NICE issues recommendations for management of Parkinson’s disease and prostate cancer
People with Parkinson’s disease admitted to hospital or to care homes should receive their medicines at appropriate times, which may mean allowing self-medication, according to a guideline published by the National Institute for Health and Clinical Excellence this week. In addition, medication should be adjusted only by, or after consultation with, a specialist. The guideline states that it is not possible to identify a universal first-line drug therapy for Parkinson’s disease. Choice will depend on clinical and lifestyle characteristics, and on patient preferences after they have been informed of the short- and long-term benefits and drawbacks of drug classes, it says.
Drugs that can be considered first for early disease include levodopa, dopamine antagonists and monoamine-oxidase-B inhibitors. For adjuvant therapy in later Parkinson’s disease, NICE recommends dopamine agonists, monoamine-oxidase-B inhibitors and catachol-o-methyltransferase inhibitors.
The guideline advises that, to avoid the potential for acute akinesia or neuroleptic malignant syndrome, medication should not be stopped abruptly (including for so-called drug holidays) or allowed to fail suddenly due to poor absorption.
People with suspected Parkinson’s disease should be referred, untreated, to a specialist for diagnosis within six weeks, says NICE. The guideline recommends that diagnosis should be reviewed every six to 12 months and reconsidered if atypical clinical features develop. It specifies that acute levodopa and apomorphine challenge tests should not be used in the differential diagnosis of parkinsonian syndromes.
Regular access to specialist nursing care, physiotherapy, occupational therapy, speech and language therapy and palliative care is also recommended in the guideline.
In separate guidance, NICE recommends the use of docetaxel as a treatment option for men with hormone-refractory metastatic prostate cancer, within its licensed indications. The guidance specifies that treatment should be stopped at the completion of planned treatment of up to 10 cycles, if severe adverse events occur, or in the presence of progression of disease as evidenced by clinical or laboratory criteria, or by imaging studies.
NICE has also issued guidance this week on atrial fibrillation and on improving outcomes in brain and other central nervous system cancers.
All NICE guidance documents can be accessed via the NICE website.
Correction
"Dopamine antagonist" in this news item should read "dopamine agonist".
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