Assessment of Rotigotine patch in Parkinson’s disease patients


By Dr Shital Shah, Consultant Physician, Frimley Health NHS Foundation Trust

Introduction:

Parkinson medications are critical and become challenging when patients are admitted to the hospital in an emergency situation with an illness and swallow difficulty. Failure to administer medication can increase the risk of aspiration and also the risk of neuroleptic malignant syndrome.

Objectives:
  • Our objectives were to know whether the correct dose of rotigotine patch is given.
  • To know whether the correct dose is used in the case of delirium or dementia
  • I used the optimal calculator as a gold standard reference (available online and intranet)
Method

I studied 70 cases of emergency admissions of Parkinson patients between September 2020 and January 2021. Out of this, 14 patients were prescribed with a patch during impatient stay. Records were obtained by hospital pharmacy database by using electronic record system. The optimal calculator used for drug conversion by clinicians and also guided by pharmacist.

Calculator 1:

For conversion to dispersible medications via nasogastric tube

Calculator 2:

For conversion to transdermal patch when there is a failure of GI route.

In all cases in our study, calculator 2 was used

Results:

A total of 70 Parkinson patients were studied in which 14 patients patch prescribed. Age range was between 46 to 106.

In 8 patients, correct dose was prescribed (calculated by optimal calculator). In 2 patients, day 1 medication was missed. No patch was given (query risk of aspiration). The next day, patients were started with regular oral medications. In 1 patient, an incorrect dose of the patch was given. The next day the patient was switched to oral medication. 2 patients were continued with patch along with oral medications. In 1 patient, reduced dose was given due to delirium/dementia.

Discussion:

Our results suggest that adequate dose prescription by use of optimal calculator was done for conversion of oral Parkinson medications to dopa equivalent dose of rotigotine in 79% of cases. Clinician needs to be more aware of urgent bedside swallow assessment on acute admission to prevent the risk of omission of medications and prescribe patch in case of difficulty. Our study showed 14% of patients – this problem was noticed. In 7% of patients, an inadequate dose was prescribed.

Conclusion:

Optimal calculator is a standard method for the conversion of oral Parkinson medications to patch form. Rotigotine patch is widely used when there is a failure to use Gastrointestinal route. It is important for standardised method to be used when converting oral PD medication to Rotigotine.

Recommendations:

Optimal calculator should be for mandatory use for all treating clinicians and pharmacists.

Poster

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