Rheumatology

Parkinson's Disease Specialist formulary list

**Other indications for particular drugs may be included on completion of further specialist lists**

For information on use of unlicensed medicines or medicines used 'off-label' - click here

The following specialist medicines are approved for prescribing by or on the recommendation of Neurology Consultants, Medicine for the Elderly Consultants or Parkinson’s disease specialists:

TAF SECTION	MEDICINE	SUMMARY OF RESTRICTED INDICATION	CATEGORY	PROTOCOL
4.2.1	Quetiapine	Behavioural and psychological symptoms of dementia (BPSD) (Psychosis, aggression, severe agitation/anxiety) in dementia with Lewy bodies (DLB) or dementia in patients with Parkinson’s disease [off-label] SEE GOOD PRACTICE GUIDES		Rationalisation of Antipsychotics in people with Dementia – Good Practice Guide for initiation of treatment Good Practice Guide for reduction and cessation of treatment SIGN 113 Diagnosis and pharmacological management of Parkinson’s disease (Jan 2010)
4.9.1	Ropinirole	First choice dopamine agonist either used alone or as adjunct to co-beneldopa or co-careldopa.		SIGN 113 Diagnosis and pharmacological management of Parkinson’s disease (Jan 2010)
	Pramipexole	First choice dopamine agonist either used alone or as adjunct to co-beneldopa or co-careldopa.
	Co-beneldopa (levodopa and benserazide)	First choice levodopa therapy in Parkinson’s disease.
	Co-careldopa (levodopa and carbidopa)	First choice levodopa therapy in Parkinson’s disease.
	Selegiline hydrochloride	Monoamine-oxidase-B inhibitor either used alone in early-stage Parkinson’s disease or as adjunct to co-beneldopa or co-careldopa in advanced Parkinson’s disease to reduce ‘end-of-dose’ deterioration.
	Rotigotine	Alternative dopamine agonist in patients with swallowing difficulties or poor compliance in early-stage idiopathic Parkinson's disease. In combination with levodopa as an alternative dopamine agonist when transdermal administration would facilitate treatment in advanced Parkinson's disease.
	Entacapone	Catechol-O-methyltransferase inhibitor as an adjunct to co-beneldopa or co-careldopa in advanced Parkinson’s disease to reduce ‘end-of-dose’ deterioration.
	Co-careldopa and entacapone (Stalevo^®)	For patients stabilised on co-careldopa and entacapone.
	Apomorphine	Management of disabling motor fluctuations despite optimal oral therapy in patients with Parkinson’s disease.		SIGN 113 Diagnosis and pharmacological management of Parkinson’s disease (Jan 2010) Shared care in development
	Domperidone	Nausea and vomiting due to dopaminergic drugs. Postural hypotension associated with dopamine receptor agonists (particularly apomorphine) [off-label].		SIGN 113 Diagnosis and pharmacological management of Parkinson’s disease (Jan 2010)
	Bromocriptine	Advanced Parkinson’s disease with levodopa therapy.		Risk of fibrosis - see MHRA Drug Safety Update, July 2008 No longer recommended unless the patient is already established on it and attempts to change to alternative therapy have failed.
	Pergolide
	Cabergoline
	Amantadine	Parkinson’s disease patients for relief of dyskinesias.		SIGN 113 Diagnosis and pharmacological management of Parkinson’s disease (Jan 2010)
4.9.2	Procyclidine hydrochloride (oral)	Parkinson’s disease patients with tremor unresponsive to other drugs
	Trihexyphenidyl hydrochloride
	Orphenadrine hydrochloride
4.11	Rivastigmine	Cognitive decline or the management of behavioural and psychological symptoms BPSD in people with dementia with Lewy bodies [off-label]	Note: - Perth & Kinross	SIGN 113 Diagnosis and pharmacological management of Parkinson’s disease (Jan 2010) SIGN 86 Management of patients with dementia (Feb 2006)

	May be prescribed by Hospital Specialists only
	May be prescribed in General Practice under the direction of a Specialist