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4.9 Drugs used in parkinsonism and related disorders

4.9.1 Dopaminergic Drugs

Amantadine capsules, elixir
Apomorphine injection (see shared care guidelines). See also note below.
Co-beneldopa capsules (Madopar, Madopar CR) dispersible tablets
Co-careldopa tablets (Sinemet, Sinemet Plus, Sinemet CR) tablets
Entacapone tablets
Entacapone / levodopa / carbidopa tablets
Opicapone tablets – see note below
Pramipexole tablets, MR tablets
Rasagiline tablets
Rivastigmine capsules, oral solution, patches
Rotigotine Patches
Ropinirole tablets, m/r tablets


1. Entacapone is approved as an add on therapy to levodopa in patients with end of dose motor fluctuations (See BNF). Prescribe for first three months until patient stabilised.

2. Opicapone is approved as a second line agent where entacapone is contraindicated or not tolerated due to adverse events. 

3. Rivastigmine is GREEN Specialist Initiated for patients with Parkinson's Disease Dementia Complex.

4. Selegiline has been associated with increased mortality and may therefore be unsuitable as a first line drug.

5. Patients receiving apomorphine and domperidone require an assessment of cardiac risk factors and ECG monitoring to reduce the risk of serious arrhythmia related to QT-prolongation – see DSU April 2016


4.9.2 Anticholinergic Drugs

Procyclidine tablets, syrup, injection
Orphenadrine tablets, elixir
Trihexyphenidyl tablets, syrup


4.9.3 Drugs used in essential tremor, chorea, tics and related disorders

Tetrabenazine tablets
Botulinum A toxin injection - see note
Botulinum B toxin injection - see note
Piracetam tablets, oral solution - Consultant Neurologist Initiation
Propranolol tablets, syrup
Primidone tablets, suspension
Riluzole tablets


1. Riluzole - The National Institute for Clinical Excellence (NICE) has recommended riluzole to treat individuals with the amyotrophic lateral sclerosis (ALS) form of motor neurone disease (MND) - see NICE TA20. Treatment should be initiated by a specialist in MND but it should then be supervised under a shared-care arrangement involving the general practioner.

2. Botulinum A toxin - There are three botulinum A toxin products (Botox, Dysport and Xeomin). Doses for these products are not interchangeable, and licensed indications may vary from product to product.

3. Botulinum B toxin is approved for use in the Trust for the unlicensed indication of sialorrhoea. 

Guidelines for the administration of botulinum toxin for cervical dystonia, hemi-facial spasm, blepharospasm, and sialorrhoea are available.

Link to BNF section: 4.9 Drugs used in parkinsonism and related disorders