Medications · Brain & nerves
Parkinson's Medicines Before Surgery
If you have Parkinson's, the single most important rule around surgery is simple: keep taking your medicines on time — including the morning of the operation. Here's why missing doses is risky, and what to remind your team.
Quick answer
Why it matters
Levodopa has a short action — often only a few hours — so even one missed dose can cause your symptoms to 'wear off': stiffness, difficulty moving, and trouble with swallowing and clearing your chest. That's why your normal morning dose is usually taken even while fasting, with a sip of water.
If you can't take tablets for a while after surgery, levodopa cannot be given through a drip. Ask your team about alternatives such as a rotigotine skin patch or giving your medicines through a feeding tube, so you don't go without.
Some common anti-sickness (anti-nausea) drugs block dopamine and make Parkinson's much worse — these include metoclopramide (Maxolon/Reglan), prochlorperazine (Stemetil), and droperidol/haloperidol. Safer choices like ondansetron or domperidone are used instead. Remind the team so the wrong one isn't given.
If you take an MAO-B inhibitor (selegiline or rasagiline), tell your anesthesiologist — a few pain medicines (especially pethidine/meperidine) are avoided to prevent a serious reaction. This is easily managed when they know in advance.
Do not stop without instruction
What to ask your doctor
- Should I take my normal Parkinson's doses on the morning of surgery? (Usually yes, with a sip of water.)
- If I can't swallow tablets afterward, can I have a rotigotine patch or my medicines via a tube so I don't miss doses?
- Please avoid dopamine-blocking anti-sickness drugs (metoclopramide, prochlorperazine) — what will you use instead?
- I take selegiline/rasagiline — which pain medicines need to be avoided?
Red flags — call your team
Red flags — call your team
- After surgery: high fever, severe stiffness, confusion, or a fast/irregular heartbeat — this can signal a dangerous reaction to missed doses (Parkinsonism-hyperpyrexia). Tell staff urgently.
- Choking, a weak cough, or trouble breathing if doses have been missed — flag it immediately, as swallowing and chest muscles are affected.
References
- Parkinson’s UK — surgery, anaesthesia and Parkinson’s (get-it-on-time principle). parkinsons.org.uk
- BJA Education / British Journal of Anaesthesia — perioperative management of Parkinson’s disease. bjaed.org
- OpenAnesthesia — Parkinson’s disease and anesthetic considerations. openanesthesia.org
Frequently asked questions
Do I take my Parkinson's medicine on the morning of surgery?
Usually yes. Parkinson's medicines are normally taken right up to and including the morning of surgery with a small sip of water, because missing doses quickly causes stiffness and swallowing and breathing problems. Always confirm with your own team, but the default is 'don't miss a dose'.
What happens if I miss my Parkinson's tablets around surgery?
Symptoms can return quickly — stiffness, difficulty moving and swallowing — and in rare cases abruptly stopping causes a serious reaction with high fever and rigidity. That's why teams work hard to keep your doses going, including using a rotigotine patch if you can't swallow tablets for a while.
Which anti-sickness drugs are unsafe with Parkinson's?
Dopamine-blocking anti-nausea drugs such as metoclopramide (Reglan/Maxolon), prochlorperazine (Stemetil) and droperidol/haloperidol can make Parkinson's much worse and should be avoided. Ondansetron and domperidone are commonly used instead. Remind your team you have Parkinson's.