Follow-Up of Advanced Parkinson’s Disease Patients after Clinical or Surgical Emergencies: A Practical Approach

Table 3

Basic recommendations for health care of physicians involved in the management of patients with advanced PD during evaluation of clinical and surgical emergencies.

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1: never stop the use of levodopa abruptly

2: change on levodopa regimen (dose and intervals of administration) should only be done in specific situations following recommendations of a specialist

3: avoid the infusion of levodopa along the administration of enteral diet

4: avoid the use of typical neuroleptics

5: when use of neuroleptics is unavoidable, clozapine and quetiapine are the safer options

6: avoid the use of drugs with potential antidopaminergic effect (neuroleptics and antiemetics)

7: if GI prokinetic drugs are necessary, give preference to domperidone

8: be vigilant for drug interactions in elderly patients with PD and different comorbidities

9: as a last resort, dispersible levodopa may be used, sublingually

10: subcutaneous apomorphine can be used as a rescue medication, when available

11: if medication regimen needs to be adjusted, preference should be given to less essential drugs, such as MAO B inhibitors, dopamine agonists, and amantadine, preferably under the guidance of a specialist

12: anticholinergics should be strongly avoided to be used in this group of patients

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