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Dopamine Agonist

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Dopamine Agonist, Non-ergot Dopamine Agonist, Ergot Dopamine Agonist

  • See Also
  1. Dopamine Agonist in Hyperprolactinemia (e.g. Bromocriptine, Parlodel)
  1. General: Parkinson's Disease related concerns
    1. Less effective than Levodopa, but are less associated with Dyskinesias
    2. Most effective agents at reducing Levodopa off-time
    3. Increased Sleepiness, edema, Nausea and Hallucinations
  2. Dosing
    1. Start at low dose and may titrate to symptom control every 5-7 days
    2. When stopping agents, taper off over 2-3 weeks
  3. Pramipexole (Mirapex)
    1. Immediate Release start 0.125 mg three times daily (may increase by 0.125-0.25 mg/week up to 4.5 mg/day)
    2. Extended Release start 0.375 mg daily (may increase by 0.75 mg/week up to 4.5 mg/day)
    3. Half life: 7-17 hours
    4. Minimal metabolism
  4. Ropinirole (Requip)
    1. Immediate Release start 0.25 mg three times daily (may increase by 0.25 mg/week up to 24 mg/day)
    2. Extended Release start 2 mg daily (may increase by 2 mg/week up to 24 mg/day)
    3. Half life: 6 hours
    4. Hepatic metabolism
  5. Rotigotine (Neupro) transdermal patch
    1. Apply once daily (available in 1, 2, 3, 4, 6 and 8 mg)
    2. One patch applied daily to a new site
    3. Do not repeat the same site for 14 days
    4. Start at 2 mg/24 hours
    5. May increase weekly to a maximum of 8 mg/24 h
  6. Apomorphine
    1. Dopamine Agonist prn for off-time and severe motor freezing episodes
    2. Start at low dose with first dose in neurology office with Blood Pressure and pulse monitoring
    3. Give with Antiemetic (NOT Zofran due to interaction causing Hypotension, Syncope)
    4. Titrate to effective dose every few days
    5. Preparations
      1. Apomorphine SQ Injection (Apokyn) (30 mg/3 ml) pen in marked in ml (not mg)
      2. Apomorphine Sublingual Film (Kynmobi)
  1. Avoid these agents in Parkinson's Disease Management
  2. Diagnostics required when on Ergot Dopamine Agonists (baseline and annual)
    1. Echocardiogram
    2. Chest XRay
    3. Erythrocyte Sedimentation Rate (ESR)
    4. Renal Function tests
  3. Bromocriptine Mesylate (Parlodel)
    1. Start at 1.25 mg PO bid
    2. Increase every 2 weeks to 5-20 mg PO bid
    3. Half life: 3-8 hours
    4. Hepatic metabolism
  4. Pergolide Mesylate (Permax): Not recommended (not available in U.S.)
    1. Half life: 27 hours
    2. Hepatic metabolism
    3. Risk of valvular disease and Pulmonary Hypertension
      1. Van Camp (2004) Lancet 363:1179-83 [PubMed]
  • Adverse Effects
  1. Somnolence
    1. Risk of sudden onset of sleep without warning ("Sleep Attacks")
  2. Hallucations
  3. Impulse control behaviors (uncommon)
    1. Behaviors seen with Dopamine Agonists include Compulsive Gambling, hypersexuality, shopping, eating
    2. Moore (2014) JAMA Intern Med 174(12):1930-3 [PubMed]
  • References
  1. Ahlskog (2011) Mayo Internal Medicine Review Lecture
  2. Schim (2001) CMEA Medicine Lecture, San Diego
  3. Clarke (2003) Clin Evid 10:1582-98 [PubMed]
  4. Clarke (2004) Lancet Neurol 3:466-74 [PubMed]
  5. Gazewood (2013) Am Fam Physician 87(4): 267-73 [PubMed]
  6. Nutt (2005) N Engl J Med 353:1021-7 [PubMed]
  7. Olanow (2001) Neurology 56:S1-88 [PubMed]
  8. Rao (2006) Am Fam Physician 74:2046-56 [PubMed]
  9. Young (1999) Am Fam Physician 59(8):2155-67 [PubMed]