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D-1 and D-2 Agonists in Parkinson's Disease

Published online by Cambridge University Press:  05 January 2016

Abraham N. Lieberman ,
Menek Goldstein ,
Govindan Gopinathan  and
Andreas Neophytides
Abraham N. Lieberman*
Affiliation:
New York University School of Medicine and New York Infirmary - Beekman Downtown Medical Center, New York
Menek Goldstein
Affiliation:
New York University School of Medicine and New York Infirmary - Beekman Downtown Medical Center, New York
Govindan Gopinathan
Affiliation:
New York University School of Medicine and New York Infirmary - Beekman Downtown Medical Center, New York
Andreas Neophytides
Affiliation:
New York University School of Medicine and New York Infirmary - Beekman Downtown Medical Center, New York
*
650 First Avenue, New York, New York, U.S.A. 10016
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Abstract:

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We have evaluated 5 DA agonists-bromocriptine, lergotrile, lisuride, pergolide, and mesulergine in studies encompassing 278 patients with advanced PD. In most of our patients the DA agonist was added to levodopa. Most of our patients were no longer satisfactorily responding to levodopa. Previous attempts at managing these patients by changing the dose of levodopa (increasing or decreasing it), the treatment schedule, or the ratio of levodopa to carbidopa or by temporarily discontinuing levodopa [drug holiday] were unsuccessful. The majority of our patients had diurnal fluctuations in performance, either “wearing off” or “on-off” phenomena. The addition of a DA agonist resulted in a decrease in parkinsonian disability in most patients and a decrease in the severity of the diurnal fluctuations in performance. Improvement in many patients was maintained for at least 2 years. Adverse effects included mental changes, dyskinesias, orthostatic hypotension, and nausea. All of the adverse effects were reversible when the agonist was decreased or discontinued. As a group the agonists behaved similarly but individual patients often responded better to one agonist than another. The main role of agonists is in combination with levodopa in the treatment of patients with early PD who have not yet developed dyskinesias or diurnal fluctuations in performance.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 14 , Issue S3 , August 1987 , pp. 466 - 473
Copyright
Copyright © Canadian Neurological Sciences Federation 1987

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