The pharmacist’s role in managing Parkinson’s disease

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By Magdalena Kowalska-Villoroel

For many British Columbians, Parkinson’s disease gained recognition when actor Michael J. Fox revealed in 1998 that he had been diagnosed with the disease. But in reality, it is the second most common progressive degenerative neurological disorder after Alzheimer’s.

There are approximately 11,000 people in our province living with Parkinson’s. The average age of diagnosis is 60, but as many as 20 per cent of people with Parkinson’s are diagnosed under the age of 50.

Parkinson’s disease results from the death of brain cells that produce the neurotransmitter dopamine. The causes of cell death are unclear and there is no known cure.

Parkinson’s can be treated in a variety of ways including rehabilitation, stress management and, in select cases, surgery. However, the most common form of treatment is medication, meaning that community pharmacists often play a significant role in caring for patients with the disease.

From my experience, some of the most commonly used medications for Parkinson’s patients are Sinemet – both regular and controlled release – and Azilect, a MAO-B inhibitor. Other commonly seen medications include; COMT inhibitors, Amantadine, and Anticholinergic medications.

Parkinson’s patients are often on other medications that do not directly treat the disease itself, but help with other symptoms, such as laxatives for constipation.

Parkinson’s patients often have constipation, and for a number of reasons. It may be due to improper functioning of part of the nervous system responsible for regulating smooth muscle activity, a side effect of medications used to treat the disease, such as Cogentin, or other common causes like stress, lack of exercise or a diet low in fibre.

Therefore, it’s essential that all causes are determined and addressed since there are multiple interactions between Parkinson’s medications and both prescription and non-prescription drugs.

The addition of any medication to the patient’s current therapy should be carefully assessed. Some of the interactions between Parkinson’s medications and other prescription medications include Levodopa with MAO Inhibitors, or Eldepryl (selegiline) with multiple antidepressants (e.g. Citalopram, Sertraline, Fluoxetine, Venlafaxine).

Patients should also be advised to seek advice every time they purchase OTC medications, including mineral-containing multivitamins. Some common interactions include Levodopa with iron supplements; Azilect (rasagiline) with DM and decongestants; Azilect (rasagiline) with St.John’s Wort; or Eldepryl (selegiline) with DM.

The timing of administration is extremely important as well. Parkinson’s medications given late (even within a half hour) can lead to severe loss of function and patient anxiety.

An issue that comes up with Parkinson’s patients is compliance. They are very often on multiple medications with complex regimens and their therapies are usually not limited to Parkinson’s disease medications alone.

Pharmacists can help with this by blister packing medications or recommending a medication reminder with a sound alarm.

We also provide other recommendations to Parkinson’s patients; such as diet restrictions while on certain medications: Levodopa competes with certain amino acids for absorption, so the absorption of levodopa may be impaired in some patients on high protein diets. Azilect interacts with tyramine-rich foods so they should be avoided or minimized, for example processed meats and fish, aged cheese spreads or poultry skin.

The role of the pharmacist in management of the disease can help patients by checking for interactions and counseling on drug use, providing education regarding diet adjustments while on certain medications or dealing with constipation, advice on the use of OTC medications, and providing emotional support to patients as well as their family members and caregivers who may be in the pharmacy more often than the patients themselves.

There’s always something new that patients can learn from a detailed medication review, even if it’s just diet adjustments or a warning regarding OTC medication use.

We ask a lot of open-ended questions and don’t expect the patient to know what issues to bring up. Every patient is treated as a family member and we appreciate the trust that the public has in us as first-line health care professionals.

Magdalena Kowalska-Villoroel, is a pharmacist and pharmacy manager at Pharmasave in Newport Village, Port Moody. She is very involved with clinical pharmacy services overall, including vaccinations, adapting prescriptions, and conducting medication reviews. Magdalena has also given presentations to Parkinson’s support groups on medications and treatment options. She works closely with Summitview Medical Centre and is available for patient consultations.

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