Medications to Avoid or to Use with Caution If You Have Parkinson’s

Antipsychotics are medications that are used to treat a variety of mental health conditions that involve psychosis. Examples include:

• schizophrenia
• bipolar disorder
• severe depression

Some antipsychotics block dopamine receptors in the brain. This means that dopamine can’t bind and act through them.

Because the motor symptoms of PD are caused by low dopamine levels, using antipsychotics can make these symptoms worse.

Psychosis, including hallucinations and delusions, affects an estimated 20%–40% of people with PD.

Pimavanserin (Nuplazid) is an antipsychotic medication specifically approved to treat PD-associated psychosis.

The Parkinson’s Foundation also notes that the atypical antipsychotics clozapine (Clozaril) and quetiapine (Seroquel) can also be used for PD-associated psychosis.

Narcotics and analgesics are used to reduce pain. Some of these drugs can interact with PD medications called monoamine oxidase B (MAO-B) inhibitors.

MAO-B inhibitors block an enzyme that breaks down dopamine in the brain, leading to an increase in dopamine levels in the brain. MAO-B inhibitors used in the treatment of PD are:

• selegiline (Eldepryl, Deprenyl, Zelapar)
• rasagiline (Azilect)
• safinamide (Xadago)

Using MAO-B inhibitors with certain narcotics or analgesics increases the risk of developing serotonin syndrome. This is a potentially life threatening condition where serotonin levels in the body are too high.

If you have PD and need to use pain-relieving medications, talk with your doctor about options that will be safe and effective for you.

Antidepressants are used to treat mental health conditions like depression and anxiety.

Certain antidepressants can interact with the MAO-B inhibitors selegiline, rasagiline, and safinamide. When this happens, it can result in a dangerously high spike in blood pressure.

Others, such as the herbal supplement St. John’s wort, block dopamine receptors in the brain, which can worsen the motor symptoms of PD.

Depression is common in PD, affecting at least 50% of people with living with PD. Some of the antidepressant medications that may safely be used to treat depression in people with PD are:

• selective serotonin reuptake inhibitors (SSRIs) like citalopram (Celexa) and sertraline (Zoloft)
• serotonin and norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor)
• mirtazapine (Remeron)

It’s typically not recommended to give an SSRI and MAO-B inhibitor together due to the risk of serotonin syndrome. However, when the potential benefit outweighs the risk, a doctor may prescribe them together at lower doses and closely monitor for symptoms of serotonin syndrome.

One 2018 study, which examined potential interactions between MAO-B inhibitors and SSRIs, found that seratonin syndrome occurs rarely, as long as the patient doesn’t take more than the recommended dose and the SSRI is prescribed at the lower end of the therapeutic range.

Non-medical treatments like psychotherapy or electroconvulsive therapy may also be beneficial for people with PD and depression.

Some types of cold and allergy medications, such as cough suppressants and decongestants or stimulants, interact with PD medications.

Specifically, these medications can interact with the MAO-B inhibitors selegiline, rasagiline, and safinamide. This can prevent these medications from working properly and may also boost your risk of side effects.

If you’re shopping for cold or allergy medications, the key is to carefully read the labels and avoid products that contain any of the above active ingredients.

Your doctor is also a great resource to suggest alternative cold and allergy medications that won’t interact with your PD medications.

Antiemetics help to ease nausea and vomiting. A variety of these drugs can block dopamine receptors in the brain, leading to a worsening of PD motor symptoms.

The anti-nausea drug most commonly used with PD is ondansetron (Zofran).

Blood pressure drugs help to lower blood pressure in people with high blood pressure.

Methyldopa (Aldomet) can affect an enzyme that converts levodopa, a very common PD medication, to dopamine in the brain. When this happens, it means that levodopa may be less effective at managing your PD symptoms.

Meanwhile, reserpine (Serpalan) can decrease levels of dopamine in the brain, meaning that it can make your PD motor symptoms worse.

If you have PD, there are many alternative blood pressure medications that you can discuss with your doctor. A few examples include beta-blockers, ACE inhibitors, and ARBs.

Muscle relaxants can help with muscle pain and spasms. The muscle relaxant cyclobenzaprine (Flexeril) can interact with the MAO-B inhibitors selegiline, rasagiline, and safinamide and cause dangerously high blood pressure.

If you have PD, there are other muscle relaxants that may be used instead of cyclobenzaprine.

Additionally, if you have PD and experience repetitive muscle spasms or cramps (dystonia) other treatments may be beneficial, such as:

• adjusting the dose or frequency of your PD medications
• trying Botox injections
• participating in physical or occupational therapy
• using deep brain stimulation

There are several types of medications that should be avoided or used with caution if you have PD. This is because these medications may interact with your PD medications or lead to your PD symptoms becoming worse.

If you have PD, it’s important to have an open conversation with your doctor about which medications to avoid or use with caution. This includes both prescription and over-the-counter medications.

In many situations, alternative medications may be available. Your doctor can also help to recommend alternative medications that don’t interact with your PD medications or make your symptoms worse.