title: Dopaminergic agonists in Parkinson's disease.
abstract: BACKGROUND
  Non-ergoline dopamine agonists (DA) are effective treatments for Parkinson's disease (PD). This review presents the pharmacology, evidence of efficacy and safety profile of pramipexole, ropinirole, and rotigotine, and practical recommendations are given regarding their use in clinical practice.
  
  
  RESULTS
  Extended-release formulations of pramipexole and ropinirole and transdermal continuous delivery rotigotine patches are currently available; these may contribute to stabilising of plasma levels. In early PD, the three drugs significantly improve disability scales, delay time to dyskinesia and allow a later introduction of levodopa. In late PD they reduced total 'off'-time, improved Unified Parkinson's Disease Rating Scale (UPDRS) in both 'on' and 'off' state and allowed a reduction in total levodopa dosage. A significant improvement in quality of life scales has also been demonstrated. Extended-release formulations have proved to be non-inferior to the immediate release formulations and are better tolerated (ropinirole). Despite a generally good safety profile, serious adverse events, such as impulse control disorder and sleep attacks, need to be routinely monitored. Although combination therapy has not been addressed in scientific literature, certain combinations, such as apomorphine and another DA, may be helpful. Switching from one DA to another is feasible and safe, although in the first days an overlap of dopaminergic side effects may occur. When treatment with DA is stopped abruptly, dopamine withdrawal syndrome may present. Suspending any DA, especially pramipexole, has been linked to onset of apathy, which may be severe.
  
  
  CONCLUSIONS
  New non-ergotine DAs are a valuable option for the treatment of both early and late PD. Despite their good safety profile, serious adverse effects may appear; these effects may have a pathoplastic effect on the course of PD and need to be monitored.
authors: Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España.
authors: A
authors: A
authors: Alonso Cánovas
authors: Servicio de Neurología, Clínica Universitaria de Navarra, Pamplona, España.
authors: R
authors: R
authors: Luquin Piudo
authors: Servicio de Neurología, Fundación Jiménez Díaz, Madrid, España.
authors: P
authors: P
authors: García Ruiz-Espiga
authors: Servicio de Neurología, Hospital La Fe, Valencia, España.
authors: J A
authors: JA
authors: Burguera
authors: Servicio de Neurología, Hospital Quirón, Málaga, España.
authors: V
authors: V
authors: Campos Arillo
authors: Servicio de Neurología, Hospital Xeral de Galicia, Santiago de Compostela, La Coruña, España.
authors: A
authors: A
authors: Castro
authors: Centro de Investigación de Parkinson, Policlínica Guipúzcoa, San Sebastián, España.
authors: G
authors: G
authors: Linazasoro
authors: Servicio de Neurología, Hospital Clínico Universitario, Zaragoza, España.
authors: J
authors: J
authors: López Del Val
authors: Servicio de Neurología, Fundación Hospital de Alcorcón, Madrid, España.
authors: L
authors: L
authors: Vela
authors: Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España. Electronic address: jcmartinezcastrillo@gmail.com.
authors: J C
authors: JC
authors: Martínez Castrillo
mesh_terms: D000978:Antiparkinson Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D018491:Dopamine Agonists / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006801:Humans; D010300:Parkinson Disease / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents; D018491:Dopamine Agonists