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Parkinson's disease - Management
Which drugs should I avoid in people with Parkinson's disease?

  • If possible, avoid the following drugs because they can worsen parkinsonism:
    • The anti-emetics, metoclopramide and prochlorperazine.
    • Anti-psychotics:
      • On specialist advice only, clozapine may be used to treat psychosis in people with Parkinson's disease. Quetiapine appears to be well-tolerated with a good safety profile, but may not be effective for psychosis in people with Parkinson's disease.
    • Some other drugs can also, less commonly, cause parkinsonism — see Differential diagnosis.
  • If possible, also avoid the following drug combinations:
    • Erythromycin and clarithromycin significantly increase the levels of bromocriptine and cabergoline. Azithromycin would not be expected to interact.
    • Ciprofloxacin significantly increases the levels of ropinirole. Use an alternative antibiotic, or seek specialist advice about dose adjustment.
    • Cough and cold preparations containing sympathomimetics (pseudoephedrine, ephedrine) should not be used with rasagiline or selegiline (risk of hypertension). Preparations containing dextromethorphan (a cough suppressant) should also not be used (risk of serotonin syndrome). People taking bromocriptine should also avoid sympathomimetics (increased risk of hypertension).
      • Advise people to check with the pharmacist before purchasing over-the-counter cough and cold remedies.
    • Pethidine should not be given with selegiline or rasagiline, or for 2 weeks after stopping these drugs (risk of central nervous system toxicity).
  • Some antidepressant drugs should not be used with some drugs for Parkinson's disease:
    • People taking rasagiline or selegiline should not use selective serotonin reuptake inhibitors, venlafaxine, duloxetine, or tricyclic antidepressants (risk of serotonin syndrome). Trazodone or mirtazapine may be cautiously used (off-label use for selegiline).
    • See Drug treatment of depression for further details.
Basis for recommendation

These recommendations are derived from: the British National Formulary [BNF 57, 2009]; a textbook, Stockley's drug interactions [Baxter, 2008]; the NICE guideline Depression in adults with a chronic physical health problem [NICE, 2009]; and publications by the Parkinson's Disease Society, which are likely to represent expert opinion [Parkinson's Disease Society, 2003; Parkinson's Disease Society, 2007].

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