Compulsive gambling, excessive sexual urges and obsessive shopping are among side effects from a Parkinson’s disease drug that specialist nurses should watch out for, says guidance on the condition.
It highlighted that such side effects can sometimes result from dopamine therapy, which is often used to treat Parkinson’s disease.
“The new guidelines mean that people should be offered clear information and consistent support at all stages of their condition”
The updated guideline on diagnosing and treating Parkinson’s in adults, published by the National Institute for Health and Care Excellence, features new advice on monitoring and managing “impulse control disorders”.
These can include compulsive gambling, hypersexuality, binge eating and obsessive shopping habits, and should be discussed with patients and their carers when starting treatment, said the guidance.
Such disorders can develop at any time in a patient with Parkinson’s on any form of dopaminergic therapy, it noted.
However, those most at risk include those on dopamine agonist therapy, and those with a history of impulsive behaviour, drinking alcohol or smoking, according to NICE.
Clinicians should be aware patients may try and conceal their behaviour, added the guidance, which said these potential side effects should be routinely discussed at review appointments.
“This drug is a lifeline for a small number of people in the advanced stages of the condition”
The guideline also includes new recommendations about drugs for managing motor and non-motor symptoms of Parkinson’s disease, advice on managing Parkinson’s disease dementia and for making referrals to occupational and speech and language therapy and nutritional support.
The charity Parkinson’s UK said the guidelines, which update a previous version from 2006, showed “enhanced understanding and awareness of the support needed by people affected by Parkinson’s”.
“The new guidelines mean that people with Parkinson’s, and their families and carers, should be offered clear information and consistent support at all stages of their condition – as well as early access to therapies,” said charity chief executive Steve Ford.
However, he said there were still “areas of concern”, including that a question mark now hung over the availability of one form of treatment for those in the advanced stages of Parkinson’s disease.
The treatment – called levodopa-carbidopa intestinal gel and marketed as Duodopa – was only recently made available on the NHS after a hard-fought campaign by Parkinson’s UK and others.
However, the new NICE guidance said NHS England should review its policy on the expensive intervention.
The treatment – which enables a key drug to be delivered direct into the gut in the form of a gel via a pump and tube – can help transform the lives of with advanced Parkinson’s, who have exhausted all other options.
Parkinson’s UK said it was a “lifeline” for the small number of people who benefited from the treatment. “The recommendation that NHS England reviews its clinical commissioning policy for Duodopa could be disastrous for people with Parkinson’s,” said Mr Ford
“There is currently no cure, and medication is the only way to manage people’s often highly debilitating symptoms,” he said. “This drug is a lifeline for a small number of people in the advanced stages of the condition who have exhausted all other medical options.
“We are very concerned that this new guidance makes it unclear whether or not patients across England will be able to access this essential treatment,” he added.
Parkinson’s drug can spark gambling and sexual impulses
Duodopa is currently available on the NHS in Northern Ireland and Scotland, and Mr Ford warned that an “unfair postcode lottery” could potentially be created by denying the treatment to patients with Parkinson’s in England and Wales.
“We will be discussing this matter with NHS England as a priority, and encouraging them to continue funding the drug for people with Parkinson’s now and in the future,” he said.
A NICE spokesman said its guideline committee had concluded that levodopa was much more expensive than best medical treatment for Parkinson’s disease, and that it was also both “less effective and more expensive” than deep brain stimulation.
“The committee concluded that NHS England review their commissioning policy for levodopa-carbidopa intestinal gel in light of this guidance,” he said.