Parkinson's Disease

Progressive neurodegenerative disease with bradykinesia plus tremor, rigidity, or postural instability. Diagnosis and the first dopaminergic prescription are made by neurology; recognition, referral, and continuing an established regimen are everyone else's job. The drugs neurology uses are on this card. - Refer, with advice

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

No dose - referral pathway, no medicine given in primary care

Progressive neurodegenerative disease with bradykinesia plus tremor, rigidity, or postural instability. Diagnosis and the first dopaminergic prescription are made by neurology; recognition, referral, and continuing an established regimen are everyone else's job. The drugs neurology uses are on this card.

Immediate-release tablets: 25 mg/100 mg (carbidopa/levodopa) every 8 hours to start; increase by one 25 mg/100 mg tablet every day or every other day as needed, to a maximum of 200 mg/800 mg (8 tablets) daily. Where more levodopa is needed: 25 mg/250 mg three to four times daily, increased in the same way, to a maximum of 200 mg/2000 mg (8 tablets) daily. Modified-release tablets: 50 mg/200 mg twice daily, adjusted at intervals of at least 2 to 4 days, up to 8 tablets daily divided into 3 or 4 doses. - Long-term; the dose is titrated to effect and not stopped abruptly

Not a paediatric prescription. The formulary does not recommend it under the age of 18, because its safety in that age group has never been established.

Egyptian National Drug Formulary - Nervous System Disorders 2025 (carbidopa and levodopa monograph, Dosage Regimen, Adult Dosing), with the indication from Parkinson Disease - StatPearls - NCBI Bookshelf - disease-level clinical article (parkinsons-disease-full.txt)

Carbidopa with levodopa is the mainstay of Parkinson's treatment - the article makes that combination the disease's principal drug therapy, and the Egyptian formulary opens its own Indications line with Parkinson's disease, so both documents agree before a dose is read. The dose is the formulary's, printed as it writes it, immediate-release and modified-release separately. Thirteen Egyptian products are registered, from LEVOCAR 100/25 mg at 18.75 EGP to SINEMET; the register files them under CARBIDOPA+LEVODOPA, which is the name the row uses. Neurology starts and titrates this - the row exists so a physician of any grade can see the regimen, continue it, and recognise what abrupt withdrawal does.

1 mg once daily as monotherapy (or as adjunct therapy without levodopa). As an adjunct to levodopa: 0.5 mg once daily, increased to 1 mg daily if needed for sufficient clinical response. - Long-term

Not a paediatric drug. The formulary states that its safety and how well it works have never been established in children or adolescents.

Egyptian National Drug Formulary - Nervous System Disorders 2025 (rasagiline monograph, Indications and Dosage Regimen, Adult dosing)

The Egyptian formulary's rasagiline monograph names this exact disease in its own Indications line and prints both regimens, so one document carries the indication and the dose - the same route the aspirin row on cerebrovascular-disease took in A5 chunk 4. Five Egyptian products are registered; DOPAMINECT 1 mg is 54 EGP for 20 tablets. It is the drug a neurologist reaches for when levodopa is being delayed in a younger patient, or when 'off' time has appeared.

Titrate weekly, base strengths: week 1, 0.088 mg three times daily; week 2, 0.18 mg three times daily; week 3, 0.35 mg three times daily. Thereafter the dose may be increased by 0.54 mg (base) at weekly intervals to a maximum of 3.3 mg (base) daily. Withdraw gradually at 0.54 mg (base) per day down to 0.54 mg daily, then by 0.264 mg (base) per day. - Long-term; escalate and withdraw gradually, never abruptly

Not a paediatric drug. The formulary does not recommend it for children or adolescents below 18 years, because the data on safety and on efficacy are lacking.

Egyptian National Drug Formulary - Nervous System Disorders 2025 (pramipexole monograph, Indications and Dosage Regimen, Parkinson's Disease)

The formulary's pramipexole monograph names Parkinson's disease first in its Indications and gives the full weekly titration, so one document carries both claims. The strengths on the row are pramipexole BASE, which is how the formulary writes them and how the tablets are labelled in Egypt: 0.25 mg of the salt is 0.18 mg of base. Nine Egyptian products are registered. Note that the register spells the ingredient PRAMIPEXOL, without the final 'e' - a search on the clinical spelling still reaches it.

100 mg once daily to start, increased to 100 mg twice daily in the second week. Further increases at intervals of not less than one week; maximum 400 mg a day, with close monitoring above 200 mg a day. Withdraw gradually - halve the dose at weekly intervals. - Long-term, but the effect fades: the formulary suggests withdrawal for 3 to 4 weeks to restore it, with other anti-Parkinson therapy continued meanwhile

The formulary states a paediatric dose only for influenza A (children 10-15 years, 100 mg once or twice a day), not for parkinsonism. No paediatric anti-Parkinson dose is given here.

Egyptian National Drug Formulary - Nervous System Disorders 2025 (amantadine monograph, Indications and Dosage Regimen, Parkinsonism)

The formulary's amantadine monograph opens its Indications with parkinsonism and with the extrapyramidal reactions that drugs cause, and prints a parkinsonism dosing block, so one document carries both claims. Six Egyptian products are registered and they are the cheapest anti-Parkinson tablets on the shelf - VIRAFLU 100 mg is 4 EGP - which matters on a chronic prescription in Cairo.

Start low and increase gradually. Usual dose 6 to 10 mg daily, divided into 3 or 4 doses at meal times; up to 12 to 15 mg daily may be required. - Long-term; do not stop abruptly

Not a paediatric drug. The formulary has never established either its safety or how well it works in paediatric patients.

Egyptian National Drug Formulary - Nervous System Disorders 2025 (trihexyphenidyl monograph, Indications and Dosage Regimen, Parkinsonism)

The formulary's trihexyphenidyl monograph names parkinsonism in its Indications and prints a parkinsonism dosing block, so one document carries both claims. It is the oldest drug here and the least well tolerated in the elderly, which is why it sits at line 3 behind levodopa and the two newer agents. The register files it as TRIHEXYPHENIDYLE, with a final 'e' - PARKINOL 5 mg, 100 tablets for 55 EGP - and a search on the clinical spelling still reaches it.

One to three sachets a day, dissolved in water. SmPC verbatim: "Adults, adolescents and older people: 1 - 3 sachets daily in divided doses, according to individual response." and "For extended use, the dose can be adjusted down to 1 or 2 sachets daily." Preparation verbatim: "Each sachet should be dissolved in 125 ml water." Where stool has already loaded the rectum the SmPC gives a separate short regimen: "Adults, adolescents and the older people: 8 sachets daily, all of which should be consumed within a 6 hour period", for no more than three days. - Longer than for ordinary constipation, and the SmPC says so by name. Verbatim: "A course of treatment for constipation with Movicol does not normally exceed 2 weeks, although this can be repeated if required. As for all laxatives, prolonged use is not usually recommended. Extended use may be necessary in the care of patients with severe chronic or resistant constipation, secondary to multiple sclerosis or Parkinson's Disease, or induced by regular constipating medication in particular opioids and antimuscarinics."

Not a paediatric prescription. SmPC verbatim: "Children (below 12 years old): Not recommended. Alternative products are available for children." Parkinson's disease is an adult diagnosis in any case.

Movicol 13.7 g powder for oral solution (macrogol 3350) SmPC sections 4.1, 4.2, 4.3 and 4.4 (eMC product 1025)

Both claims come from documents that were opened, and the SmPC names the disease itself rather than just the symptom. The disease article names the drug, verbatim: "Sildenafil may be prescribed for erectile dysfunction, polyethylene glycol for constipation, modafinil for excessive daytime somnolence, and methylphenidate for persistent fatigue." and frames why it belongs on the card - "Acknowledging the nonmotor manifestations of PD is essential, as these symptoms can profoundly affect quality of life and require targeted management." The SmPC's indication is "the treatment of chronic constipation", and its own posology section singles out Parkinson's Disease as a reason for extended use. Constipation in Parkinson's is not incidental: it is one of the earliest features, and it is worsened by the antimuscarinic already on the card. MOVICOL 20 sachets is on the Egyptian register at 273 EGP, with a paediatric presentation beside it.

50 mg about an hour before sex, at most once a day. SmPC verbatim: "The recommended dose is 50 mg taken as needed approximately one hour before sexual activity. Based on efficacy and tolerability, the dose may be increased to 100 mg or decreased to 25 mg. The maximum recommended dose is 100 mg. The maximum recommended dosing frequency is once per day. If VIAGRA is taken with food, the onset of activity may be delayed compared to the fasted state." The SmPC drops the starting dose to 25 mg in severe renal impairment, in hepatic impairment such as cirrhosis, and alongside a CYP3A4 inhibitor. It also warns that "sexual stimulation is required" for it to work at all. - Taken as needed rather than as a standing dose - there is no course to finish and no titration schedule to keep to.

Not a paediatric prescription. SmPC verbatim: "VIAGRA is not indicated for individuals below 18 years of age." Parkinson's disease is an adult diagnosis in any case.

VIAGRA 50 mg film-coated tablets (sildenafil) SmPC sections 4.1, 4.2 and 4.3 (eMC product 1072)

The disease article names the drug and the symptom, verbatim: "Sildenafil may be prescribed for erectile dysfunction, polyethylene glycol for constipation, modafinil for excessive daytime somnolence, and methylphenidate for persistent fatigue." and again under its own recommendations - "Current recommendations include: Sildenafil can be used to treat erectile dysfunction." The SmPC's indication section names the same condition, verbatim: "VIAGRA is indicated in adult men with erectile dysfunction, which is the inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance." The boundary matters and is stated plainly: the licensed disease here is erectile dysfunction, not Parkinson's disease. The row sits on this card for the same reason the macrogol row does - the article's framing that "Acknowledging the nonmotor manifestations of PD is essential, as these symptoms can profoundly affect quality of life and require targeted management." Erectile dysfunction is one of the commonest and least raised of them. Sildenafil is inexpensive in Egypt, with 50 mg tablets on the register from about 7 EGP.