An update on the use of non-ergot dopamine agonists for the treatment of Parkinson's disease

Expert Opin Pharmacother. 2020 Dec;21(18):2279-2291. doi: 10.1080/14656566.2020.1805432. Epub 2020 Aug 17.

Abstract

Introduction: Long-term treatment of Parkinson's disease (PD) with levodopa is hampered by motor complications related to the inability of residual nigrostriatal neurons to convert levodopa to dopamine (DA) and use it appropriately. This generated a tendency to postpone levodopa, favoring the initial use of DA agonists, which directly stimulate striatal dopaminergic receptors. Use of DA agonists, however, is associated with multiple side effects and their efficacy is limited by suboptimal bioavailability.

Areas covered: This paper reviewed the latest preclinical and clinical findings on the efficacy and adverse effects of non-ergot DA agonists, discussing the present and future of this class of compounds in PD therapy.

Expert opinion: The latest findings confirm the effectiveness of DA agonists as initial treatment or adjunctive therapy to levodopa in advanced PD, but a more conservative approach to their use is emerging, due to the complexity and repercussions of their side effects. As various factors may increase the individual risk to side effects, assessing such risk and calibrating the use of DA agonists accordingly may become extremely important in the clinical management of PD, as well as the availability of new DA agonists with better profiles of safety and efficacy.

Keywords: Dopamine agonists; Parkinson’s disease; preclinical and clinical findings; side effects.

Publication types

  • Review

MeSH terms

  • Antiparkinson Agents / administration & dosage
  • Antiparkinson Agents / adverse effects
  • Antiparkinson Agents / therapeutic use*
  • Clinical Trials as Topic
  • Dopamine Agonists / administration & dosage
  • Dopamine Agonists / adverse effects
  • Dopamine Agonists / therapeutic use*
  • Drug Administration Schedule
  • Drug Evaluation, Preclinical
  • Humans
  • Levodopa / administration & dosage
  • Levodopa / adverse effects
  • Levodopa / therapeutic use*
  • Motor Activity / drug effects
  • Parkinson Disease / drug therapy*
  • Parkinson Disease / metabolism
  • Treatment Outcome

Substances

  • Antiparkinson Agents
  • Dopamine Agonists
  • Levodopa