Anxiety | Cognitive behavioral therapy, selective serotonin reuptake inhibitors, venlafaxine, minimize “off” times. |
Cognitive impairment | Eliminate anticholinergic agents. Add cholinesterase inhibitor. |
Constipation | Fiber, hydration, exercise, laxatives, stool softeners. |
Daytime sleepiness | Proper night time sleep hygiene, reduce dose of dopamine agonist, referral to sleep specialist to rule out apnea and sleep disorders. |
Depression | Selective serotonin reuptake inhibitor, newer-generation serotonin norepinephrine reuptake inhibitor, cognitive behavioral therapy. |
Drooling | Local injection of botulinum toxin, atropine sublingual drop, glycopyrrolate, ipratropium sublingual spray. |
Dysphagia | Referral to speech therapist, dysphagia diet, avoid anticholinergic medications, manage dry mouth. |
Fatigue | Caffeine, armodafinil, modafinil, proper night time sleep hygiene, referral to sleep specialist to rule out sleep disorder. |
Falling | Referral to physical therapy; assistance with ambulation, minimize risk for bone fractures, treat osteoporosis. |
Hallucinations/psychosis | Eliminate adjunctive medications, especially anticholinergic agents and dopamine agonists. Add clozapine, quetiapine, pimavanserin. |
Impulse control disorder | Discontinue dopamine agonist or add clozapine, quetiapine, or naltrexone |
Insomnia | Nonbenzodiazepine GABAA agonists, trazodone. |
Orthostatic hypotension | Reduce dose of alpha-blockers, dopamine agonist, diuretics, vasodilators. Abdominal compression, add salt and water to diet, water boluses, fludrocortisone, midodrine, droxidopa, pyridostigmine. |
Overactive bladder | Behavioral therapies (eg, bladder training, fluid management, pelvic ... |