Dopamine Agonists

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These medications stimulate the parts of the human brain influenced by dopamine. In effect, the brain is tricked into thinking it is receiving the dopamine it needs. In general, dopamine agonists are not as potent as carbidopa/levodopa and may be less likely to cause dyskinesias.

Forms of Dopamine Agonists

Pramipexole (Mirapex®)

Available Doses: .125 mg, .25 mg, .5 mg, .75 mg, 1 mg, 1.5 mg
Typical Treatment Regimen: 1.5–4.5 mg total daily dose (3 times/day)
Side Effects*: Low blood pressure, nausea, leg swelling and discoloration, confusion, sleep attacks, compulsive behaviors like gambling
Indications: Monotherapy or combination therapy for slowness, stiffness and tremor

Pramipexole Dihydrochloride Extended-Release (Mirapex ER®)

Available Doses: .375 mg, .75 mg., 1.5 mg, 2.25 mg, 3 mg, 3.75 mg, 4.5 mg
Typical Treatment Regimen: 1.5–4.5 mg once/day
Side Effects*: Low blood pressure, nausea, leg swelling and discoloration, confusion, sleep attacks, compulsive behaviors like gambling
Indications: Monotherapy or combination therapy for slowness, stiffness and tremor

Ropinirole (Requip®)

Available Doses: .25 mg, .5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5mg
Typical Treatment Regimen: 9–24 mg total daily dose (3 times/day)
Side Effects*: Low blood pressure, nausea, leg swelling and discoloration, confusion, sleep attacks, compulsive behaviors like gambling
Indications: Monotherapy or combination therapy for slowness, stiffness and tremor

Ropinirole Extended-Release Tablets (Requip® XL™)

Available Doses: (All doses taken once a day) 2 mg, 4 mg, 6 mg, 8 mg, 12 mg
Initial Dosing: 8–24 mg once/day
Side Effects*: Low blood pressure, nausea, leg swelling and discoloration, confusion, sleep attacks, compulsive behaviors like gambling
Indications: Monotherapy or combination therapy for slowness, stiffness and tremor

Apomorphine Hydrochloride Injection (APOKYN®)

Available Doses: 30 mg/3 ml vial
Typical Treatment Regimen: .2 mL during “off” periods
Side Effects*: Low blood pressure, nausea, leg swelling and discoloration, confusion, sleep attacks, compulsive behaviors like gambling. May receive antinausea medication daily for 3 days before starting medication
Indications: Adjunct therapy as needed for OFF periods. It is the only injectable, fast-acting dopaminergic drug, starts working in 10 minutes and lasts for 90 minutes

Apomorphine hydrochloride (KYNMOBI™) 

Available Doses:  10 mg, 15 mg, 20 mg, 25 mg, and 30 mg sublingual film
Typical Treatment Regimen:  One 10mg film placed under the tongue as needed, up to five doses per day, separated by at least 2 hours. These films are similar in appearance to breath freshening strips. However, these are placed under the tongue rather than on top.
Side Effects*:  nausea, oral/pharyngeal soft tissue swelling, oral/pharyngeal soft tissue pain and numbness, dizziness, and sleepiness. May receive anti-nausea medication daily for 3 days before starting medication
Indications: for the acute, intermittent treatment of “off” episodes in Parkinson’s disease. It is the only sublingual therapy approved for the on-demand treatment of Parkinson’s disease OFF episodes. 

Rotigotine Transdermal System (Neupro®)

Available Doses: 1 mg, 2 mg, 3 mg, 4 mg, 6 mg, 8 mg patch
Typical Treatment Regimen: 4–8 mg once/day
Side Effects*: Low blood pressure, nausea, leg swelling and discoloration, confusion, sleep attacks, compulsive behaviors like gambling, skin rashes
Indications: Monotherapy or combination therapy for slowness, stiffness and tremor; skin patch delivery is an advantage for some

Common Side Effects for Dopamine Agonists

  • Excessive daytime sleepiness or sudden sleep attacks
  • Visual hallucinations
  • Confusion
  • Leg swelling and discoloration
  • Dyskinesia (not as common)
  • Compulsive behaviors (such as uncontrolled shopping, gambling, eating, and sexual urges)

Quick Facts

  • Dopamine agonists are a different class of drugs than levodopa.
  • While levodopa is converted in the brain into dopamine, dopamine agonists  mimic the effects of dopamine without having to be converted.
  • Apart from carbidopa/levodopa, dopamine agonists are often the first medication prescribed to treat PD but can also be used in later stages of PD with carbidopa/levodopa.

Disclaimers:

* Please note that the side effects listed in the tables that accompany each class of medication are the most commonly experienced. Not all individuals will experience such side effects. For many people who do experience side effects, they can often be effectively limited or eliminated with careful adjustments to dosage or the timing of the individual doses.

Speak to the treating physician immediately if any side effects are experienced. For a complete description of each drug and its possible side effects, please request a “package insert” from your pharmacist for each drug used. It is recommended that all prescriptions be filled at the same pharmacy to avoid interactions between medications. Interactions can be dangerous and even life-threatening, so make sure the pharmacist knows of all medications and supplements being taken, including over-the-counter medications and supplements.

Caution: PD medications may have interactions with certain foods, other medications, vitamins, herbal supplements, over the counter cold pills and other remedies. Anyone taking a PD medication should talk to their doctor and pharmacist about potential drug interactions.

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