{ "schema_version": 1, "kind": "condition", "id": "parkinsonism", "name": "Parkinsonism", "category": "chronic", "sources": "ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class ND66 - condition scope only, no dose · Parkinson Disease - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470193/ · Parkinsonism - disease-level clinical article (parkinsonism-clinical.txt)", "review_status": "reviewed", "verified_against": "Parkinsonism - disease-level clinical article (parkinsonism-clinical.txt)", "verified_date": "2026-09", "treatments": [ { "id": 1372, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "A clinical syndrome of tremor, rigidity, bradykinesia, and postural instability that can be idiopathic Parkinson's disease, drug-induced, or from another cause; the GP's key task is checking for and stopping an offending drug such as an antipsychotic or metoclopramide, and referring to neurology for diagnosis and treatment initiation.", "adult_duration": "Refer, with advice", "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": "A clinical syndrome of tremor, rigidity, bradykinesia, and postural instability that can be idiopathic Parkinson's disease, drug-induced, or from another cause; the GP's key task is checking for and stopping an offending drug such as an antipsychotic or metoclopramide, and referring to neurology for diagnosis and treatment initiation.", "cautions": [ "RED FLAG - Severe dysphagia leading to aspiration pneumonia: assess urgently and refer.", "Referral confirms the diagnosis and looks for the cause. Where the cause is a drug, stopping that drug comes first and often resolves the symptoms on its own; the medicines below are for what persists after that.", "RED FLAG - Levodopa must not be stopped abruptly - abrupt withdrawal risks neuroleptic malignant syndrome. This is separate from recognising and stopping an offending drug such as an antipsychotic.", "RED FLAG - Rapid onset or symmetrical parkinsonism suggesting a drug cause rather than idiopathic disease, early falls or cognitive decline (possible atypical parkinsonism), or swallowing difficulty." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children follow the same pathway: recognise and refer. Neither medicine below is a primary-care paediatric treatment.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "parkinsonism" }, { "id": 1373, "generic": "Trihexyphenidyl", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": null, "adult_dose": "0.5 to 1 mg twice daily, increased gradually to 2 mg three times daily", "adult_duration": "long-term", "dose_source": "Parkinsonism - disease-level clinical article (parkinsonism-clinical.txt)", "rationale": "The article uses anticholinergics for the tremor and rigidity of parkinsonism and specifically for the drug-induced form, naming trihexyphenidyl and benztropine.", "cautions": [ "In drug-induced parkinsonism the first step is stopping the causative drug, which on its own resolves the symptoms. Where an antipsychotic is needed for a psychiatric illness, the article prefers an atypical one for its lower risk.", "In the elderly this is the drug to be careful with: confusion and hallucinations, and the antimuscarinic effects - dry mouth, constipation, urinary retention and tachycardia - which together add up to a falls risk. Start at the bottom of the range and stop it if the patient becomes confused.", "The Egyptian formulary's own parkinsonism range is higher, 6 to 10 mg daily in 3 or 4 divided doses. The dose above is the article's lower starting range. The two sources do not agree, and both are stated rather than one being chosen silently." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not a primary-care paediatric indication; refer.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "PARKINOL 5 MG 100 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 55.0, "pack_count": 100, "unit_price": 0.55, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "parkinsonism" }, { "id": 1374, "generic": "Amantadine", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 100.0, "adult_dose": "100 mg two or three times daily", "adult_duration": "long-term", "dose_source": "Parkinsonism - disease-level clinical article (parkinsonism-clinical.txt)", "rationale": "The article's option for drug-induced parkinsonism when anticholinergics have not worked. It blocks NMDA and acetylcholine receptors, and comes as 100 mg immediate-release tablets or capsules.", "cautions": [ "In drug-induced parkinsonism the first step is stopping the causative drug, which on its own resolves the symptoms. Where an antipsychotic is needed for a psychiatric illness, the article prefers an atypical one for its lower risk.", "Excreted by the kidney - use with caution and a lower dose in kidney impairment.", "Livedo reticularis and pedal oedema are the common adverse effects." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not a primary-care paediatric indication; refer.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "AMANTINE 100MG 24CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 6.0, "pack_count": 24, "unit_price": 0.25, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VIRAFLU 100MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 4.0, "pack_count": 10, "unit_price": 0.4, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ADAMINE 100MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA", "price_egp": 18.0, "pack_count": 20, "unit_price": 0.9, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "INFEX 100MG 60 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)", "price_egp": 54.0, "pack_count": 60, "unit_price": 0.9, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PK-MERZ 100 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MARCYRL PHARMACEUTICAL INDUSTRIES (MPI) > MERZ", "price_egp": 27.0, "pack_count": 30, "unit_price": 0.9, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "parkinsonism" } ] }