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Ropinirole and Pramipexole, the New Agonists

Published online by Cambridge University Press:  02 December 2014

Douglas E. Hobson ,
Emmanuelle Pourcher  and
W.R. Wayne Martin
Douglas E. Hobson
Affiliation:
The University of Manitoba, Winnipeg, Manitoba
Emmanuelle Pourcher
Affiliation:
Laval University, Quebec City, Quebec
W.R. Wayne Martin
Affiliation:
University of Alberta, Edmonton, Alberta
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Abstract

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Ropinirole and pramipexole are non-ergoline dopamine agonists which are relatively specific for the D2 family of dopamine receptors. They have side-effect profiles linked to peripheral and central dopaminergic stimulation, amenable to tolerance through a slow titration or the addition of domperidone in sensitive patients. They do not have the uncommon but problematic ergot-related side effects of bromocriptine and pergolide. Ropinirole and pramipexole have both been shown to be efficacious when used as monotherapy in early Parkinson's disease (PD), and have been suggested as being less likely than levodopa to lead to the early development of motor fluctuations and dyskinesias in this clinical setting. They have also been shown to be useful as adjunctive therapy to levodopa in advanced PD and to have a levodopa-sparing effect in these patients. Dose equivalents amongst the available dopamine agonists is difficult to know with certainty but has been estimated as follows: 30 mg of bromocriptine, 15 mg of ropinirole, 4.5 mg of pramipexole, and 3.0 mg of pergolide

Résumé

RÉSUMÉ

Le ropinirole et le pramipexole sont des agonistes dopaminergiques non dérivés de l'ergot, qui sont relativement spécifiques pour les récepteurs dopaminergiques de la famille D2. Ils ont des profils d'effets secondaires reliés à la stimulation dopamin-ergique périphérique et centrale, et une augmentation progressive de la posologie ou l'addition de dompéridone chez les patients sensibles favorise la tolérance. Ils n'ont pas les effets secondaires rares et problématiques, reliés à l'er-got, de la bromocriptine et du pergolide. Il a été démontré que le ropinirole et le pramipexole sont tous deux efficaces en monothérapie dans la maladie de Parkinson (MP) au début, et il semble qu'ils aient moins tendance que la lévodopa à provoquer l'apparition précoce de fluctuations motrices et de dyskinésies dans ce contexte clinique. On a également démontré qu'ils sont utiles comme traitement adjuvant à la lévodopa dans la MP en phase avancée et qu'ils ont un effet d'épargne de la lévodopa chez ces patients. Il est difficile de déterminer avec certitude les doses équivalentes des agonistes dopaminergiques disponibles, mais elles ont été estimées comme suit: bromocriptine 30 mg, ropinirole 15 mg, pramipexole 4.5 mg et pergolide 3.0 mg.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 26 , Issue S2 , August 1999 , pp. S27 - S33
Copyright
Copyright © The Canadian Journal of Neurological 1999

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