How to succeed in using dopamine agonists in Parkinson's disease
L. M. Shulman
University of Miami School of Medicine, Miami, Florida, USA
Dopamine receptor agonists are assuming increased importance in the treatment of both early and advanced symptoms of Parkinson's disease (PD). However, tolerability of these drugs can be a problem. Identifying patients who are at increased risk of adverse effects is central to using dopamine agonists in PD. The newer agonists, pramipexole and ropinirole, are generally adequate without levodopa for early symptoms and carry the hope for a more acceptable profile of long-term side-effects. In the patient with advanced disease, all four dopamine agonists significantly augment the response to levodopa, which reduces the problems of motor fluctuations and drug related dyskinesia. Understanding the common pitfalls when prescribing these drugs will facilitate their safety and efficacy.
Keywords: dopamine agonists, Parkinson's disease, Therapy
Keywords: dopamine agonists, Parkinson's disease, Therapy
Introduction
The use of dopamine agonists in patients with Parkinson's disease (PD) can be both challenging and time-consuming, yet dopamine receptor agonists are assuming an ever increasing prominence in the management of PD. It is not an overstatement to say that patients with Parkinson's symptoms will be less optimally managed over the course of their illness if agonists are not added to their regimen. Dopamine agonists have rightfully assumed an important role in the management of symptoms of PD. However, the science behind the use of this class of drugs with precision lags significantly behind the needs of clinical practice. It is desirable to identify PD patients who will benefit from the use of dopamine agonists and specifically at what disease stage maximum benefit can be obtained. These are compelling questions given the cost of these medications, the side-effect profile and the presence of therapeutic alternatives.
With the array of antiparkinsonian medications now available it is essential that these medications be used in the right order, in the right doses and in the right combinations to maximize benefit and minimize both short-term and long-term adverse effects. A sound scientific foundation should guide the choice from the four dopamine agonists currently available. Incomplete scientific knowledge, a combination of fragmentary but tantalizing scientific clues and a growing body of clinical experience allow one to make the best possible therapeutic decisions for patients. Strategies that will assist in the successful use of dopamine agonists in patients with PD are the topic of this paper.
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The use of dopamine agonists in patients with Parkinson's disease (PD) can be both challenging and time-consuming, yet dopamine receptor agonists are assuming an ever increasing prominence in the management of PD. It is not an overstatement to say that patients with Parkinson's symptoms will be less optimally managed over the course of their illness if agonists are not added to their regimen. Dopamine agonists have rightfully assumed an important role in the management of symptoms of PD. However, the science behind the use of this class of drugs with precision lags significantly behind the needs of clinical practice. It is desirable to identify PD patients who will benefit from the use of dopamine agonists and specifically at what disease stage maximum benefit can be obtained. These are compelling questions given the cost of these medications, the side-effect profile and the presence of therapeutic alternatives.
With the array of antiparkinsonian medications now available it is essential that these medications be used in the right order, in the right doses and in the right combinations to maximize benefit and minimize both short-term and long-term adverse effects. A sound scientific foundation should guide the choice from the four dopamine agonists currently available. Incomplete scientific knowledge, a combination of fragmentary but tantalizing scientific clues and a growing body of clinical experience allow one to make the best possible therapeutic decisions for patients. Strategies that will assist in the successful use of dopamine agonists in patients with PD are the topic of this paper.
DOWNLOAD COMPLETE PDF HERE
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