a pharmacist consulting with patientFebruary 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.” Health professionals 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.”

QS 164 also includes quality statements around the administration of levodopa in care settings. It says adults with Parkinson’s disease who are in hospital or a care home should be taking levodopa within 30 minutes of their individually prescribed administration time. This means that adults with Parkinson’s disease will need to “have an accurate medicines chart that reflects timings for levodopa before admission,” it says.

“Practitioners should support adults with Parkinson’s disease to take levodopa on time, which may include self-medication. Practitioners should report any medicines-related patient safety incidents for adults with Parkinson’s disease.”

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

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

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