Missing or delaying levodopa doses around surgery can bring on severe rigidity, swallowing difficulty and immobility within hours, and rarely a life-threatening reaction resembling neuroleptic malignant syndrome. Fasting orders and ward drug rounds are the usual causes.
Patients with Parkinson disease should take their usual doses on the morning of surgery with sips of water, and receive them on time afterwards. When a patient cannot swallow, the neurology or pharmacy team can advise on an alternative route. Avoid dopamine-blocking antiemetics such as metoclopramide and prochlorperazine.
- Write the exact times of Parkinson medicines on the drug chart, not 'three times a day'.
- Give the morning dose on the day of surgery with a sip of water.
- Avoid metoclopramide, prochlorperazine and haloperidol; ask pharmacy for a safer antiemetic.
- Call neurology or pharmacy early if the patient cannot swallow after surgery.
Why it matters
A missed dose can undo a good operation by stopping the patient from mobilising.
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