From the Guidelines
Managing nausea and appetite loss in Parkinson's disease requires a multi-faceted approach, prioritizing adjustments to Parkinson's medications and considering domperidone (10mg three times daily before meals) to control nausea without worsening symptoms, as evidenced by recent studies 1. First, adjust Parkinson's medications as these symptoms are often side effects of dopaminergic drugs like levodopa and dopamine agonists. Taking medications with small meals or snacks can reduce nausea. For appetite stimulation, consider small, frequent meals that are visually appealing and easy to eat. Ginger tea, ginger candies, or supplements (250-500mg twice daily) may help reduce nausea naturally, as suggested by various studies 1. Ensure proper hydration and consider nutritional supplements like Ensure or Boost if weight loss occurs. Addressing constipation with increased fiber intake and adequate fluids can also improve appetite. Some patients benefit from medical cannabis where legal, or prescription appetite stimulants like mirtazapine (15mg at bedtime). These approaches work because they either directly address the gastrointestinal side effects of Parkinson's medications or help manage the autonomic nervous system dysfunction that often accompanies the disease and affects digestive function, as noted in recent clinical guidelines 1. It is also crucial to monitor vitamin status, particularly vitamin D, and consider supplementation to slow disease progression and reduce the risk of fractures, as recommended by recent research 1. Overall, a comprehensive management plan should prioritize minimizing morbidity, mortality, and improving quality of life for patients with Parkinson's disease, as supported by the most recent and highest quality studies 1.
From the FDA Drug Label
Carbidopa may also reduce nausea and vomiting and permit more rapid titration of levodopa.
The use of carbidopa in combination with levodopa may help manage nausea and appetite loss in patients with Parkinson's disease by reducing nausea and vomiting, allowing for more rapid titration of levodopa 2.
- Key benefits of using carbidopa with levodopa include decreased peripheral decarboxylation of levodopa and potential reduction of nausea and vomiting.
- This combination may be considered as a treatment option to help alleviate nausea and appetite loss in patients with Parkinson's disease.
From the Research
Nausea and Appetite Loss in Parkinson's Disease
- Nausea and appetite loss are common non-motor symptoms in patients with Parkinson's disease 3
- Possible determinants of weight loss in Parkinson's disease include loss of appetite, impaired hand-mouth coordination, difficulty in chewing and dysphagia, nausea, intestinal hypomotility, and increased energy requirements due to muscular rigidity and involuntary movements 3
- Nausea and vomiting can significantly affect the quality of life of patients with Parkinson's disease, and management strategies are crucial to improve their well-being 4
Management of Nausea and Appetite Loss
- Treatment of nausea and vomiting in Parkinson's disease is challenging due to the limited options available, as antiemetics that antagonize central dopamine can exacerbate motor control or precipitate Parkinsonism-hyperpyrexia syndrome 4
- Quetiapine has been successfully used for the management of nausea and vomiting in an individual with idiopathic Parkinson's disease, providing a potential option for patients with limited treatment choices 4
- Hospital pharmacists play a crucial role in the pharmacotherapeutic management of inpatients with Parkinson's disease, and protocols for handling nausea and vomiting are considered a main improvement area 5
Nutrition and Weight Management
- Monitoring weight and nutritional status should be part of Parkinson's disease management, as low body weight is associated with negative health effects and a poor prognosis 3
- Noticeable weight gain has been reported after subthalamic or pallidal deep brain stimulation, highlighting the importance of nutrition and weight management in patients with Parkinson's disease 3