Levodopa Cabergoline

Shoptaw S., Watson D.W., Reiber C. et al. Randomized controlled pilot trial of cabergoline, hydergine and levodopa/carbidopa Los Angeles Cocaine Rapid Efficacy Screening Trial (CREST). Addiction. 100(Suppl. 1) 78, 2005. 

Dopamine receptor agonists. Deficient dopaminergic transmission in the striatum can be compensated by ergot derivatives (bromocriptine p. 114], lisu-ride, cabergoline, and pergolide) and nonergot compounds (ropinirole, prami-pexole). These agonists stimulate dopamine receptors (D2, D3, and D sub-types), have lower clinical efficacy than levodopa, and share its main adverse effects. 

At least as effective as bromocriptine in the treatment of advanced parkinsonian patients with levodopa-related motor fluctuations adverse effects similar in incidence and severity appears to lack some of the toxicity seen with bromocriptine, pergolide, and cabergoline (e.g., pleuropulmonary disease) may be a useful alternative in patients with intolerable adverse effects due to ergot derivatives... 

Dopamine agonists suppress prolactin release very effectively in patients with hyperprolactinemia. GH release is reduced in patients with acromegaly, although not as effectively. Cabergoline and bromocriptine are also used in Parkinson s disease to improve motor function and reduce levodopa requirements (see Chapter 28). Newer, nonergot D2 agonists... 

Dopamine agonists Bromocriptine Cabergoline Pergolide Pramipexole Ropinirole Directly stimulates dopamine receptors in basal ganglia. May produce fewer side effects (dyskinesias, fluctuations in response) than levodopa preliminary evidence suggests that early use may also delay the progression of Parkinson disease. 

Clarke CE, Deane KD. Cabergoline versus bromocriptine for levodopa-induced complications in Parkinson s disease. Cochrane Database Syst Rev 2001 (1) CD001519. 

Pal S, Bhattacharya KF, Agapito C, Chaudhuri KR. A study of excessive daytime sleepiness and its clinical significance in three groups of Parkinson s disease patients taking pra-mipexole, cabergoline and levodopa mono and combination therapy. J Neural Transm 2001 108(l) 71-7. 

Dopamine antagonists (e.g., phenothiazines, haloperidol, methyidopa) Opiates Estrogens H2-antagonists (e.g., cimetidine) MAO inhibitors Dopamine agonists (e.g., levodopa, bromocriptine, pergolide, cabergoline) ... 

Ouattara B, Belkhir S, Morissette M et al (2009) Implication of NMDA receptors in the antidyskinetic activity of cabergoline, Cl-1041, and Ro 61-8048 in MPTP monkeys with levodopa-induced dyskinesias. J Mol Neurosci 38 128-142... 

Another similar patient taking cabergoline 2 mg twice daily, selegiline, entacapone, and levodopa/carbidopa, experienced symptoms of overdose (hyperkinesia of the extremities) 3 days after starting itraconazole 200 mg twice daily. She reduced the dose of her Parkinson s medication, and had marked improvement in her usual Parkinson s symptoms, which then gradually reduced after stopping the itraconazole. This was repeated following two additional periods of itraconazole therapy. ... 

---