People with Parkinson’s disease may require medication for other reasons. Their general practitioner should therefore be careful to consider any prescriptions from other specialists for drugs that may worsen certain motor and non-motor symptoms of the disease. Sometimes, these are ‘over-the-counter’ drugs. These include, for example, drugs with anti-dopaminergic action that are commonly used to treat nausea (metoclopramide) or motion sickness (promethazine), drugs that induce/worsen orthostatic hypotension such as the alpha-lithics often used for benign prostatic hyperplasia, or anticholinergics used for overactive bladder symptoms that may worsen cognitive and neuropsychiatric symptoms of the disease. Similarly, neurologists should avoid the use of anticholinergics for the treatment of motor symptoms of the disease, although these have been used in the past, and for the treatment of psychosis in Parkinson’s disease, use only quetiapine or clozapine and avoid first-generation neuroleptics due to their anti-dopaminergic action. It is good practice to consult the referring neurologist for potential drug-drug interactions, especially when other specialists prescribe drugs acting on the central nervous system.

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