Agonist substitution in advanced Parkinson's disease

Abstract

We studied whether Parkinson's disease patients who had lost efficacy from pergolide (PERG) could benefit if transferred to bromocriptine (BCT) therapy. Using paired t-tests, we compared motor scores at baseline (when patients were still on PERG) and after 6 months of BCT therapy in 11 patients. No significant improvement occurred in any measure on BCT therapy (mean dose 33.6 mg/day), although patients remained stable. In 6 patients on whom "on/off" data were obtained, decreased "off" time and increased "on" time without chorea occurred, but these changes were not statistically significant. The side effect profile was similar with the 2 drugs.

Conversion from dopamine agonists to pramipexole

“…In a fiveyear study of bromocriptine and pergolide, Goetz et al found that patients whose bromocriptine efficacy waned, experienced renewed efficacy after switching to pergolide [4]. Similarly, in patients showing a progressive loss of efficacy from pergolide, conversion to bromocriptine stabilized motor function [5].…”

“…■ Key words dopamine agonists · pramipexole · Parkinson's disease · motor complications dopamine agonists are quite similar [12,18], a few studies indicate that in patients in whom efficacy waned from one dopamine agonist, renewed benefit may occur after switchover to another dopamine agonist [4,5]. This has been documented in patients switched from bromocriptine to pergolide [4] and vice versa [5].…”

“…This has been documented in patients switched from bromocriptine to pergolide [4] and vice versa [5]. This apparent paradox can be explained by a selection bias inherent to clinical trials.…”

Medication Management of Parkinson's Disease: Early versus Advanced Stages

“…Thus, switching from bromocriptine to pergolide or pergolide to bromocriptine may provide such benefit. 28,29 Moreover, DAs with different elimination pathways should be considered if patients have liver and/or kidney disease. If patients have concomitant liver disease, pramipexole is more appropriate because it is not metabolized by the liver and is excreted mostly via the kidney.…”

Visual hallucinations and symptoms of REM sleep behavior disorder in Parkinsonian tauopathies

“…We documented comorbidities, disease duration and medication dosages at last visit. For dopamine agonists, a pergolide equivalent dosage was calculated as 1 mg of pergolide ¼ 1 mg of pramipexole ¼ 3 mg of ropinirole ¼ 10 mg of bromocriptine (Goetz et al, 1989). The Institutional Review Board (IRB) of the Rush University Medical Center approved the study, and participants signed informed consent.…”