Respecting the Patient’s Choice: A Case of Possible Drug-Induced Parkinsonism

Abstract

This report describes a case of likely drug-induced Parkinsonism (DIP) identified by the pharmacist. A 54-year-old female patient was referred by a physician to the pharmacist in a rural, integrated care team for a comprehensive medication review (CMR) to address the patient’s concerns of possible Parkinson’s disease (PD). While PD may occur over the progression of age, medications that affect dopamine transport can also cause DIP, a secondary form of Parkinson’s disease. Although PD and DIP may be clinically indistinguishable, differentiation may be possible by reviewing a patient’s medication history for any potential causative drugs correlating to the timeline of the onset of symptoms. In this case, the pharmacist reviewed the medication profile and identified medications that could be responsible for causing DIP, specifically bupropion. The pharmacist suggested discontinuing bupropion and identifying another option for treating depression. The patient appreciated the suggestion and education, but ultimately preferred continuing her bupropion therapy instead of discontinuing therapy or changing to an alternative agent. At a follow-up meeting with the pharmacist, not only was the patient still experiencing tremors despite taking carbidopa/levodopa, but additional medications known to be potential inducers of tremors were added to her regimen. Although the pharmacist repeatedly discussed DIP with the patient and believed stopping bupropion would determine whether her Parkinsonism was PD or DIP, ultimately the patient continued taking bupropion because of concerns related to depression severity and the impact on her well-being. The patient’s wishes were respected.

Drug induced Parkinson’s: A comprehensive review of the issues and measures required to tackle the same

“…In this reported case, a 54-year-old female patient with suspected Parkinson's disease or drug-induced Parkinsonism (DIP) was advised by a pharmacist to discontinue bupropion, a potential causative drug for DIP; however, the patient chose to continue bupropion due to concerns about depression severity, and recovery outcomes or symptom resolution were not specified in the case, emphasizing the importance of patient preferences in treatment decisions [40].…”

Medicine Use in Chronic Diseases

“…Aldarwesh et al, in a study among patients with autoimmune rheumatic disease where hydroxychloroquine has the potential for ocular toxicity, reported a lack of communication between patients and providers about the risk for retinopathy [ 2 ]. On the other hand, a case study reported by Undeberg et al from a rural town in the United States showed the importance of respecting the patient’s decision even when it does not align with the recommendation from the provider [ 3 ].…”