54OMISSION OF DOPAMINERGIC DRUGS IN HOSPITALIZED PARKINSON's PATIENTS: A STUDY OF DRUG AVAILABILITY

Abstract

Introduction: Omission of dopaminergic medication is common in hospitalized Parkinson's patients and can lead to avoidable deterioration in motor function. This study aimed to determine how much medication is omitted because it is not available, and which medications were implicated. Methods: In a large district general hospital data were extracted for all admissions with a diagnosis of Parkinson's Disease from 1st April 2012 to 31st March 2014. We then extracted medication data from the electronic drug prescription and administration system. We included all L-dopa preparations, ropinirole, pramipexole, rotigotine, pergolide, bromocriptine, selegiline and rasagiline. Results: There were 827 admissions among 472 patients. There were 34,168 scheduled doses of 36 different preparations of dopaminergic medication and 3322 (9.7%) doses omitted. 875 (26% of omitted doses, 2.6% of scheduled dopaminergic medication) were omitted because medication was not available. 351 (42.4%) hospitalizations and 257 (54.5.%) patients had at least 1 dose of medication not available. For Ldopa, dopamine agonists and MAOIBs: 581 (1.9%), 235 (8.1%) and 59 (7.7%) doses respectively were unavailable (Chi -squared test, p < 0.001). For Stalevo, 30 (4.0%) doses were unavailable compared to 551 (1.9%) doses of other L-dopa preparations (p < 0.001). Conclusion: This study confirms poor availability of dopaminergic medication to hospitalized PD patients: more than 50% of patients missed at least one dose as the drug was not available. Dopamine agonists, and MAOIBs are less readily available than L-dopa preparations. Among L-dopa preparations Stalevo (L-dopa, carbidopa and entacapone) is less readily available than co-careldopa and co-beneldopa. The variety of preparations used is large and wards cannot hold a complete stock. We recommend pharmacists ensure wards know where in the hospital to obtain PD medication. We recommend movement disorder specialist agree a substitution policy with pharmacy departments so suitable alternatives can be dispensed pending procurement of usual medication.