Medications that May Be Contraindicated in Parkinson’s Disease
| Medical Purpose: | Safe Medications: | Use With Caution in Parkinson's Disease* |
|---|---|---|
| Antipsychotics | quetiapine clozapine (weekly CBC with differential monitoring to detect agranulocytosis) |
avoid all other typical and atypical antipsychotics (e.g. haloperidol, risperidone, olanzapine, aripiprazole, ziprasidone, paliperidone) |
| Pain Medication | most are safe to use, but narcotic medications may cause confusion/psychosis and constipation | if patient is taking MAO-B inhibitor such as selegiline or rasagiline |
| Anesthesia | request a consult with the anesthesiologist, surgeon, and Parkinson's doctor to determine best anesthesia given the Parkinson's symptoms and medications |
if patient is taking MAO-B inhibitor such as selegiline or rasagiline, caution against tramadol.** Absolute contraindication: droperidol |
| Nausea/GI Drugs | domperidone, ondansetron, granisetron | metoclopramide, promethazine, droperidol, prochlormethazine, prochlorperazine |
| Antidepressants | fluoxetine, sertraline, paroxetine, citalopram, escitalopram, venlafaxine | aripiprazole |
| Muscle Relaxants |
Note that dopaminergic medication should always be prioritized and optimized first. baclofen, botulinum toxin |
cyclobenzaprine |
| Antihistamines | cetirizine, loratadine | diphenhydramine |
| Urinary Symptoms | mirabegron, botulinum toxin | oxybutynin, tolterodine |
*"Use With Caution" refers to medications with possible negative implications in PD. However, if after careful assessment and all safer options exhausted, an experienced clinician may deem the typically "caution" medications as outweighing the risks for a patient. Please check with prescribing physician.
**Some PD perioperative guidelines may recommend continuing rasagiline through the perioperative period, including day of surgery, as abrupt discontinuation may worsen PD symptoms and contribute to parkinsonism-hyperpyrexia syndrome in rare cases. Rasagiline remains highly selective for MAO-B at standard doses 0.5-1mg/day.
Note: for cognitive/delirium risks, avoid benztropine and high dose benzodiazepines
This sheet is not exhaustive and there may be exceptions. This guide reflects Canadian medication practices. If travelling internationally, verify medication safety with a local pharmacist or your family physician. If within British Columbia or the Yukon, family physicians and nurse practitioners may be connected with specialist colleagues for urgent advice within two hours by contacting Rapid Access to Consultative Expertise (RACE) through the RACEapp+ (https://raceapp.ca) or telephone line (1-877-696-2131).
This informational sheet was prepared with contributions from Dr. Martin J. McKeown, MD, FRCPC, Dr. Larry Leung, BSc(Pharm), PharmD, RPh, and Dr. Daryl Wile, MD, FRCPC.
Last updated: June 5, 2026