Parkinson’s: why does medication timing matter so much?
In Parkinson’s it is not enough to take the medication: it must be taken at the times set by the neurologist, because this determines whether the person can move normally throughout the day.
In short
- In Parkinson’s, medication times are set by the neurologist for each person, and keeping to them is key to controlling symptoms.
- A delay or a missed dose can bring back slowness, stiffness or tremor, and in extreme cases stopping it suddenly can cause a serious syndrome.
- Protein in food can reduce the effect of levodopa in some people, but the diet should not be changed without advice.
- Some medicines, such as metoclopramide or haloperidol, can make Parkinson’s worse: always tell professionals that your relative has it.
Medication timing matters so much in Parkinson’s because the medicines make up for the lack of dopamine for a limited time. If the next dose arrives late, symptoms return. The UK charity Parkinson’s UK sums it up: the key issue with Parkinson’s medication is timing, and each person needs to take it at specific times.
In Spain around 160,000 people are estimated to live with Parkinson’s, according to the Spanish Parkinson’s Federation. We explain why punctuality matters so much and how the family can help.
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Why is timing so important in Parkinson’s?
Because keeping to the times determines whether symptoms are steadily controlled throughout the day. The times are set for each person by the neurologist or specialist nurse and are usually adjusted as the condition progresses.
Over time, many people experience fluctuations: “on” periods, when the medication is working and they move well, and “off” periods, when symptoms return. The Spanish Parkinson’s Federation explains that these fluctuations are usually linked to the effect of the medication and stresses that adherence is crucial to successful treatment.
Parkinson’s UK points out that not getting medication on time can make the difference between someone functioning independently and relying on others for basic activities such as walking and eating.
What happens if a dose is late or missed?
Most often symptoms return or get worse: slowness, stiffness, tremor, difficulty walking or swallowing. That is why delays should be avoided just as much as missed doses.
- Do not double up: the MedlinePlus leaflet on carbidopa and levodopa says you should not take a double dose to make up for a missed one. Exactly what to do about a missed dose depends on the medicine: check the leaflet or ask the pharmacist.
- Do not stop suddenly: stopping levodopa abruptly can cause a serious syndrome with fever, muscle stiffness and confusion. Any withdrawal is decided and planned by the doctor.
- Repeatedly missed doses: Parkinson’s UK warns that, in extreme cases, missed doses can lead to a potentially fatal syndrome similar to neuroleptic malignant syndrome.
If you notice that “off” periods are more frequent or that the medication wears off sooner, mention it to the neurologist: the timing or the treatment may need adjusting.
Do meals and protein affect the medication?
They can in some people. Amino acids from dietary protein can compete with levodopa and reduce how much reaches the brain, so some people find their medication works less well after a protein rich meal.
The effect varies a great deal. In a retrospective study published in 2016 in the Journal of Clinical Movement Disorders, 5.9% of people treated with levodopa had fluctuations linked to protein, rising to 12.4% among those who already had motor fluctuations. The authors also warn that restricting protein can lead to weight loss.
So do not change the diet on your own: MedlinePlus advises talking to the doctor before switching to a high protein diet. To find out more about food and medicines, read our article on foods that interfere with medication.
Which medicines can make Parkinson’s worse?
Medicines that block dopamine receptors can worsen Parkinson’s symptoms. That is why any doctor, in A&E, in hospital or at the health centre, should know that the person has Parkinson’s.
| Situation | Medicines Parkinson’s UK advises avoiding or monitoring |
|---|---|
| Nausea and vomiting | Metoclopramide and prochlorperazine |
| Hallucinations or confusion | Older antipsychotics such as haloperidol |
| Colds, together with MAO B inhibitors | Products containing pseudoephedrine or ephedrine |
| Long term use | Some antihistamines, such as cinnarizine |
This table is only a guide. Before taking any new medicine, including those bought without a prescription, check with the pharmacist.
A practical example: Manuel and his five doses a day
Take the case of Manuel, 74, who has had Parkinson’s for six years. His neurologist has prescribed levodopa five times a day, plus four other medicines for blood pressure and cholesterol. His wife, Pilar, notices that on some afternoons Manuel can hardly get out of his armchair, and discovers that he sometimes takes the five o’clock dose at half past six because he loses track of time.
The sensible thing would be for Pilar to note down for a few days the times of each dose and the “off” periods to show the neurologist, set phone alarms for the exact times and prepare the medication separated by dose. If Manuel goes into hospital, they should take his medication and the list of times and remind staff that he has Parkinson’s. To keep track of doses from a distance, our article on how to know whether your parents are taking their medication may help.
How can IMA Health help you?
Parkinson’s UK notes that preparing medication in a monitored dosage system can be useful when there are more than four doses a day. With IMA Health, a specialised pharmacy prepares the medication by the day and time of each dose, following the regimen set by the doctor, and IMA coordinates with the pharmacy, handles home delivery and provides personalised follow-up. You can see how it works in what an SPD is.
Sources
- Parkinson's UK: Key information for community pharmacists
- Spanish Parkinson's Federation: what is Parkinson's? (in Spanish)
- MedlinePlus: carbidopa and levodopa (Spanish version)
- Virmani T. et al. Motor fluctuations due to interaction between dietary protein and levodopa in Parkinson's disease. J Clin Mov Disord, 2016
This article is for information only and does not replace advice from your doctor or pharmacist.