MEDICATIONS ASSOCIATED WITH DRUG INTERACTIONS OR WORSENING OF PARKINSON’S SYMPTOMS Health Professionals Antidepressants Monoamine oxidase inhibitors (MAOIs) Phenelzine Tranylcypromine Medications to be given with caution Moclobemide

Tricyclic and Tetracyclic antidepressants to people with Parkinson’s Dothiepin Clomipramine Imipramine Doxepin Mianserin Nortriptyline

Selective Serotonin Re-uptake Inhibitors (SSRIs) and Serotonin-Noradrenaline Re-uptake Inhibitors (SNRIs) Citalopram Fluvoxamine Reboxetine Fluoxetine

The following drugs from the above group are commonly utilised under specialist supervision. Paroxetine Venlafaxine Mirtazapine Sertraline

Antiemetics 7th Edition May 2016 Metoclopramide Prochlorperazine Parkinson’s is a complex progressive condition and is often associated Antipsychotics with co-morbidities. Many medications used for the treatment of other medical Amisulpride Chlorpromazine Clozapine Flupenthixol conditions have the potential to alter or interfere with the brain’s dopamine system Fluphenazine Haloperidol and their detrimental effect on Parkinson’s is sometimes overlooked, i.e. increased Pericyazine Pimozide Risperidone Thiothixene risk of confusion, hallucinations, postural hypotension and motor disturbances Thioridazine Trifluoperazine such as bradykinesis and dyskinesia. Zuclopenthixol

Antihistamines However, the need to effectively treat other medical conditions and the possibility Promethazine Methdilazine of causing or worsening existing Parkinson’s has to be considered. Trimeprazine

Antihypertensives and Antianginals This brochure is designed to provide information on those drugs that most Avoid: Methyldopa. commonly cause problems for people with Parkinson’s. It is not an exhaustive list Caution with Calcium Channel antagonists, ACE Inhibitors, Angiotension II Blockers and Imdur. and therefore a specialist in Parkinson’s, or a pharmacist, should be consulted Others before any medications are taken by patients with Parkinson’s. This publication Bupropion Lithium covers only medications currently available in Australia. Tetrabenzine Phenytoin The stamp below is used in rehabilitation facilities to highlight the most common Medications are marketed under many names. This page lists only the generic name. medications contraindicated in Parkinson’s.

NO METOCLOPRAMIDE / PROCHLORPERAZINE CONTACT DETAILS NO HALOPERIDOL / Parkinson’s Australia Inc. RISPERIDONE / PERICYAZINE FREE CALL 1800 644 189 Web: www.parkinsons.org.au This edition was prepared by Dr B I Vieira, Consultant Physician, Dr Oksana Burford, Pharmacist and Janet McLeod, Parkinson’s Nurse © Parkinson’s Western Australia Inc. Specialist. Distributed by Parkinson’s Western Australia and endorsed by Parkinson’s Australia. LEVODOPA AND COMT INHIBITORS GLUTAMATE ANTAGONIST (Sinemet, Sinemet CR, Madopar, Madopar HBS, Kinson, Duodopa,Stalevo, Comtan) Amantadine (Symmetrel) Medication Interaction Action Medication Interaction Action Baclofen Increased risk of hallucinations, confusion, Try to avoid combination Anti-cholinergics Confusion, hallucinations, nightmares, Avoid combination (Lioresal, Clofen, headache, nausea and symptoms of gastrointestinal disturbances Stelax) Parkinson’s Bupropion (Zyban) As above Avoid combination Benzodiazepines Diazepam and nitrazepam may reduce effect May be used together but of levodopa and increase muscle tone monitor for decline in cognition MAO-B INHIBITORS and symptom control Selegiline, (Eldepryl, Selgene), Rasagiline (Azilect) Antiemetic drugs Will oppose effects of levodopa and will Use alternatives such as Medication Interaction Action (See front page) make condition worse domperidone (Motilium) or Pethidine Risk of serotonin syndrome** and other Avoid combination ondansetron (Zofran) potentially life-threatening reactions Antihypertensive May increase hypotensive effect of levodopa Monitor postural blood Moclobemide Increased risk of tyramine-mediated Avoid combination and antianginal pressure hypertensive episodes drugs SSRIs Risk of serotonin syndrome** and other Avoid combination Antipsychotic May oppose effect of levodopa and may Avoid the combination or use potentially life-threatening reactions drugs make condition worse small doses of Quetiapine or Olanzapine (Seroquel and Tricyclic Risk of serotonin syndrome** and other Avoid combination Zyprexa) antidepressants potentially life-threatening reactions Phenytoin May reduce effect of levodopa Monitor closely MAOIs Hypertensive crisis – potentially Do not give selegiline for two to life-threatening three weeks after ceasing Isoniazid May reduce levodopa concentration in Monitor closely MAOI plasma and reduce control of Parkinson’s Clozapine Risk of serotonin syndrome** and other Avoid combination DOPAMINE AGONISTS potentially life-threatening reactions Apomorphine (Apomine, Movapo), Bromocriptine1 (Parlodel, Kripton), Cabergoline (Cabaser), Dextromethorphan, Risk of serotonin syndrome** Avoid combination Pergolide (Permax), Pramipexole (Sifrol, Sifrol ER), Rotigotine (Neupro) pseudoephedrine (cough suppressant Medication Interaction Action and cold remedies) Antipsychotic May oppose effects of dopamine agonists Avoid the combination or use drugs and may make symptoms worse small doses of Quetiapine or **serotonin syndrome may exhibit as signs of sweating, high temperature, restlessness, tremor, confusion, myoclonus, ataxia and hyperreflexia Olanzepine (Seroquel and Zyprexa) • Some medications have the potential to prolong the QT interval when combined with Parkinson’s medications such as Amantadine and Apomorphine. Caution is advised. Refer to www.azcert.org 1Erythromycin Increases the absorption and decreases the Monitor for signs of dopamine metabolism of bromocriptine agonist toxicity or choose • Patients with Parkinson’s often have: another antibiotic - Severe and difficult to treat constipation: use caution when prescribing narcotic analgesia, Sympathom- Potential to cause hypertension and seizures Avoid combination e.g. codeine phosphate, morphine. imetic drugs - Severe and challenging depression: Tramadol hydrochloride has the potential to interact with SSRI’s (cough and cold and lead to increased confusion and delirium. remedies) - Co morbidities such as cardio vascular conditions and the medications used in the treatment of Antihypertensive Potential to cause postural hypotension and Monitor blood pressure both these are under constant development. The prescriber must be aware that in conjunction with the drugs falls supine and erect antihypertensive effect of Parkinson’s and the medications used in its treatment, hypotension may Ondansetron Potential to cause postural hypotension Avoid with Apomorphine occur with an added risk of postural hypotension.