Implications of dopaminergic medication withdrawal in Parkinson's disease.
J KoschelK Ray ChaudhuriL TöngesM ThielV RaederWolfgang H JostPublished in: Journal of neural transmission (Vienna, Austria : 1996) (2021)
The trajectory of the use of dopamine replacement therapy (DRT) in Parkinson's disease (PD) is variable and doses may need to be increased, but also tapered. The plan for dose adjustment is usually done as per drug information recommendations from the licensing bodies, but there are no clear guidelines with regards to the best practice regarding the tapering off schedule given sudden dose reductions of drugs such as dopamine agonists may have serious adverse consequences. A systematic literature search was, therefore, performed to derive recommendations and the data show that there are no controlled studies or evidence-based recommendations how to taper or discontinue PD medication in a systematic manner. Most of the data were available on the dopamine agonist withdrawal syndrome (DAWS) and we found only two instructions on how to reduce pramipexole and rotigotine published by the EMA. We suggest that based on the available data, levodopa, dopamine agonists (DA), and amantadine should not be discontinued abruptly. Abrupt or sudden reduction of DA or amantadine in particular can lead to severe life-threatening withdrawal symptoms. Tapering off levodopa, COMT inhibitors, and MAO-B inhibitors may worsen motor and non-motor symptoms. Based on our clinical experience, we have proposed how to reduce PD medication and this work will form the basis of a future Delphi panel to define the recommendations in a consensus.
Keyphrases
- clinical practice
- adverse drug
- replacement therapy
- uric acid
- electronic health record
- healthcare
- big data
- parkinson disease
- deep brain stimulation
- systematic review
- primary care
- prefrontal cortex
- emergency department
- drug induced
- data analysis
- randomized controlled trial
- smoking cessation
- deep learning
- machine learning
- depressive symptoms
- case control