Review Article

CNS Drugs

, Volume 24, Issue 11, pp 941-968

First online:

Dopamine Receptor Agonists for the Treatment of Early or Advanced Parkinson’s Disease

  • Santiago Perez-LloretAffiliated withDepartment of Clinical Pharmacology and Neurosciences, Faculty of Medicine, Hospital and University of Toulouse and INSERM CIC9023 and UMR 825Clinical Pharmacology Center, Raul Carrea Institute for Neurological Research
  • , Olivier RascolAffiliated withDepartment of Clinical Pharmacology and Neurosciences, Faculty of Medicine, Hospital and University of Toulouse and INSERM CIC9023 and UMR 825 Email author 

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Abstract

Dopamine receptor agonists are indicated for the symptomatic treatment of early, moderate or advanced Parkinson’s disease as well as for the reduction of levodopa-related motor complications. Ergolinic dopamine agonists, such as bromocriptine or pergolide, were initially developed and marketed, and then non-ergolinic dopamine agonists, such as pramipexole and ropinirole, were introduced, reducing the risk of drug-induced fibrotic reactions. Once-daily, controlled-release oral and transdermal formulations have been developed aiming at providing more stable 24-hour plasma drug concentrations and more convenient administration. A disease-modifying effect of dopamine agonists has not been demonstrated clinically.

As with any other drug, dopamine agonists can also cause adverse drug reactions, which can be related or unrelated to dopaminergic hyperactivation. Dopaminergic reactions include nausea, hallucinations, confusion and orthostatic hypotension, among others, which were readily identified in pre-marketing clinical trials. During post-marketing surveillance, important adverse reactions were identified, such as daytime somnolence, impulse-control disorders and heart valve fibrosis. Other issues, including the efficacy of dopamine agonists for the treatment of non-motor symptoms, remain under evaluation.