Dopamine Agonists

What are the facts

• Dopamine agonists are a different class of drugs than levodopa.
• While levodopa is converted in the brain into dopamine, dopamine agonists actually mimic the effects of dopamine without having to be converted.
• Dopamine agonists are often the first medication prescribed to treat PD, but can also be used in later stages of PD with carbidopa/levodopa.

The following are the most commonly prescribed dopamine agonists in the U.S. :

• Pramipexole (Mirapex®)
  • Approved by the FDA in 1997
  • Effective in the early treatment of the motor symptoms of PD and plays an important role in controlling motor fluctuations.
• Ropinirole (Requip®)
  • Approved by the FDA in 1997
  • Effective in the early treatment of the motor symptoms of PD and plays an important role in controlling motor fluctuations.
• Rotigotine (Neupro® patch)
  • Formulated as a once-daily transdermal (skin) patch that is changed every 24 hours.
  • Clinical trials have shown Neupro is just as effective as the oral dopamine agonists: pramipexole and ropinirole.
  • The most common side effect is skin irritation, which is usually mild. Patients are able to tolerate the patch better when they rotate the sites where they adhere the patch.
  • Although the patch was recalled in 2008 because of a manufacturing and quality control issue, , it was reintroduced to the U.S. market in 2012, following improvements and a study of the new formulation.
• Apomorphine (Apokyn®)
  • Apomorphine was first used to treat PD in 1950, but its use was associated with many side effects, especially nausea and vomiting.
  • In the 1990s apomorphine was released in a self-injectable form. It is now used as a “rescue” drug for people with advanced PD and severe “off” episodes.
  • It can be used as many as five times per day as a “rescue” agent.

Dopamine agonists can be used effectively as a single drug in early stages of PD or in combination with carbidopa/levodopa later on.

What are the Side Effects?

• Excessive daytime sleepiness
• Visual hallucinations
• Confusion
• Swelling of the ankles
• Dyskinesia (not as common)
• Compulsive behaviors (such as uncontrolled shopping, gambling, eating, and sexual urges.)

Note: Pergolide and Bromocriptine are no longer available in the U.S. as treatment for PD.

Caution: PD medications may have interactions with certain foods, other medications, vitamins, herbal supplements, over the counter cold pills and other remedies.  Anyone taking a PD medication should talk to their doctor and pharmacist about potential drug interactions.