Hostname: page-component-77c89778f8-fv566 Total loading time: 0 Render date: 2024-07-25T02:39:58.175Z Has data issue: false hasContentIssue false
  • English
  • Français

Should Dopamine Agonists Be Given Early or Late? A Review of Nine Years Experience with Bromocriptine

Published online by Cambridge University Press:  18 September 2015

Abraham N. Lieberman ,
Govindan Gopinathan ,
Hassan Hassouri ,
Andreas Neophytides  and
Menek Goldstein
Govindan Gopinathan
Affiliation:
Department of Neurology, New York, University School of Medicine, New York
Hassan Hassouri
Affiliation:
Department of Neurology, New York, University School of Medicine, New York
Andreas Neophytides
Affiliation:
Department of Neurology, New York, University School of Medicine, New York
Menek Goldstein
Affiliation:
Department of Neurology, New York, University School of Medicine, New York
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Experience with bromocriptine in 106 patients treated over nine years was reviewed. Most of the patients were already being treated with levodopa (combined with a peripheral decarbosylase inhibitor). These patients, after having initially achieved a good response to levodopa, were no longer responding satisfactorily. Most of the patients were also experiencing diurnal oscillations in performance: “wearing off” and “on-off” phenomena. In these patients previous attempts at changing the dose (increasing or decreasing) or changing the scheduling of levodopa had been unsuccessful. Bromocriptine was added to levodopa beginning at a dose of 5mg/day, and each week was increased by another 5mg/day. At a dose of bromocriptine of at least 25 mg/day, there was a decrease in disability in the majority of patients with a decrease in the severity of the diurnal oscillations in performance (especially “wearing off” phenomena). In most patients, the addition of bromocriptine resulted in an approximately 10% reduction in the dose of levodopa. The majority of patients sustained their improvement at least one year. In some patients improvement was sustained for up to five years. The therapeutic efficacy of bromocriptine was limited in many patients by the occurrence of adverse effects including mental changes, dyskinesias, orthostatic hypotension, and nausea. These adverse effects could often be minimized by reducing the dose of bromocriptine or levodopa. All adverse effects were reversible upon stopping the drug. We have found bromocriptine to be a valuable adjunct in the treatment of these patients.

Type
7. Treatment of Parkinson’s Disease
Information
Canadian Journal of Neurological Sciences , Volume 11 , Issue S1: Current Concepts and Controversies in Parkinson’s Disease , February 1984 , pp. 233 - 237
Copyright
Copyright © Canadian Neurological Sciences Federation 1984

References

Calne, DB, Williams, AC.Neophytides, A. (1978) Long term treatment of parkinsonism with bromocriptine. Lancet i:735–378.CrossRefGoogle Scholar
Goldstein, M.Lew, JY, Engle, J. (1979) Dopaminergic ergot derivatives and motor funciton. Fuxe, K.Calne, DB (Editors). Pergamen Press. Oxford, pp. 235–260.Google Scholar
Lees, AJ, Haddad, S, Shaw, KM, (1978) Bromocriptine in parkinsonism. Arch. Neurol. 35:503–505.CrossRefGoogle ScholarPubMed
Lieberman, A, Zolfaghari, M.Boal, D, (1976a) The anti-parkinsonian efficacy of bromocriptine. Neurology 26:405–409.CrossRefGoogle Scholar
Lieberman, A, Kupersmith, M, Estey, E.Goldstein, M, (1976b) Treatment of Parkinson’s disease with bromocriptine. New Engl. J. Med. 295:1400–1404.CrossRefGoogle ScholarPubMed
Lieberman, AN, Kupersmith, M, Gopinathan, G, (1979a) Bromocriptine in Parkinson’s disease: further studies. Neurology 29:363–369.CrossRefGoogle ScholarPubMed
Lieberman, AN, Kupersmith, M, Gopinathan, G. (1979b) Modification of the “on-off” effect with bromocriptine and lergotrile. In Dopaminergic Ergot derivatives and motor function. Fuxe, K, Calne, DB (Editors). Pergamen Press, Oxford & New York. pp. 285–295.Google Scholar
Lieberman, A, Dziatolowski, M, Kupersmith, M, (1979c) Dementia in Parkinson’s disease. Ann. Neurol. 6:355–359.CrossRefGoogle Scholar
Lieberman, A.Kupersmith, M, Neophytides, A, (1980a) Long term efficacy of bromocriptine in Parkinson’s disease. Neurology 30:518–523.CrossRefGoogle Scholar
Lieberman, AN, Kupersmith, M.Neophytides, A, (1980b) Bromocriptine in Parkinson’s disease: report on 106 patients treated for up to five years. In Ergot Compounds and Brain Function: Neuroendocrine and Neuropsychiatric Aspects. Goldstein, M.et al. (Editors) Raven Press, New York, pp. 245–253.Google Scholar
Lieberman, A, Dziatolowski, M.Gopinathan, G, (1980c) Evaluation of Neuroendocrine and Neuropsychiatric Aspects. Goldstein, M, et al. (Editors) Raven Press. New York, pp. 277–286.Google Scholar
Lieberman, AN, Neophytides, A.Leibowitz, M, (1983) Comparative efficacy of pergolide and bromocriptine in patients with advanced Parkinson’s disease. Adv. in Neurol. 37:95–108.Google ScholarPubMed
Schran, HF, Bhuta, SI, Schwarz, HJ.Thorner, MO. (1980) The pharmacokinetics of bromocriptine in man. In Ergot Compounds and Brain Function: Neuroendocrine and Neuropsychiatric Aspects. Goldstein, Met al. (Editors) Raven Press, New York, pp. 125–139.Google Scholar
Teychenne, PF, Berg, S, Rud, D, Ray, A. (1982) Bromocriptine: low dose therapy in Parkinson’s disease. Neurology 32:577–583.CrossRefGoogle Scholar