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Tuesday, March 11, 2014
Factors in choosing dopamine agonists
My mother has had PD for 19 years and is now very rigid with very few on times. She has cut back her sinemet to 4 25/100CRs because dykinesias were frequent and violent. (She cut 3 10/100s.) She is on Mirapex and sleeps often and has short term memory loss. Would Requip be better for dykinesias? Can more than one agonist be used?
You haven`t told me how old your mother is. As a general rule in older (say more than 70-75 years old) patients, the dopamine agonists are harder to use due to a greater likelihood of hallucinations. None of the agonists has been shown to be superior to the others. However, it may be well worth changing to Requip as some patients respond better to one than the other. Adding Seroquel to help control the hallucinations is also an option. Finally, surgery (pallidotomy) may help control dyskinesias.
Arif Dalvi, MD
College of Medicine
University of Cincinnati