or long gaps because doses are 'held', can precipitate a parkinonism-hyperpyrexia syndrome resembling neuroleptic malignant syndrome, with rigidity, fever and autonomic instability.
Avoid dopamine-blocking antiemetics such as metoclopramide and prochlorperazine, which worsen parkinsonism; use domperidone or ondansetron instead. Reconcile the exact home timings on admission, because standard drug rounds rarely match a Parkinson's regimen.
- Give levodopa and dopamine agonists on the patient's own schedule, including when nil by mouth.
- Abrupt withdrawal can cause a parkinsonism-hyperpyrexia syndrome like neuroleptic malignant syndrome.
- Avoid metoclopramide and prochlorperazine; prefer domperidone or ondansetron for nausea.
- Reconcile exact home dose timings on admission; standard drug rounds rarely fit.
Why it matters
A missed or delayed Parkinson's regimen is a common, preventable cause of avoidable deterioration and crisis in hospital.
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