Ensure the patient is aware that the PD medication is to control their symptoms rather  than cure their disease, and that they will need to be on the treatment indefinitely. Specific PD medications will target motor symptoms/dyskinesias.

Medical professionals often refer to PD medications by their brand names. Internet forums sometimes allude to there being a difference in efficacy between branded and generic versions, which can be a cause of concern to a patient. There is no stipulation that PD medications must be prescribed by brand.

The medication regimen is tailored to each individual person because PD affects people differently. Symptoms can vary between people hour by hour and minute by minute. Drug regimen and timings are specific for each person and it is this personalised approach that produces the best outcomes.

It is important that each patient takes their medications at a time that is right for them. This is usually when the last dose is starting to wear off – a key point to reinforce.

Some patients do not start their medicines immediately. They could have fears about side-effects and/or a poor understanding of what the medicine is for. Use the consultation to determine and provide assurance for any inhibitions the patient may have about taking the medicine(s).

Patients with PD sometimes miss doses of their medicines. People may forget to take their medicines for a variety of reasons. Sometimes there is cognitive decline and/or some early memory loss. Advise patients to set timers or use compliance aids to help with timely medication administration.

There may be support from carers, who can help with medicines administration. Family members can also help to prompt timely administration.

PD medications provide control of symptoms throughout the day and relieve the main motor symptoms such as rigidity/stiffness and tremor

In the early stages of PD, a patient may not notice when a dose of levodopa begins to wear off. You can explain on/off periods as ‘on’ being when a person’s symptoms are controlled and they are feeling at their most capable, whereas ‘off’ is when a person’s symptoms recur and are most debilitating

By asking if they notice when the medicine is not working, you are checking for ‘off’ periods. Tweaking of timings to take medications is usually beneficial. It is about making sure that the medication is taken at the optimal times to keep symptoms controlled

You could suggest that the patient keeps a medication diary and offer to review this or encourage them to take it to their next  appointment with their specialist.

You can use the PIL to point out common side-effects of PD medications and explain what “common” means in this context.

• Hallucinations/drug-induced psychosis are more common with levodopa and dopamine agonists
• Nausea is common and domperidone is often co-prescribed for the first two to four weeks of treatment, by which time the nausea is likely to have subsided. If it hasn’t, domperidone can be continued and taken on a ‘when necessary’ basis
• Mention sudden onset of sleepiness (including in the daytime), particularly when doses of levodopa or dopamine agonists are increased/adjusted and advise not to drive or operate heavy machinery until established on the new dose
• For patients who are newly started on dopamine agonists, the prescriber should already have checked for baseline addictive behaviours as these can be a warning for further development of compulsive behaviours. Use the PIL to point out the relevant information to the patient and ask if it was discussed with them. Report any worsening of these behaviours to the specialist
• Discuss the importance of not abruptly stopping PD medicines without consulting their specialist as this can lead to acute akinesia or, in some cases, neuroleptic malignant syndrome.

Swallowing difficulties can be an issue for people with PD and can occur at any stage. Different formulations can help. You may notice excess saliva or drooling during your consultation, which can be a sign of swallowing difficulties for the patient.

Tremor, shaking and rigidity are all common symptoms of PD and getting medicines out of their packaging can be difficult. Offer some compliance aids to help.

If a person is taking levodopa it is best to avoid supplements that contain iron as it reduces the bioavailability of levodopa, lowering efficacy. If a person is on a MAO-B inhibitor, OTC preparations containing sympathomimetic (e.g. pseudoephedrine) are contraindicated.

Non-pharmacological treatment of motor and non-motor symptoms is important. Encourage patients to engage in regular exercise, as this can slow progression of symptoms in PD.

Patients may ask about the interaction between protein and levodopa as this is widely documented. Those who experience motor fluctuations on levodopa can be advised to follow a protein redistribution diet. Lowering protein intake during the day can maximise the effectiveness of levodopa treatment. It is important that patients don’t cut their total daily protein consumption but reduce it during the day and leave most intake to the final main meal of the day.

People with PD are required to inform the DVLA and could be fined up to £1,000 if they don’t. Driving ability could be affected by sudden onset of sleep due to certain medications, levels of alertness, reaction times, decision-making and tremor.