Pharm

Dopamine Agonist

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Dopamine Agonist, Non-ergot Dopamine Agonist, Ergot Dopamine Agonist

  1. General: Parkinson's Disease related concerns
    1. Less effective than Sinemet, but are less associated with Dyskinesias
    2. Most effective agents at reducing Sinemet off-time
    3. Increased Sleepiness, edema, Nausea and Hallucinations
  2. Pramipexole (Mirapex)
    1. Start at 0.125 mg PO tid
    2. Increase every week to 1.5 mg PO tid
    3. Half life: 7-17 hours
    4. Minimal metabolism
  3. Ropinirole (Requip)
    1. Start at 0.25 mg PO tid
    2. Increase every week to 1 mg PO tid
    3. Half life: 6 hours
    4. Hepatic metabolism
  4. Rotigotine (Neupro) Transdermal
    1. Dopamine Agonist transdermal patch
    2. Dosing
      1. One patch applied daily to a new site
      2. Do not repeat the same site for 14 days
      3. Start at 2 mg/24 hours
      4. May increase weekly to a maximum of 8 mg/24 h
  5. Apomorphine (Apokyn)
    1. Subcutaneous Injectable Non-ergot Dopamine Agonist
    2. Decreases Sinemet off-time
    3. Significant side effects and typically started only by experienced clinicians (started as inpatient)
  1. Diagnostics required when on Ergot Dopamine Agonists (baseline and annual)
    1. Echocardiogram
    2. Chest XRay
    3. Erythrocyte Sedimentation Rate (ESR)
    4. Renal Function tests
  2. Bromocriptine mesylate (Parlodel)
    1. Start at 1.25 mg PO bid
    2. Increase every 2 weeks to 5-20 mg PO bid
    3. Half life: 3-8 hours
    4. Hepatic metabolism
  3. Pergolide mesylate (Permax): Not recommended (not available in U.S.)
    1. Half life: 27 hours
    2. Hepatic metabolism
    3. Risk of valvular disease and Pulmonary Hypertension
      1. Van Camp (2004) Lancet 363:1179-83 [PubMed]
  • Adverse Effects
  1. Impulse control behaviors (rare)
    1. Behaviors seen with Dopamine Agonists include Compulsive Gambling, hypersexuality, shopping, eating
    2. Moore (2014) JAMA Intern Med 174(12):1930-3 [PubMed]