Dopamine agonists: Adverse effects (AAN report)

Subject: Dopamine agonists: Adverse effects (AAN report)

Date: 4/26/1999

1. Dopamine agonists and orthostatic hypotension in Parkinson's disease
KA Kujawa, S Leurgans, R Raman, CG Goetz
Neurology 1999;52(Suppl 2):A407

Acute orthostatic hypotension is a frequent adverse effect at commencement of dopamine agonist therapy, according to this study. Twenty-nine consecutive patients without previous OH were evaluated within two hours of receiving their first DA dose. Ten patients displayed OH, defined as a systolic change of more than 25 mmHg, or a diastolic change of more than 10 mmHg.; 3 of the 10 were symptomatic. Each of the agonists tested–pergolide, pramipexole, and ropinirole–produced OH. The authors conclude, " Because of acute orthostatic hypotension, we recommend that dopamine agonists be started under the direct supervision of a physician or nurse. Monitoring blood pressure in the outpatient clinic is a simple procedure which can assist in patient management."

2. Falling asleep at the wheel: A serious side effect of pramipexole and ropinirole
SJ Frucht, J Rogers, PE Greene, MF Gordon, S Fahn
Neurology 1999;52(Suppl 2):A409

This study reports on 8 male PD patients without prior history of sleep disturbances who developed sudden, overwhelming sleepiness while driving, resulting in falling asleep and automobile accidents. Patients were 54-83 years old, with disease of 2.5-13 years' duration. Seven patients were on pramipexole (mean 2.9 mg/day), and one on ropinirole (16 mg/day). The authors suggest that all patients beginning treatment with these drugs be warned of this possible side effect, and be specifically asked whether they drive.

E-MOVE Editor: Richard Robinson, NASW, WE MOVE

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