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4.3 Movement disorders

First line drugs Second line drugs Specialist drugs Secondary care drugs

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only

 

 

4.3.1 Dystonias and other involuntary movements

 

Antipsychotics (first-generation)

Promazine hydrochloride (Amber 1)

  • Tablets 25mg, 50mg
  • Oral Solution 50mg/5mL    

 

 

Neuroprotective agents

Riluzole (Amber 3)

  • Tablets 50mg
  • Teglutik Oral suspension 5mg/ml

Notes:

  • Riluzole is used to extend life or the time to mechanical ventilation in patients with motor neurone disease (MND) who have amyotrophic lateral sclerosis (ALS).
  • Use as per NICE TA20: Guidance on the use of Riluzole (Rilutek) for the treatment of motor neurone disease (January 2001) 
  • Treatment should be initiated and stabilised by a specialist in MND for the first three months
  • GPs will continue monitoring the patient and prescribing riluzole thereafter. The specialist will advise the GP on the estimated duration of treatment, when to continue prescribing and when to stop. The specialist will also alert GPs to potential side effects.  

 

 

Neurotoxins (Botulinum toxins)

Botulinum toxin type A

Traffic Light Status: Double Red when used for hyperhidrosis and cluster headache. 

Prescribers must seek prior approval from the Individual Funding Request (IFR) panel for use of Botulinum Toxin A in patients with hyperhidrosis and in patients with cluster headache

 

  • Dysport ® Injection 500 unit vial
  • Botox ® Injection 100 unit vial
  • Xeomin® Injection 50 unit vial, 100 unit vial 

Notes:

 

 

 

4.3.2 Parkinson's disease 

National Guidelines

 

 

Important notes:

  • It is important to eliminate the possibility of anti-dopaminergic drugs causing parkinsonian symptoms, for example prochlorperazine, metoclopramide, chlorpromazine, trifluoperazine, haloperidol and thioridazine. 

     

  • Elderly: Antiparkinsonism drugs carry a special risk of inducing confusion in the elderly. It is particularly important to initiate treatment with low doses and to use small increments.  

 

Antimuscarinics

Orphenadrine hydrochloride

  • Tablets 50mg
  • Prescribe as Disipal in primary care 

 

Procyclidine hydrochloride

  • Tablets 5mg
  • Syrup 5mg in 5mL
  • Injection 10mg in 2mL 

 

Trihexphenidyl hydrochloride

  • Tablets 2mg, 5mg    

 

 

Catechol-O-Methyltransferase inhibitors 

Entacapone

  • Tablets 200mg

 

 

Dopamine Precursors

Co-beneldopa

  • Capsule 62.5mg, 125mg, 250mg
  • Dispersible tablets 62.5mg, 125mg
  • Modified Release capsule 125mg

 

Co-careldopa

  • Tablets 62.5mg, 110mg, 125mg, 275mg
  • Modified Release tablets 125mg, 250mg

 

Notes:

  • Patient and Carer advice: Sudden onset of sleep - Excessive daytime sleepiness and sudden onset of sleep can occur with co-careldopa, co-beneldopa, and the dopamine receptor agonists. Patients starting on treatment with these drugs should be warned of the possibility of these effects and of the need to exercise caution when driving or operating machinery. Patients, who have suffered excessive sedation or sudden onset of sleep, should refrain from driving or operating machines, until those effects have stopped.
  • When co-careldopa (10/100) is used, the dose of carbidopa may be insufficient to achieve full inhibition of extracerebral dopa-decarboxylase; co-careldopa 25/100 should therefore be used so that the daily dose of carbidopa is at least 75mg.
  • Levodopa therapy should be initiated with low doses and gradually increased, by small increments, at intervals of 2-3 days. The final dose is usually a compromise between increased mobility and dose-limiting side effects.
  • Modified release preparations may help with “end-of-dose” deterioration or nocturnal immobility and rigidity.  

 

Carbidopa with entacapone and levodopa 

Stalevo®

  • Tablets levodopa 50 mg, carbidopa 12.5 mg, entacapone 200 mg
  • Tablets levodopa 75 mg, carbidopa 18.75 mg, entacapone 200 mg
  • Tablets levodopa 100 mg, carbidopa 25 mg, entacapone 200 mg
  • Tablets levodopa 125 mg, carbidopa 31.25 mg, entacapone 200 mg
  • Tablets levodopa 150 mg, carbidopa 37.5 mg, entacapone 200 mg
  • Tablets levodopa 175 mg, carbidopa 43.75 mg, entacapone 200 mg
  • Tablets levodopa 200 mg, carbidopa 50 mg, entacapone 200 mg  

 

 

Dopamine Receptor Agonists 

Amantadine hydrochloride

  • Capsules 100mg
  • Syrup 50mg in 5mL  

 

Apomorphine hydrochloride (Amber SCG) (Shared Care Guidlines)

  • APO-go PEN 10mg/ml; 3ml Pen Injector
  • APO-go PFS 5mg/ml; 10ml prefilled syringe
  • APO-go 10mg/ml ampoules; 2ml and 5ml amps

 

Cabergoline

  • Tablets 1mg, 2mg

Notes:

  • Cabergoline: Please remember to optimize patient's prescription as their doses change; two 1mg tablets are considerably more costly than one 2mg tablet.

 

Pergolide

  • Tablets 50micrograms, 250micrograms, 1mg

 

Pramipexole

  • Tablets 88micrograms, 180micrograms, 350micrograms, 700micrograms
  • Modified Release Tablets 260micrograms, 520micrograms, 1.05mg, 1.57mg, 2.1mg, 2.62mg, 3.15mg

 

Ropinirole

  • Tablets 1mg, 2mg, 5mg
  • Starter pack (250micrograms, 500micrograms and 1mg tablets)
  • Modified Release Tablets 2mg, 4mg, 8mg

 

Rotigotine

  • Transdermal patch 2mg in 24 hours, 4mg in 24 hours, 6mg in 24 hours, 8 mg in 24 hours  

 

 

Monoamine-oxidase B inhibitors 

Rasagiline

  • Tablets 1mg

 

Selegiline hydrochloride

  • Tablets 5mg, 10mg  

 

 

 

 

 

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only

 

Return to Chapter: 4. Nervous System

Last updated by: Sheila Wood on 25-07-2019 10:58