Patients with Parkinson’s disease (PD) who had their medication switched because of shortages have been detrimentally affected by the change, a leading UK charity has said.
In a press release, published on 30 January 2023, Parkinson’s UK said patients had been left with “devastating effects” after being given prescriptions for a mixture of both Sinemet (Carbidopa/levodopa; Organon Pharma UK) and its generic version, co-careldopa; with some patients not consulted about the change before it happened.
The charity cited the example of one patient, who had lived well with PD for 17 years, developed slow speech, and was left in pain and with an uncontrolled tremor after his normal branded medication was switched to generic co-careldopa.
Janine Barnes, a neurology specialist pharmacist at the Dudley Group NHS Foundation Trust and founder of the Parkinson’s Disease Specialist Pharmacy Network (PDSPN), said that “numerous people” with PD had informed her that they had lost control of their symptoms when their branded medication was switched to generic.
“Medical colleagues often believe that this is not the case as the active drug received by the patient remains constant but, in my experience, the change in drug diluent, absorption characteristics etc., can have a dramatic effect on symptom control,” she said.
“We advise people with [PD] to request a specific brand on their prescription, if they find that it works better for them, and then legally this brand will be dispensed by their pharmacist.”
Barnes said changes should not be made without discussion with the patient and the original medication brand should be supplied as soon as it becomes available again.
“I do not believe that the specialist needs to be involved in these conversations as the pharmacist can manage these discussions and ensure that a patient is prescribed the same product as previously or returned to the initial product as soon as it becomes available again,” she added.
“I think that involving a specialist in these decisions will slow the process down considerably in view of current NHS pressures and is unnecessary.”
Stephanie Bancroft, a community pharmacist and chair of the PDSPN, said that past shortages in supply of Sinemet — most recently in 2020 — were “challenging for everyone” and a change from branded to generic had sometimes been necessary to avoid the patient going without medication.
“Cost savings is [another] possible reason that medications may be switched from branded to generic,” she added.
“There is an NHS policy in place to do this, where possible, but in the case of [PD] medications, the cost savings are not as evident as with some other drugs.”
However, she added: “If a patient has been stabilised on Sinemet by their consultant, this should not be changed to a generic version by their GP without discussing the change with the consultant and patient.”