Contact the person's Parkinson's disease specialist team if the following adverse effects of anti-parkinsonian medication occur, as alterations to the medication may be needed:

• Fibrotic reactions (such as cardiac valvulopathy and retroperitoneal fibrosis) related to ergot-derived dopamine agonists (bromocriptine, cabergoline, or pergolide).
• Nausea and vomiting related to anti-parkinsonian medication.
• Motor complications, including motor fluctuations and dyskinesias.
• Dystonic or akathisia-related pain.
• Neuropsychiatric symptoms, including:
• Cognitive impairment.
• Daytime hypersomnolence or excessive drowsiness.
• Impulse control and related disorders, such as hypersexuality, pathological gambling, or compulsive buying.
• Psychotic symptoms, confusion, and vivid dreaming.
• Sleep disturbance.
• Autonomic disturbances.
• Diarrhoea:
• May be caused by entacapone and tolcapone (catechol-O-methyltransferase inhibitors).
• Dose reduction or, if severe, discontinuation may be considered.
• Excessive saliva (sialorrhoea).
• Excessive sweating (hyperhidrosis).
• Hypotension and Postural (orthostatic) hypotension.
• Peripheral oedema:
• May occur with amantadine and dopamine agonists, but is not dose dependent.
• Diuretics or discontinuation of the offending medication may be considered.
• Weight loss.

The following adverse effects can initially be managed in primary care, but liaison with or referral to the person's Parkinson's disease specialist team may be needed if initial measures fail:

• Constipation.
• Nausea and vomiting unrelated to anti-parkinsonian medication.

In depth