Choosing the Right Dopamine Agonist for Patients With Parkinson's Disease

C. Lebrun-Frenay, M. Borg

Disclosures

Curr Med Res Opin. 2002;18(4) 

In This Article

Summary and Introduction

Dopamine receptor agonists (DA) are assuming an increasing importance in the treatment of both early and advanced symptoms of Parkinson's disease (PD). However, choosing the right DA for patients with PD unfortunately remains more a pragmatic medical art than a science. The aim of this review is to provide a realistic point of view on the strengths and weaknesses of five DAs: bromocriptine, ropinirole, pergolide, pramipexole and piribedil. This has been done by analysing their respective: (1) flexibility in PD, i.e. in monotherapy, in early and in late combination with levodopa; (2) safety profile and (3) titration schedule. These five DAs are not evenly matched regarding these three criteria. The differences observed highlight the therapeutic value of piribedil, which has a flexible indication, adapted to all stages of PD, a safer profile and the most simple initiation schedule.

Despite the fact that the use of dopamine agonists in patients with Parkinson's disease (PD) can be both challenging and time-consuming, dopamine receptor agonists are assuming an ever-increasing prominence in the management of PD. It is not an overstatement to say that patients with Parkinson's symptoms will be less than optimally managed over the course of their illness if these agonists are not added to their regimen. However, the science behind the use of this class of drugs with precision lags significantly behind the needs of clinical practice. With the array of antiparkinsonian medications now available, it is essential that these medications be used in the right order, in the right doses and in the right combinations to maximise benefits and minimise both short-term and long-term adverse effects.

A sound scientific foundation should guide the choice from among the five dopamine agonists currently available. Incomplete scientific knowledge, a combination of fragmentary but tantalising scientific clues and a growing body of clinical experience, allow one to make the best possible therapeutic decisions for patients. Nevertheless, choosing the right dopamine agonist for a patient with PD unfortunately remains more an art than a science. Strategies to assist in the successful choice of dopamine agonists in patients with PD are the topic of this paper.

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