We read the publication by Mann et al. regarding the PRISCUS List 2.0 with great interest (1). Adapting pharmacotherapy to the special requirements of elderly persons is without argument justified, but the dichotomization created by the Delphi procedure into “potentially inadequate medication” (PIM) or non-PIM has resulted in recommendations that lack a scientific evidence base and deviate from the clinical expert consensus of the international Parkinson specialist societies. The following evaluations of anti-Parkinson medications are partly implausible and misleading:
All MAO-B inhibitors are classified as PIM and recommended as an alternative to the dopamine agonist ropinirole (and in the detailed PRISCUS LIST rotigotine), although dopamine agonists were identified as clearly having more adverse effects in a large “real world” comparison study (2).
Ropinirole (and rotigotine) are listed as an alternative to two non-ergot-dopamine agonists that were classified as PIM: piribedil and pramipexole. As regards geriatric adverse effects, differences between these dopamine agonists can’t be concluded for hallucinations/delirium nor for orthostasis (3).
Amantadine should in fact be used restrictively on older persons and current guidelines recommend it only in case of dopaminergic induced hyperkinesia as the medication of choice. In this indication the use of levodopa or dopamine agonists as recommended in the PRISCUS List is counterproductive.
In sum, the recommendation concluded from the PRISCUS List to use preferentially dopamine agonists as alternatives to MAO-B inhibitors or amantadine in older persons is misleading and even dangerous in geriatric patients because of the particularly high risk of adverse effects of dopamine agonists. We advise a revision of the recommendations of the PRISCUS List for anti-Parkinson treatment with support and input from neurologists.
Footnotes
Conflict of interest statement
GE received payments from AbbVie, Esteve, Stada, BIAL, and Desitin for participating in advisory boards. He was paid lecture fees by AbbVieBial,, Esteve, Stada, und Zambon.
TW received advisory fees from AbbVie, Zambon, Biall, and Kyowa. He was paid lecture fees by AbbVie, Bial, Desitin, Zambon, Stada, and Esteve.
References
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