Long term role of pergolide as an adjunct therapy in Parkinson's disease: influence on disability, blood pressure, weight and levodopa syndrome

Pergolide is a dopamine agonist acting on D1 and D2 receptors and has been used as an adjunct therapy with levodopa. We have retrospectively investigated its role over a duration of upto six years in Parkinson's disease (PD) patients to study: (1) its influence on the progression of disability related to PD; (2) effect on blood pressure and weight during the treatment period; (3) whether the use of pergolide has a long term levodopa sparing effect; (4) and how is it tolerated during this period? We studied 43 patients who had been on adjunct therapy with pergolide in addition to levodopa for more than six months. Mean age was 66 years, mean duration of PD prior to adding pergolide was 8 years and final assessment was done after a mean duration of adjunct therapy of 29 (6-72) months. There was no progression of disease disability as assessed on Hoehn and Yahr stage (p = 0.09) and Webster score (p = 0.20), while there was an improvement in symptom score (p = 0.001). There was an insignificant reduction in the dose of levodopa at final assessment from 630 to 535 mg (p = 0.06). A significant number of patients were able to discontinue taking selegiline (p = 0.002). There was no change in the number of patients with hallucinations (p = 0.15) and dyskinesia (p = 0.09). There was a significant fall in weight (p = 0.02), systolic (p = 0.023) and diastolic blood pressure (p = 0.03). This fall did not correlate with age, dose of pergolide or levodopa or disease severity but was influenced by duration of treatment. Ten patients discontinued pergolide for minor reasons after a mean duration of therapy for 23 months. We conclude that pergolide is a valuable adjunct therapy with levodopa over a duration of upto six years to maintain control of motor symptoms of Parkinson's disease. (C) 1999 Elsevier Science Ltd. All rights reserved.