Since Parkinson’s disease management depends mainly on oral medication, patient compliance or patient adherence to the medicines prescribed as well as not quitting the drugs altogether without informing the doctor is a very important issue. The absolute necessity of taking the medicines at proper times and in their prescribed doses cannot be overemphasized and should be clearly understood by the patient, family members or other caregivers. The dangers of quitting Parkinson’s disease drugs without informing the doctor also needs to be stressed.
Patient compliance means taking the medicines on time and in the prescribed doses. There are different types of drugs with multiple doses and formulations, each with variable rates of absorption, which makes it imperative that the prescribed medicines are taken on time and without altering the dosage except under medical supervision. Unwillingness or inability to adhere to this may lead to exacerbation of symptoms or development of other complications, and may affect the doctor’s monitoring of the disease progression leading to further prescription of anti-Parkinson’s medicines.
Causes of Patient Non-compliance
There are a number of reasons that patients may not comply with their prescription of Parkinson’s drugs. These include :
- Ignorance about the importance of taking medicines on time and in the correct doses.
- Unavailability of medicines.
- Cost of medicines.
- Trying alternative therapies.
- Side effects of drugs, as well as concerns about drug interactions.
- Patients may feel that they do not need the dose increase that the doctor prescribed.
- Patients do not decrease the dose of medicine, even if advised by the doctor, in the misconception that their condition will worsen if they do so.
- Multiple dose regimens may make compliance difficult.
Complications of Patient Non-compliance
- Overuse of medicines may cause psychiatric problems and increase motor complications.
- If medicines are not taken as prescribed, the smooth flow of dopamine in the brain is interrupted, leading to irregular control of symptoms.
- Missing a dose by even 15 or 30 minutes may result in an “off” period which may last for several hours.
Quitting Parkinson’s Disease Drugs
Often patients of Parkinson’s disease decide to stop taking drugs because of misconceptions about dangers of taking medications for prolonged periods. Some people think that levodopa may speed the progression of Parkinson’s disease although there is no truth in this theory. Other patients are not ready to accept that they will have to be on medication for the rest of their lives. There is another misconception that drugs stop acting after a few years. This is not correct, although doses may need to be increased due to progression of the disease. Another common reason for quitting drugs is to try alternative therapies, like homeopathic or herbal remedies, which they feel will work better for them.
Dangers of Trying Alternate Therapies
- Herbal medications are often effective since they may contain levodopa but it should be remembered that this levodopa exists along other compounds and some toxic side effects are possible.
- The exact dose of herbal remedies cannot be controlled due to varying levels of compounds among each season’s cultivation. This is very important since exact dose of the drug is crucial for proper control of symptoms and each patient’s dose is tailor-made for him alone.
- Unknown drug interactions.
- There is no standard quality control.
- Patients may be ill-informed about the effect of alternative therapies and their supposed efficacy.
However complementary therapies should not be totally avoided, provided that you have discussed it with your medical doctor and considering these alternative remedies for other aspects of your health, rather than for the treatment and management of Parkinson’s disease.
Dangers of Quitting Anti-Parkinson’s Drugs
- Symptoms, which were previously controlled, will become exacerbated.
- Increase in muscle stiffness.
- Development of other complications.