Inappropriate Antidopaminergic Drug Use in Parkinson's Disease Inpatients

Introduction: Many patients with Parkinson's disease (PD) require hospitalization for medical or surgical problems other than motor features of PD, and are often admitted to non-neurological wards. Objectives: To assess the prevalence of inappropriate antidopaminergic drug use (prescription and administration) among PD inpatients. Other objectives were to study an association between chronic antidopaminergic prescription and the prevalence of inappropriate drug use in PD inpatients and to assess omission of chronic anti-PD treatment during admission. Methods: Patients with PD admitted to a small acute care hospital with no Neurology ward from January 2009 to August 2011 were identified through hospital discharge data. Medical notes, nursing notes, and drug charts were reviewed retrospectively. Results: 73 admissions from 47 patients were included in the study. Prevalence of inappropriate antidopaminergic prescription was 43,8 %. Antipsychotics (mainly haloperidol) were prescribed in 24 admissions and administered in 11. Metoclopramide was prescribed in 17 admissions and administered in 9. 14/73 admissions were on chronic antipsychotics; mostly on quetiapine. Chronic domperidone was prescribed in 9/73 admissions. Chronic antipsychotic use was positively associated with inappropriate antipsychotic administration: OR = 8,1 CI 95% (2,0-32,85). Chronic anti-PD prescription was omitted in 12/73 admissions. Conclusion: Although not always administered, inappropriate antidopaminergic drugs were very frequently prescribed in PD inpatients. Patients on chronic antipsychotics had an 8 fold risk increase of inappropriate antipsychotic administration. Chronic antiemetic treatment was correct in most of the cases, and domperidone was frequent in the outpatient setting. Omission of anti-PD medication was quite frequent. Protocols and health care professionals' education would be helpful to improve the care of PD inpatients.