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Review
February 2017

Recommendations for the Treatment of Patients With Parkinson Disease During Ramadan

Author Affiliations
  • 1Centre Hospitalier Universitaire Nantes
  • 2INSERM, Hôpital Laennec, Nantes, France
  • 3Department of Neurology, Ibn Sina Hospital, Kuwait
  • 4Department of Medicine, University of Kuwait, Al-Khaldiya, Kuwait
JAMA Neurol. 2017;74(2):233-237. doi:10.1001/jamaneurol.2016.4291
Key Points

Question  How can clinicians manage Parkinson disease treatment during Ramadan?

Findings  To our knowledge, there are no published recommendations on the medical management of Parkinson disease during Ramadan. Given the safety and efficacy of overnight switch between dopamine agonists and the existence of tables enabling an equivalent dosage of levodopa of any antiparkinsonian drug combination to be calculated, we suggest switching the patient’s treatment overnight to an equivalent dosage of a dopamine agonist that can be administered once daily or by transdermal patch.

Meaning  Switching the patient’s treatment to an equivalent dosage of a dopamine agonist that can be administered once daily or by transdermal patch is a reasonable option to consider for patients treated with low-to-moderate amount of Parkinson disease medication.

Abstract

Importance  Every year, Ramadan fasting is practiced by many Muslim individuals. In cases of chronic disease, religious texts allow fasting to be broken. However, many believers still want to fast even at the risk of damaging their health. To our knowledge, there are no published recommendations on the medical management of Parkinson disease (PD) during Ramadan. Effective treatments exist in PD and usually require several daily drug intakes. Apart from worsening symptoms, interrupting PD treatment might lead to a severe withdrawal syndrome.

Observations  Although no specific studies on this topic have led to formal recommendations, we suggest some options for adapting the treatment for patients who fast during Ramadan. The general principle is based on switching the patient’s treatment to an equivalent dosage of a dopamine agonist that can be administered once daily or by transdermal patch. However, such an option is only feasible for patients who require a moderate amount of PD treatment and can tolerate dopamine agonist therapy.

Conclusions and Relevance  Because many patients with PD require regular multiple daily administration of dopamine-replacement medication, the management of Ramadan fasting is not easy. Switching the patient’s treatment to an equivalent dosage of a dopamine agonist that can be administered once daily or by transdermal patch seems to be a reasonable option to consider for patients treated with a low-to-moderate amount of PD medication.

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