Ask Your Pharmacist Week 2023: Questions and answers with pharmacists

The week is run by the National Pharmacy Association, a trade body that supports independent community pharmacies, to raise awareness of community pharmacy.

We asked the Parkinson’s community to send in questions they’d like pharmacists to answer. We shared these with 3 Pharmacists who are members of the Parkinson's Specialist Pharmacy Network (PDSPN) Committee, Janine Barnes, Stephanie Bancroft and Shelley Jones, and they’ve answered your questions below. You can find out more about the PDSPN here.

Question: Are there any dispensing rules about breaking the seals on jars of tablets and adding more? Sometimes I’ve received containers that have been opened but I prefer for the jar to be left intact and for extra tablets to be put in a separate bottle.

Answer: There are no specific dispensing rules. Sometimes the quantity of the original container is not always appropriate so the medication has to be dispensed in additional containers.

Unless the container is specified as a ‘special container’, it can be opened to add more tablets/capsules. Read more about the recent reclassification of Madopar to special container status.

You may find that some Parkinson’s medications contain desiccants (drying agents) in the container lid. These are often in a silica gel form and are designed to remove water vapour from inside the medicine container to protect the medication from moisture damage.

If there is a desiccant in the lid of the bottle it is preferable to add medication to this container rather than putting excess tablets or capsules in a separate container.

Question: Is there any medication that will help with drooling from the corner of my mouth?

Answer: Guidance from the National Institute for Health and Care Excellence (NICE) suggests a medication called glycopyrronium bromide for the management of drooling in Parkinson’s. We would suggest speaking to your Parkinson’s nurse or specialist who will be able to give you further information about your different treatment options.

Question: Why has Eldepryl (Selegiline) been out of production for so many months? It’s only just come back. Why did Orion Pharma have trouble sourcing the active ingredient for Eldepryl?

Answer: Unfortunately, over recent years we’ve seen more inconsistency with drug supplies, including the supply of raw ingredients. There are a few different reasons for this, such as manufacturing quality issues and problems with distributing the drug from manufacturing sites.

Orion, who produce Eldepryl, shared their supply issues with Parkinson’s UK so they could alert members of the Parkinson’s community

Parkinson’s UK shares a monthly update on medicine supply issues they’ve been made aware of.

Parkinson’s UK also regularly shares any issues they’re hearing from the community about medicine supply with the Department of Health and Social Care so they can take action to reduce supply issues.

If you are having any issues accessing your medicines please call the Parkinson’s UK helpline on 0808 800 0303 to report it. For opening times and other ways to contact Parkinson’s UK’s helpline, visit their helpline web page. They need to know the medicine name, the strength and manufacturer of the medicine, as well as where you live as it might be a local issue.

Question: Why is there no consistency with medication shape and colour? Often people remember what tablet to take by its colour

Answer: As pharmacists, we recognise that the lack of consistency with the shape and colour of medications is frustrating and can cause confusion for patients. Unfortunately, this is an issue with all generic medications and it is out of the pharmacist's immediate control.

You can ask your community pharmacist to try to supply the same brand of generic medication each time you have a repeat prescription so that the shape and colour will be the same but there is no guarantee that this is possible.

Question: I am on Madopar 3 times a day and slow release overnight. A nutritionist has suggested that I might be short of magnesium as I am suffering from constipation. I am concerned that I cannot take it as I am on Madopar.

Answer: Information from Stockleys, a drug interaction checker used by pharmacists, suggests that people may experience constipation issues when taking levodopa and magnesium together.

However this will likely vary depending on which formulation of levodopa you’re taking so we would suggest speaking to your community pharmacist or Parkinson’s specialist first, to check whether it’s likely to be an issue in your case.

Question: What do pharmacists recommend, either prescribed or over the counter, for people with Parkinson’s who cannot sleep?

Answer: We would suggest that you try to review your sleep routine and habits outside of your Parkinson's and treatments for the condition.

Consider the following factors:

• Any daytime sleeping or naps you’re having. 
• Rigidity you’re experiencing overnight that may impact your sleep.
• If you’re frequently urinating overnight, this may impact your sleep.

We would then suggest trying to practise a good night-time routine. Reduce the use of screens before sleeping and implement techniques to rest the mind and body prior to bedtime, like sleep apps.

Limiting caffeine, alcohol and nicotine before bed and managing exposure to light is also recommended. Read more about sleep and Parkinson’s.

We would not recommend using over the counter remedies for sleep. However, if you have tried all of the above and are still experiencing sleep difficulties, speak to your GP who may be able to prescribe you a short course of melatonin to help maintain your sleep cycle.

Final thoughts

Community pharmacists are an important part of helping people to manage their condition. If you have any questions about your medicines please do ask us.