Published 4 August 2009, doi:10.1136/bmj.b3145
Cite this as: BMJ 2009;339:b3145

Letters

Heat waves and the elderly

Drugs for Parkinson’s disease

The first 100% of the full text of this article appears below.

That drugs for Parkinson’s disease should be reconsidered, stopped, or reduced in managing older people during heat waves needs to be challenged.¹

Missed (or even reduced) doses of dopaminergic agents such as levodopa or dopamine agonists have been associated with the potentially life threatening condition neuroleptic malignant-like syndrome.^{2 3} This condition, which is associated with confusion, rigidity, fever, and raised muscle enzyme activities, is more likely in dehydrated people and during hot weather.⁴

The advice should be for patients to continue their usual treatment (unless advised by a movement disorder specialist that they are being overtreated) and focus on ensuring adequate hydration. Any other approach could undermine the important message that patients with Parkinson’s disease require the correct treatment every time.⁵

Cite this as: BMJ 2009;339:b3145

¹ Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield S44 5BL

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Competing interests: None declared.

1. Olde Rikkert MG, Melis RJ, Claasen JA. Heat waves and dehydration in the elderly. BMJ 2009;339:b2663. (2 July.)[Free Full Text]
2. Kipps CM, Fung VS, Grattan-Smith P, de Moore GM, Morris JG. Movement disorder emergencies. Movement Disorders 2005;20:322-34.[CrossRef][Web of Science][Medline]
3. Morris J, Douglas A. It was not just a heatwave! Age Ageing 2006;35:640-1.[Abstract/Free Full Text]
4. Takubo H, Harada T, Hashimoto T, Inaba Y, Kanazawa I, Kuno S, et al. A collaborative study on the malignant syndrome in Parkinson’s disease and related disorders. Parkinsonism and Related Disorders 2003;9(supp 1):31-41.[CrossRef]
5. Parkinson’s Disease Society. "Get it on time" campaign. www.parkinsons.org.uk/about_us/policy_and_campaigns-1/current_campaigns/get_it_on_time_campaign.aspx

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Heat waves and dehydration in the elderly

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