Pergolide adverse effects

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... 

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. 

In one study of 17 patients with mild Parkinson s disease who were given either mesulergine or pergolide, mesulergine impaired the quality of life frequent adverse effects were vomiting, lassitude, abdominal discomfort, depression, right bundle-branch block, fuzzy-headedness, and increasing insuhn requirements in a patient with diabetes (SEDA-13,113). 

The adverse effects of pergolide, a dopamine receptor agonist, resemble those of bromocriptine (SEDA-10, 118) (SEDA-13,113). 

In 41 patients with Parkinson s disease who took pergolide, confusion and hallucinations were the adverse effects that were most likely to result in withdrawal of pergolide (2). Symptoms suggestive of dose-related angina pectoris occurred in four patients in the open phase and two patients in the earlier double-blind phase these symptoms were easily controlled by dosage reduction or withdrawal of pergolide without sequelae. There was leukopenia in one patient. 

A recommended initial dose of pergolide (which is about 13 times more potent than bromocriptine) is 0.05 mg/day for 2 days, gradually increasing the dose by approximately 0.1-0.15 mg/day every 3 days over a 12-day period. Should more drug be needed, the dose then may be increased by 0.25 mg every 3 days until symptoms are eliminated or adverse effects occur. The mean therapeutic dose in most clinical trials was approximately 3 mg/day. 

Pramipexole is initiated at a dose of 0.125 mg three times a day and increased every 5 to 7 days as tolerated. In a fixed-dose study, daily doses of 3, 4.5, and 6 mg were not more effective than 1.5 mg/day, and the higher doses were associated with a higher frequency of adverse effects. When switching from bromocriptine or pergolide to pramipexole, a 10 1 and 1 1 dosage substitution is recommended, respectively. Ropinirole is initiated at 0.25 mg three times a day and increased by 0.25 mg three times a day on a weekly basis to a maximum of 24 mg/day. The dose of dopaminergic agonists is best determined by slow titration to enhance tolerance and to find the least dose that provides optimal benefit. 

Postural hypotension on starting dopamine agonists is a well recognised adverse effect, but this appears to be the only report that this might be of more concern in patients taking antihypertensives. The manufacturers of pergolide recommend caution when it is given with antihypertensives be-... 

A retrospective study of patients with Parkinson s disease taking selegiline 5 to to mg daily (and other anti-parkinson drugs such as levo-dopa/carbidopa, bromocriptine, amantadine, pergolide, and antimuscarinics) noted that the addition of trazodone 25 to 150 mg daily caused no adverse effects and the patients appeared to obtain overall benefit, including some improvement in parkinsonian symptoms. ... 

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