title: Emerging drugs for autonomic dysfunction in Parkinson's disease.
abstract: BACKGROUND
  Autonomic dysfunction, including orthostatic hypotension (OH), sialorrhea, sexual dysfunction, urinary dysfunction and constipation is a common feature of Parkinson's disease (PD). Even though its treatment has been recognized as a major unmet need in PD, there is a paucity of clinical trials to assess their treatment.
  
  
  METHODS
  Evidence about the efficacy and safety of available treatments for autonomic dysfunction is summarized. Potential targets for upcoming therapies are then discussed in light of what is currently known about the physiopathology of each disorder in PD. Proof-of-concept trials and circumstantial evidence about treatments for autonomic dysfunction as well as upcoming clinical trials are discussed. Finally, critical aspects of clinical trials design are considered.
  
  
  CONCLUSIONS
  Botulinum toxin (BTX) or glycopyrrolate might be used for sialorrhea whereas macrogol could be useful in constipation. There is preliminary evidence suggesting that fludrocortisone, domperidone, droxidopa or fipamezole may be effective for the treatment of OH. Tropicamide, clonidine or radiotherapy are under development for sialorrhea. Sildenafil may be effective for the treatment of erectile dysfunction; BTX or behavioral therapy for urinary incontinence and lubiprostone and probiotics for constipation. Sound clinical trials are needed in order to allow firm evidence-based recommendations about these treatments.
authors: University of Toulouse III, University Hospital, Department of Clinical Pharmacology and Neuroscience, Toulouse, France. splloret@fleni.org.ar
authors: Santiago
authors: S
authors: Perez-Lloret
authors: María Verónica
authors: MV
authors: Rey
authors: Anne
authors: A
authors: Pavy-Le Traon
authors: Olivier
authors: O
authors: Rascol
mesh_terms: D000818:Animals; D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001337:Autonomic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001342:Autonomic Nervous System Diseases / Q000209:etiology / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D003248:Constipation / Q000209:etiology / Q000517:prevention & control; D015507:Drugs, Investigational / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007024:Hypotension, Orthostatic / Q000209:etiology / Q000517:prevention & control; D010300:Parkinson Disease / Q000188:drug therapy* / Q000503:physiopathology; D012798:Sialorrhea / Q000209:etiology / Q000517:prevention & control; D014549:Urinary Incontinence / Q000209:etiology / Q000517:prevention & control
chemical_list: D000978:Antiparkinson Agents; D001337:Autonomic Agents; D015507:Drugs, Investigational