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

Dopamine Agonists in Parkinson's Disease

Levodopa (L-dopa) is the most widely used therapy for symptomatic management in PD. However, L-dopa is not effective for treating all parkinsonian symptoms, it exerts no known effect on slowing disease progression and it induces a number of adverse reactions classified as either 'peripheral' (e.g. nausea, vomiting, hypotension) or 'central' (e.g. psychosis and motor complications such as fluctuations and dyskinesias). As a result, many patients require alternative therapies.

Dopamine agonists are some of these commonly used alternative treatments for PD. They are a class of drugs with diverse physical and chemical properties which share the capacity to directly stimulate dopamine receptors, presumably because they incorporate a dopamine-like moiety within their molecular configuration.[1] There has been considerable interest in this class of drugs because of their potential to provide antiparkinsonian effects while avoiding some of the problems associated with levodopa. Historically, they have been used primarily as adjuncts to levodopa in patients who have begun to experience motor complications. A growing body of laboratory and clinical data now suggests that it is preferable to use dopamine agonists as initial symptomatic therapy to reduce the risk of development of the motor complications associated with levodopa therapy. Dopamine agonists offer several theoretical advantages over levodopa.[2,3,4,5,6] These theoretical advantages have been confirmed in clinical practice and taken into account by the most recent guidelines of the American Academy of Neurology, which has recommended dopamine agonist use in monotherapy from the early stages of Parkinson's disease.[7]

Bromocriptine (Parlodel®) and pergolide (Permax®) have been used in the treatment of PD for many years. Two new dopamine agonists have been introduced to the market for treatment of PD: pramipexole (Mirapex®, Mirapexin®), and ropinirole (Requip®). The dopamine agonist piribedil (Trivastal retard 50®, Pronoran®) has also been available for many years. Despite the fact that this list of five dopamine agonists is not exhaustive, they represent the majority of the worldwide prescription of dopamine agonists.

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