Dopamine agonists in Parkinsons Disease

Dopamine agonists in Parkinsons Disease

What dopamine agonists are available to treat Parkinsons Disease, and what are their most common side effects? 

Until 1997, only two dopamine agonists (bromocriptine and pergolide) were clinically used in Parkinsons Disease.

Since then, pramipexole, ropinirole, apomorphine, and rotigotine have become commercially available.

Both bromocriptine and pergolide are ergot derivatives and have the risk of complications such as vasoconstriction (with acroparesthesias and angina), exacerbation of peptic ulcer disease, erythromelalgia, and valvular, pulmonary, and retroperitoneal fibrosis.

Pramipexole, ropinirole, and rotigotine are nonergoline agonists and have a lower risk of such complications.

What are the most common side effects of Dopamine agonists

Although dopamine agonists display fewer motor complications than levodopa, they may exacerbate peak-dose dyskinesias and other undesired dopaminergic effects, such as

  • nausea,
  • vomiting,
  • anorexia,
  • drowsiness,
  • sudden sleep attacks,
  • malaise,
  • orthostatic hypotension,
  • confusion, and
  • hallucinations

Furthermore, dopamine agonists have been linked to the dopamine dysregulation syndrome, including impulse control disorders as well as hypersexuality, pathological gambling, compulsive shopping, and other impulsive and compulsive behaviors. 

Sources

  • Jankovic J, Stacy M: Medical management of levodopa-associated motor complications in patients with Parkinson’s disease. CNS Drugs 21(8):677-692, 2007. 
  • Jankovic J, Poewe W: Therapies in Parkinson’s disease. Curr Opin Neurol 25(4):433-447, 2012. 
  • Hely MA, Morris JG, Reid WG, Trafficante R: Sydney Multicenter Study of Parkinson’s Disease: non-L-dopa-responsive problems dominate at 15 years. Mov Disord 20(2):190-199, 2005. 
  • Katzenschlager R, Head J, Schrag A, Ben-Shlomo Y, Evans A, Lees AJ; Parkinson’s Disease Research Group of the United Kingdom: Fourteen-year final report of the randomized PDRG-UK trial comparing three initial treatments in PD. Neurology 71:474-480, 2008. 
  • Cilia R, Akpalu A, Sarfo FS, Cham M, Amboni M, Cereda E, et al.: The modern pre-levodopa era of Parkinson’s disease: insights into motor complications from sub-Saharan Africa. Brain 137(Pt 10):2731-2742, 2014.
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