PMID: 9711976: Should treatment of PD start with a dopamine agonist?

[janet paterson <janet313@xxxxxxxxxxx>]

Should treatment of Parkinson's disease be started with a dopamine agonist?

Which drugs to use when initiating pharmacotherapy in early Parkinson's disease 
(PD) is a complex treatment decision that depends on factors such as disease 
severity, functional disability, and psychosocial handicap, as well as 
individual aspects of age, employment status, cognitive impairment, and 
co-morbidity.

Without clear proof of a drug's capacity to markedly alter or even stop 
progression of the disease, there is no pharmacologic strategy that can be 
currently viewed as universal first-line treatment.

Dopamine (DA) replacement strategies offer greatest symptomatic relief and are 
needed whenever there is significant functional disability.

All currently available oral DA agonists have been shown to be less effective 
and less well tolerated than levodopa.

This has also been shown in recent double-blind controlled studies for the 
novel agonists such as ropinirole or cabergoline, although they appear equally 
effective in mild disease for the first 6-12 months of therapy.

Taking into account the significant difference in cost between levodopa and DA 
agonists, there is at present no reason to universally start DA replacement 
therapy with a DA agonist in most patients.

Dopamine agonists remain first-line treatment only for those at particular risk 
for developing levodopa-induced dyskinesias, i.e., young-onset PD patients.


Neurology 1998 Aug;51(2 Suppl 2):S21-4
Poewe W
Department of Neurology, University of Innsbruck, Austria.
PMID: 9711976, UI: 98375794

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janet paterson
52 now / 41 dx / 37 onset
snail-mail: PO Box 171  Almonte  Ontario  K0A 1A0  Canada
website: a new voice <>
e-mail: <janet313@xxxxxxxxxxx>