Antiemetic Parkinson's disease — GPhC CRA MCQ
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Correct answer: B — Avoid metoclopramide and obtain a non-dopamine-antagonist antiemetic plan
Avoid metoclopramide and obtain a non-dopamine-antagonist antiemetic plan: Metoclopramide can worsen Parkinson motor symptoms through dopamine antagonism, so treatment should be selected with the Parkinson regimen and patient risks in mind. Use metoclopramide and continue co-careldopa at the existing times: Metoclopramide blocks dopamine receptors and may exacerbate parkinsonism. Use prochlorperazine and continue co-careldopa at the existing times: Prochlorperazine can also worsen Parkinson symptoms. Pause co-careldopa until nausea has been absent for 48 hours: Abrupt interruption can cause severe immobility and a dangerous withdrawal syndrome. Take an additional co-careldopa dose with each nausea episode: Unprescribed extra dosing does not treat viral nausea and may increase dopaminergic adverse effects.
Reference: NICE NG71: Parkinson’s disease in adults: https://www.nice.org.uk/guidance/ng71/chapter/recommendations; BNF: metoclopramide hydrochloride: https://bnf.nice.org.uk/drugs/metoclopramide-hydrochloride/; NHS SPS: managing inadvertent delays in Parkinson’s medicines: https://www.sps.nhs.uk/articles/managing-inadvertent-delays-in-medication-for-parkinsons-disease/