A 72-year-old male with Parkinson's disease is experiencing worsening tremors despite taking his medications regularly. He also complains of occasional nausea after taking his medications. What could be the reason for these symptoms and what are the next steps?
It's possible that the patient is experiencing wearing-off phenomena, where symptoms return as the effect of levodopa wears off before the next dose. The nausea could be a side effect of the levodopa. His medication regimen might need adjustment, such as more frequent dosing, adding a COMT inhibitor or an MAO-B inhibitor to prolong the effect of levodopa, or using a drug to control nausea. A referral to his neurologist for a detailed review is recommended.