Polypharmacy Guidance: appropriate prescribing, making medicines safe, effective and sustainable 2025 - 2028

Parkinson’s Disease

Antiparkinsonian medicines are essential medicines for treating the motor complications of Parkinson’s disease (PD). For most people with PD, medication is the only way to control their symptoms.

• Liaise with the PD specialist if changes to antiparkinsonian medication are needed.
• Medication should be taken at specific times to ensure that the control of symptoms is maintained without deterioration. Delay of medication can result in someone being unable to function independently at work or at home, and becoming reliant on others for simple everyday activities such as walking and eating
• Individuals should be asked about non-motor symptoms which might be impacting on their quality of life.

Dementia

Dementia is a progressive neurological condition that is currently irreversible.

This hot topic considers the appropriateness of therapy (acetylcholinesterase inhibitors and memantine) to manage dementia.

• A thorough clinical assessment including delirium screening should be completed if there is increasing confusion, hallucinations, stress and distress behaviours.
• Review and consider environmental, social, physical and medication changes and other stressors such as acute intercurrent illness, pain, constipation. Include a review of all medicines with anticholinergic effects. Any changes or causes should be managed prior to initiating medication.

• Review medication after initiation, considering perceived benefit/stability and severity of side effects, including bradycardia or gastrointestinal side effects
• Be aware that stopping established treatment may lead to loss of cognition or function which may not be regained if the medication is restarted. Carefully consider the risks and benefits of de-prescribing