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Precautions for patients considering medical or surgical treatment
People with Parkinson's disease should be aware of several precautions when planning major medical or surgical treatments (for example, abdominal surgery or joint replacement surgery). Similar precautions apply to a person with Parkinson's disease who must be taken to a hospital emergency department for urgent treatment (for example, fever, chest pain or confusion).
When someone with Parkinson's disease is being evaluated for medical or surgical treatment, it is extremely important to make sure that that all health care providers know that he/she has Parkinson's disease. It is also necessary to review with the doctor(s) what medications should be avoided because of the disease or its treatment.
Avoid the following medications:
- Chlorpromazine (Thorazine®)
- Fluphenazine (Prolixin®)
- Haloperidol (Haldol®)
- Loxapine (Loxitane®; Loxapac®)
- Molindone (Moban®)
- Olanzapine (Zyprexa®)(usually)
- Perphenazine (Trilafon®)
- Risperidone (Risperdol®)
- Thioridazine (Mellaril®)
- Thiothixene (Navene®)
- Trifluoperazine (Stelazine®)
The following medications may be used if needed:
- Clozapine (Clozaril®)
- Diazepam (Valium®)
- Lorazepam (Ativan ®)
- Propofol (Diprivan®)
- Quetiapine (Seroquel ®)
For patients who require treatment for nausea avoid the following medications:
- Chlorpromazine (Thorazine®)
- Droperidol (Inapsine®)
- Metoclopromide (Reglan®; Maxeran®)
- Prochlorperazine (Compazine®; Stemetil®)
- Trimethobenzamide (Tigan®)
Medications that may be used for nasuea include:
- Domperidone* (Motilium®)
- Dolasetron (Ansemet®)
- Granisetron (Kytril®)
- Ondanzatron (Zofran®)
*not available the United States but available in Canada
Patients receiving selegeline
Individuals who take selegiline (Eldepryl®, Atapryl®, Carbex®) should never receive meperidine (Demerol®), a pain medication frequently used before or after medical or surgical procedures. Rarely, severe reactions have occurred in people taking both selegiline and certain antidepressants (both tricyclic and SSRIs).
Antiparkinsonian medication and surgery
Prior to surgery, levodopa (carbidopa/levodopa or Sinemet®) as well as dopamine agonists (bromocriptine (Parlodel®), pergolide (Permax®), pramipexole (Mirapex) or ropinirole (Requip®)) should be continued as late as possible on the day of the operation and resumed as early as possible after the operation (with sips of water or by nasogastric tube).
The time for recovery after a surgical procedure or major medical problem may be prolonged in people with Parkinson's disease. Resuming Parkinson's disease medication as soon as possible and early mobilization (sitting up in bed, sitting in a chair, and walking if possible) may help prevent complications and shorten time spent in the hospital.
Summary
These precautions for a person with Parkinson's disease who is about to undergo major surgical or medical care can be summarized as follows:
1) Be sure that all medical personnel are aware of the Parkinson's disease diagnosis.
2) Avoid medications that block dopamine receptors. Many medications used for anxiety, confusion, and psychosis as well as antinausea medications block dopamine receptors. Meperidine must not be used in individuals who take selegiline. Share the list (above) with your doctor(s).
3) Take Parkinson's disease medications until the surgical or medical procedure and then resume these medications as soon after the procedure as possible.
4) Because recovery from major surgery may take longer for people with Parkinson's disease, physical therapy and extra recovery time may be necessary.
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