It's that time of year, where the weather turns cooler and the cold and flu season is upon us. What does that mean for people living with Parkinson's disease? What medications can be taken for symptom management and which ones should be avoided?
Any illness can bring on new PD motor and non-motor symptoms or increase ongoing ones, such as mood change and fatigue. Most flu and cold symptoms are similar, including fever, cough, shortness of breath, runny nose, etc. If you feel your symptoms are lengthy or severe, it may be important to talk to your doctor or give them a visit. While there is no cure, there are some prescription treatments, such as Tamiflu, which can decrease flu length and severity when taken within 48 hours of symptom onset and has proven to be safe for those living with Parkinson's.
At the end of the day - the Parkinson's patient must decide which is more important to get relief from - aggravating cold and flu symptoms or Parkinson's symptoms. It is possible to take over the counter medications if you have Parkinson's disease. However, there are potential risk and benefits, as well as strategies and alternatives that may also address cold and flu concerns. A person with Parkinson's does not necessarily need to suffer through cold and flu symptoms.
Most of the caution comes from introducing new medications to existing medications you may already be on to treat Parkinson's symptoms. If choosing to take over the counter medications to help with symptom relief of cold/flu like symptoms - be extra cautious when it comes to monitoring existing Parkinson's symptoms such as drowsiness, stiffness, balance, and dizziness which may worsen. Use extra caution when driving, standing up too quickly to avoid dizziness, or walking with extra assistance to avoid falls. These PD symptoms may increase or be more bothersome than usual when mixing over the counter cold medications with Parkinson's disease medications.
MEDICATIONS TO AVOID It's always important to check with your doctor and pharmacist for which medications are safe for mild heacaches, cold symptoms, or coughs. Some over the counter cold, sinus, or cough medications (Sudafed, Robitussin, or Nyquil) can interact with Parkinson's drugs such as Azilect (rasagiline), selegiline or Xadago (safinamide). Also be sure to check your PD medication labels and warnings to see if any specific over the counter medications are listed to avoid.
Also, medications such as anticholinergics (Benadryl) may cause acute confusion and even contribute to long-term cognitive changes. It is important to keep in mind when selecting cough or flu medications that the intent is not to treat long-term issues and increased Parkinsonian symptoms are not permanent. Below are some tips to help you navigate Parkinson's while also addressing cold and flu symptoms from the Parkinson's Foundation:
If memory or thinking problems are present, take caution with drugs that may be sedating (such as Sudafed) or that contain anticholinergics (for example: Trihexphenidyl, Benadryl, Cogentin, Parsitan). Because of memory and thinking issues, anticholinergics are only rarely used to address cough and cold symptoms.
Cough syrups with pain medication (such as codeine) could lead to memory issues, thinking problems or sedation. If you take one of these medications your memory and thinking should be monitored as confusion could lead to falls and other negative consequences.
Pain medication (such as meperidine) can interact with other medications and can result in sedation.
It may be useful to temporarily stop monoamine oxidase (MAO-B) inhibitor drugs (such as selegiline, rasagiline, safinamide) to avoid drug-drug interactions with cyclobenzaprine, dextromethorphan (often found in cough medicine), meperidine (also sold as Demerol) methadone, St. John's wort or in the pain medicine tramadol. Talk to your doctor before making these changes to your medications and make sure it is ok to stop these drugs cold turkey. Many require tapering off. This should only be done in extreme cases.
Psuedoephedrine, phenylephrine, and phenylpropanolamine can be found in any cold or flu medication and could increase blood pressure and possibly increase the risk of stroke, especially in those with already existing high blood pressure.
Aspirin, acetaminophen, and other nonsteroidal anti-inflammatory drugs are usually safe, but can have side effects (particularly gastrointestinal).
Antihistamines can sometimes cause drowsiness, but many people with PD can tolerate them for short courses.
TIPS FOR MANAGING COLD AND FLU SYMPTOMS WITH PD
When it comes to choosing which over the counter medications are right for you, it can be a daunting task, especially when you already are feeling lousy. Here are some tips to consider when choosing which over the counter cold and flu medication may be best for you:
Treat only symptoms you have and be wary of multi-symptom products
Know your dose and don't overdose - read directions carefully on the package and stick with appropriate dosing schedule
Know your own unique health risks (for example, decongestants can cause blood pressure spikes, especially if you have hypertension)
Don't double up and accidentally take two medicines with similar ingredients.
Consider trying alternatives (rest, fluids, saline nasal sprays, salt-water gargles, honey for cough).
One of the best ways to protect yourself from the flu is to get a flu shot. It's especially important for people over 65 and who are at higher risk for getting the flu or having more significant flu symptoms. The best time to get vaccinated is in the fall so that protection lasts throughout the winter.
Regular handwashing, staying home if you don't feel well, and sneezing or coughing into your elbow are all common-sense precautions to guard against the spread of respiratory illnesses. These activities, as well as wearing a mask and keeping distance in public have become second nature for many of us during the pandemic- but they also apply in the cold and flu season especially if you are in a shared public space in close proximity to other sick people, such as a doctor's office.
Stick to a healthy diet and regular exercise routine, and don't forget to stay hydrated for overall wellness. Some people choose to introduce additional vitamin supplements such as Vitamin C, Vitamin D and zinc. Keep in mind that introducing additional medications can impact gut health and increase constipation, which may require additional treatment.
The Flu, COVID-19, and Parkinson's. Rachel Dolhun, MD. Vice President, medical communications. The Michael J. Fox Foundation for Parkinson's Research. https://www.michaeljfox.org/sites/default/files/media/document/Flu_Covid19_Guide_11.29.20_0.pdf
Tips for People with Parkinson's Who Want to Take Over the Counter Medications During Flu Season. www.parkinson.org/blog/research/flu-season. Sep 06, 2017. Dr. Michael S. Okun, University of Florida Health Center for Movement Disorders and Neurorestoration.