Objective: Detection of the most common and most serious drug-related problems in the pharmacotherapy of Parkinson’s disease (PD), particularly with focus on interactions and contraindications to ultimately optimize treatment strategies.

Background: PD usually occurs with many concomitant diseases. Due to age-related comorbidities and PD related non-motor symptoms, there may be a pronounced polypharmacy, which is a risk factor for drug safety.

Methods: We conducted a prospective observational study in a hospital over a period of 14 months. The analysis focused on the medication regime on admission and discharge of PD patients with concomitant diseases and comorbidities. We included patients with the following three criteria: Diagnosis of Idiopathic Parkinson Syndrome (IPS), polypharmacy in the medication regime at discharge, i.e. at least five different medications, and at least one comorbidity, which required additional pharmacotherapy. Interactions were recorded by evaluating the patient’s medication regime using the professional information provided by the manufacturers.

Results: 127 IPS patients were included in the study of which 19.7% were classified as Hoehn & Yahr stage 5, 36.8% as stage 4 and 33.8% as stage 3. The median age was 70 years. The average disease duration was 10 years. The predominant reason for hospital admission were motor fluctuations and psychiatric symptoms, such as dementia, hallucination and depression. On admission 92 of 127 patients (72%) received co-medication in addition to the anti-PD drugs, which act on the nervous system according to the ATC classification system. As a result, 168 of 208 possible interactions (81%) could be caused by CNS-active drugs. With 21 interactions (10.1%) the second most common group of interactions could be caused by CYP-interacting substances. Interactions of more than one medication with warning for QT-time prolongations could occur in 12 cases (5.8%). All 208 interactions are based on the described medication analysis and could potentially lead to clinical relevant additive effects, mutual attenuation or gain of side effects.

Conclusions: The data demonstrates that a specific medication management is required in patients with advanced IPS and comorbidities to avoid medication interactions and therefore improve drug safety, especially if a polypharmacy with either CNS active drugs, QT-time prolonging substances or CYP-interacting drugs are applied.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/drug-safety-in-the-pharmacotherapy-of-parkinsons-disease/