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a doctor in consultation imageFebruary 9 2018

Precautions around the use of dopaminergic drugs in Parkinson’s disease are included in a new NICE Quality Standard. 

One of the five quality statements in QS 164 says that patients receiving dopaminergic therapy should be given advice about the risk of developing impulse control disorders. The quality statement has been included as “dopaminergic therapy, especially with dopamine agonists, is associated with a risk of developing impulse control disorders,” says NICE.

“It is important to discuss this risk and provide information to adults with Parkinson's disease, and their family members and carers, when starting treatment and at least annually. This will help them to recognise the symptoms and know where to get help if these develop.”

NICE expects healthcare professionals to “provide oral and written information about the risk of developing impulse control disorders to adults with Parkinson's disease when starting dopaminergic therapy (not just dopamine agonists) and discuss this with them at least annually.” They should also provide information for family members and carers if appropriate.

In addition, “oral and written information should be given about:

  • the different types of impulse control disorders (for example, compulsive gambling, hypersexuality, binge eating and obsessive shopping);
  • the increased risk of impulse control disorders developing with dopamine agonists;
  • the risk that impulse control disorders may be concealed by the person affected;
  • who to contact if impulse control disorders develop;
  • the possibility that if problematic impulse control disorders develop, dopamine agonist therapy will be reviewed and may be reduced or stopped.”

A sperate quality statement says that patients should have a point of contact with specialist services. They should also be “referred to physiotherapy, occupational therapy or speech and language therapy if they have problems with balance, motor function, activities of daily living, communication, swallowing or saliva.”

This means GPs and others need to be “aware of local referral pathways to physiotherapy, occupational therapy and speech and language therapy for adults with Parkinson’s disease.” Healthcare professionals should “carry out regular assessments of balance, motor function, activities of daily living, communication, swallowing and saliva for adults with Parkinson’s disease and refer them for physiotherapy, occupational therapy or speech and language therapy specific for Parkinson’s disease if problems are identified.”

A further quality statement says patients should have access to clozapine and patient monitoring for treating hallucinations and delusions.

The Quality Standards should be used alongside NICE guideline NG71 on Parkinson’s disease in adults.

Links:
NICE QS 164 Parkinson’s Disease          
NICE Guideline on Parkinson’s disease in adults NG71   

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