For those admitted with known Parkinson’s disease:

1. Ensure to prescribe their regular PD medications, ensuring CORRECT:

• • Drug
  • Dose
  • Timings
  • Formulation (standard VS modified release, patch)

(review patient medications, GP record or last clinic letter for up to date list of medications)

Patient’s may come to ED with their own medications – please encourage them to take them as per their usual timings if they are able. Note down for nursing staff if these are prescribed and self administered.

Missed doses

If closer to missed dose, give now and space out next doses equally (e.g. 4hrly if this is usual regimen)

If closer to next dose, skip missed dose and consider giving next dose earlier

If unsure, please liaise with pharmacy

What do you do if the patient can’t swallow?

We will need to work out what alternative routes we could use, for example dispensable via NG or patches, and what dose.

For an ED clinical it is most likely beyond us and we may need help! Speak to pharmacy if support required.

CHFT Guideline

The above guidance can indicated whether medications can be crushed to go given in yoghurt or water or go down an NG tube.

If an oral route is not possible, then consider rotigotine patch. Calculate patch dose using trust guideline (hyperlinked above). Combine doses for patient on frequency not available. For example on five times day dosing combine BD an TDS dosing, also combine all levodopa formations (standard release and modified release) for true total dose.

New guidance takes into account the risk of delirium, so please do not underdose from what is calculated on the conversion unless specialist advice sought.

If you need any assistance calculating the dose, please speak to pharmacy for advice.

NOTE: Most Parkinson’s medications now stocked in ED – Emergency PD medications also available on ward 5 if struggling for supply out of hours.

Further inpatient guidance –

Trust guidance – 2026 (July) – Parkinsons Disease Guideline (COMBINED) (Review July 2029).pdf