Resting tremor, rigidity, bradykinesia, postural instability
Younger patient → Dopamine agonist (pramipexole/ropinirole) — fewer long-term dyskinesias
Elderly / more disabling → Carbidopa/levodopa (most effective); + MAO-B inhibitor, amantadine (dyskinesia)
Order set
- Clinical diagnosis
- MRI to exclude mimics
- Medication review
Criteria
AdmitSevere complications / aspiration
DischargeMedications optimised, safe mobility/swallow, follow-up
Key
- Anticholinergics (benztropine) help tremor but worsen dementia & glaucoma.
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
- Rapid progression
- Early falls/autonomic (atypical)
Differentials
- Essential tremor
- Drug-induced parkinsonism
- MSA/PSP
- Lewy body
Common mistakes
- Anticholinergics in elderly
- Abruptly stopping dopaminergics
Disposition & follow-up
Dopaminergic therapy; neurology/PD nurse follow-up.
Discharge package
MedicationsDopaminergic therapy — do not stop abruptly
Follow-upNeurology/PD nurse
LifestyleFalls prevention, physio/OT
Warning symptomsFalls, swallowing problems, confusion
💊 Treatment detail — doses & preparation
Carbidopa/levodopadopamine replacement
Dose25/100 mg TDS, titrate weekly; take 30 min before protein meals
Preparation10/100, 25/100, 25/250 mg tablets; CR/D dispersible forms exist
MonitorDyskinesia, wearing-off, orthostasis; never stop abruptly (NMS-like)
Pramipexoledopamine agonist
Dose0.125 mg TDS, ↑weekly to 0.5–1 mg TDS
Preparation0.125–1 mg tablets
MonitorImpulse-control disorders, sleep attacks, renal dosing
RasagilineMAO-B inhibitor
Dose1 mg OD
Preparation0.5/1 mg tablets
MonitorInteractions: SSRIs/tramadol (serotonin), tyramine less relevant
📖 NICE / MDS Parkinson'sReviewed July 2026