Parkinson's disease is among the most complex conditions to face — not only for patients but also for caregivers and other health and pharmacy professionals involved in the field of long-term care. The disease's degenerative nature means that by the time post-acute and LTC facilities get involved, patients are at Parkinson's most difficult stage.

Medication is not the only treatment for Parkinson's, but in the disease's advanced phases it is by far the most important. LTC providers and their pharmacy partners play an important role in ensuring medication adherence among patients, helping them enjoy their late years in as much comfort and peace as possible.

Fundamentals of the Parkinson's medication regimen

Although the cause of Parkinson's disease remains largely unknown — only a handful of rare genetic mutations have been definitively associated with it — its pathology is otherwise generally understood. Difficulties with motor control are the condition's primary (though far from the only) visible symptom, and the drugs carbidopa and levodopa are most critical to its management, according to the Mayo Clinic.

Those two medications are almost always used together, and thus commonly referred to as carbidopa-levodopa therapy. Administration as an oral medication is most common, but it can also be taken as an inhalant or, in rare cases, as a gel that is delivered directly to the small intestine through a feeding tube. (The latter is mostly confined to late-stage Parkinson's patients for whom more conventional carbidopa-levodopa is ineffective.)

Other medications may be used to address patients' inability to produce dopamine alongside or in place of carbidopa-levodopa therapy, including monoamine oxidase inhibitors, dopamine agonists, anticholinergics, and catecholo-O-methyl-transferase inhibitors. The latter two are less common today due to the problematic side effects with which they're often associated (such as hallucinations, sleep problems, and various compulsive, manic behaviors), but haven't disappeared completely.

The question of medication adherence

For many people, adherence to a medication regimen is often no simple matter. A study published in the Oman Medical Journal and archived by the National Institutes of Health found that about 50% of medication non-adherence was unintentional, attributable to forgetfulness or a misunderstanding of certain regimens.

The research also observed that this can be a particularly significant issue for patients with chronic illnesses. Indeed, another NIH-archived study from the journal Frontiers in Neurology found that non-adherence was frequent among Parkinson's patients with "more complicated medication regimens," and far from uncommon across the entire demographic of the disease's living patients. This is an extremely serious issue, seeing as the Parkinson's Foundation stresses the importance of on-time dosage and the danger of deviating from an established medication schedule.

There are several key reasons why patients end up straying from the parameters of the medication plans devised and prescribed by their physicians. As alluded to above, complexity is one of them — as Parkinson's progresses, dosing schedules become more intricate and even more important to maintain. Depression is another common precursor to non-adherence, as are other cognitive impairments and/or psychiatric disorders.

By contrast, patients who are very knowledgeable about the disease, are supported by a partner, or had good clinical control are more likely to stick to medication regimens, according to the ADHESON Study Group. Outside of the clinical-trial realm, it's the responsibility of LTC and post-acute facility leaders to keep a firm hand on the situation so Parkinson's patients don't experience treatment setbacks or side effects that could have been avoided or mitigated. Pharmacy partners must support these efforts by maintaining an efficient and accurate supply of essential medications.

Maintaining proper contraindications

Generally speaking, LTC and post-acute care facilities (and the pharmacies serving them) are well-equipped to handle the complex requirements of patients with Parkinson's or other chronic degenerative diseases. Alzheimer's Disease, dementia, and other forms of cognitive decline are quite common in this care environment, and advanced cases of multiple sclerosis or Lou Gehrig's disease are also seen with some frequency. These conditions all have notable medication requirements of their own.

However, there are quite a few common medications that can have dangerous interactions with carbidopa-levodopa and other key Parkinson's drugs. Coupled with the strong possibility that seniors with later-stage Parkinson's may have comorbid chronic pain, autoimmune disorders, gastrointestinal issues, neurological ailments, or behavioral health conditions, upholding drug contraindications is of the utmost importance.

The biggest issue is with drugs that block dopamine reception or deplete it. As noted by the American Parkinson's Disease Association, this is counterproductive for Parkinson's patients and potentially very dangerous. The vast majority of typical and atypical antipsychotics, several anti-emetics (including the common Reglan and Phenergan), two blood-pressure drugs (the anti-hypertensive Serpalan and Aldomet) and several common medications for hyperkinesis (Xenazine, Austedo, and Ingrezza) must all be contraindicated.

Outside of those they ordinarily take, Parkinson's patients must also be kept away from MAO-inhibiting drugs. Numerous antidepressants are thus disqualified, as they would be not only dangerous but redundant, and various narcotic pain medications, anesthetics, muscle relaxants (specifically Flexeril), and even over-the-counter cold and allergy medications should be avoided as well. Lastly, while benzodiazepines and bladder-control medications aren't necessarily dangerous when interacting, their reactions can include hallucinations and confusion.

Pharmacists' role in boosting adherence

Clearly, there are many factors that can affect outcomes in patients with Parkinson’s Disease. It’s critical to monitor therapy closely and work to mitigate any issues that could jeopardize the medication adherence of patients with Parkinson's Disease.

By using FrameworkLTC from SoftWriters, LTC pharmacy personnel can boost the efficiency and accuracy of drug order processing, dispensing, billing, and other critical functions. Additionally, the analytical reporting capabilities of FrameworkLTC can help pharmacies amass data on medication trends, which in turn will assist in pinpointing instances of improper drug prescribing and potentially even identify previously unknown interactions.

With RxPertise Consulting Software from SoftWriters, the consultant pharmacist can closely monitor the medication regimen, identify abnormalities, make recommendations, and track results with the goal of improved outcomes and safety of the patient. RxPertise is the leading Medication Regimen Review solution in the LTC industry.