Pergolide Levodopa

Opioids, benzodiazepines, barbiturates, corticosteroids, dopamine agonists (e.g., amantadine, bromocriptine, levodopa, pergolide, pramipexole, ropinirole), H2-receptor antagonists, anticholinergics (e.g., diphenhydramine, trihexylphenidyl), P-adrenergic blockers, clonidine, methyldopa, carbamazepine, phenytoin, baclofen, cyclobenzaprine, lithium, antidepressants (e.g., tricyclic antidepressants, selective serotonin reuptake inhibitors), and interleukin-2... 

DOPAMINERGICS PARACETAMOL Amantadine, bromocriptine, levodopa, pergolide, pramipexole and selegiline may slow the onset of action of intermittent-dose paracetamol Anticholinergic effects delay gastric emptying and absorption Warn patients that the action of paracetamol may be delayed. This will not be the case when paracetamol is taken regularly... 

The most important alternatives to levodopa therapy are direct-acting dopamine receptor agonists, such as ropinirole,pramipexole, or pergolide (Fig. 46-5). A number of studies have shown that use of these agents may help to delay the need for use of levodopa/carbidopa. This has... 

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. 

Pergolide is usually administered in divided doses 3 times/day. During dosage titration, the dosage of concurrent levodopa/carbidopa may be cautiously decreased. In clinical studies, the mean therapeutic daily dosage of pergolide was 3 mg/day. 

The average concurrent daily dosage of levodopa/carbidopa (expressed as levodopa) was approximately 650 mg/day. The efficacy of pergolide at doses above 5 mg/day has not been systematically evaluated. 

The use of pergolide in patients on levodopa may cause or exacerbate pre-existing states of confusion and hallucinations or preexisting dyskinesia. 

Discontinuation of therapy Abrupt discontinuation of pergolide in patients receiving it chronically as an adjunct to levodopa may precipitate the onset of hallucinations and confusion. Discontinue pergolide gradually whenever possible, even if the patient is to remain on levodopa. 

Two reviews with respect to the efficacy of pergolide for levodopa-induced motor complications... 

Clarke CE, SpeUer JM. Pergolide for levodopa-induced complications in Parkinson s disease. Cochrane Database Syst Rev 1999. 

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 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. 

Cabergoline, bromocriptine, and pergolide have been used in Parkinson s disease to improve motor function and reduce levodopa requirements as discussed in Chapter 28 Pharmacologic Management of Parkinsonism Other Movement Disorders. Cabergoline has also been effective in restless legs syndrome. 

Later, the disease does not respond to the drug and doses are required to be given in combination with carbidopa. Levodopa is effective in relieving bradykinesia and other disorderly voluntary movements. Parkinson s disease is not a hereditary disease. Drugs such as levodopa, carbidopa, benserazide, bromocriptine, pergolide, selegiline, and amantadine are used as therapeutic agents.61... 

A 36-year-old woman with a 4-year history of Parkinson s disease, who had been taking pergolide 3 mg/day and levodopa 200 mg/day continued to take it during pregnancy. The end-of-dose wearing-off effect completely disappeared, and reappeared at their previous intensity after delivery. There were no adverse effects in the mother. The baby was healthy at birth and remained so at the time of the report, at the age of 13 months. 

Czech neurologists have described seven men, aged 35-70 years, in whom sexual behavior was greatly increased and who had frequent spontaneous penile erections (13). All had been taking levodopa, to which pergolide 3 mg/day had been added, and all had advanced fluctuating... 

Supraventricular extra beats have rarely been reported after low doses of ropinirole and have also been reported after pergolide and levodopa (1). Symptomatic postural hypotension has occurred after even low oral doses of ropinirole (2-5), related to peripheral dopaminergic activity. Hypotensive effects occur within 3 minutes of standing, usually between 2 and 4 hours after an oral dose, associated with nonspecific malaise (2). Dizziness occurred in up to 40% of patients in clinical trials. Related symptoms include faintness, malaise, and yawning (2). Bradycardia has occasionally accompanied postural hypotension (4). Syncope has been reported. 

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