Patient groups and experts in Parkinson’s cite the accessibility of
community pharmacies and the expertise of pharmacists as key to helping improve outcomes for patients.
Patients should always use the same brand – it doesn’t matter if it’s a name brand or a generic, but always use the same one that suits you. This is because the use of different fillers can quite significantly affect the absorption of drugs in our case, so we strongly advocate sticking to the same brand.
Community pharmacists are critical in the management of Parkinson’s because the medications taken by patients can be very complex.
They are required to be taken very much according to regimen. There isn’t flexibility in when you take them, and always taking medicines on time is very important with Parkinson’s disease and pharmacists can reinforce this.
Some patients may be on half a dozen different drugs anywhere from two to three hours a day and many people are taking 40 tablets a day and that’s just for Parkinson’s disease. Given about 80 per cent of patients are over the age of 65, they’re likely to be on other medicines as well, so they may be taking a lot of tablets a day.
Pharmacists are easily accessible and usually there’s a long follow-up time between neurologist appointments.
Noncompliance with medication at times results in unnecessary and preventable admissions to hospital for Parkinson’s patients.
Medication management is identified as a major concern for someone living with Parkinson’s, and for their families. Poor medication management is reflected in poor quality of life. Greater emphasis on ensuring medications compliance and education is a key to improving the quality of life for patients.
Drug therapy is difficult to manage. At one end of the spectrum some patients literally cannot move without their medicines and at the other end you get some of the uncontrolled movements associated with taking the medicines.
Another issue is that some of the medicines can create compulsive behaviour, so some patients become compulsive gamblers or sex addicts. Any compulsive behaviour you can think of can be caused by some of these drugs. Pharmacists see these patients a lot more often than their doctors do and so can pick up behavioural changes and start asking questions, and also discuss medication side effects with them.
What is Parkinson’s disease?
It is the second most common neurological disease after Alzheimer’s and currently in Australia there are about 70,000 people living with it.
There is no cure for Parkinson’s disease and the symptoms generally progress slowly over time. Early in the disease, these are characterised by rigidity, slowness of movement, and difficulty with walking. Thinking and behavioural problems may also occur and dementia becomes common in the advanced stages of the disease.
Initial treatment is typically with levodopa, with dopamine agonists being added once levodopa becomes less effective. As the disease progresses and neurons in key parts of the brain continue to be lost, these medications also become less effective while, at the same time, they produce complications, particularly involuntary writhing movements which are treated by adding COMT inhibitors.
Surgery to place the electrodes for deep-brain stimulation has been used to reduce motor symptoms in severe cases where drugs are ineffective.