Symptom | Therapy | NICE guidelines5 | MDS EBM review27 | Comments |
---|---|---|---|---|
Depression | Pramipexole Consider antidepressant | n/a | + | Optimise dopaminergic therapy SSRIs and venlafaxine effective |
CBT | ||||
Dementia | Cholinesterase inhibitor eg rivastigmine | + | + | May worsen tremor, GI/bladder AEs |
Psychosis | Quetiapine | + | + | Usually first line |
Clozapine | + | + | Requires FBC monitoring | |
Postural hypotension | Midodrine Fludrocortisone | + | +/– | Reduce anti-hypertensives and other potential exacerbating drugs |
Constipation | Macrogol Lubiprostone Probiotics and prebiotic fibre | n/a | +/– +/– + | Ensure good hydration Constipation may impact on medication absorption |
Drooling | Glycopyrronium | + | + | Anticholinergics may cause cognitive AEs |
BoNT injection to salivary glands | + | + | ||
Nocturnal akinesia | Levodopa CR Rotigotine | + | + | |
REM sleep behaviour disorder | Clonazepam Melatonin | + | n/a |
+ = recommended by guidance; +/– = possibly useful or evidence insufficient; AE = adverse effect; BoNT = botulinum neurotoxin; CBT = cognitive-behavioural therapy; CR = controlled release; FBC = full blood count; GI = gastrointestinal; MDS = International Parkinson and Movement Disorder Society; n/a = no recommendation; NICE = National Institute for Health and Care Excellence; REM = rapid eye movement; SSRIs = selective serotonin reuptake inhibitors.