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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
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Abstract

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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

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