Pramipexole and Parkinson's disease, an update

Introduction and development. Pramipexole is a non-ergotic D-2/D-3 dopaminergic agonist that can be used to treat the symptoms of Parkinson's disease safely and effectively both as monotherapy in the early stages and in the advanced phases in association with levodopa, which improves the motor fluctuations and dyskinesias. Furthermore, in laboratory studies pramipexole has proved to exert neuroprotector effects and its use in clinical practice from the early stages of the disease has been related to a delay in the appearance of motor complications (fluctuations and dyskinesias). It has recently been shown that it is especially valuable in the treatment of tremors and is also effective in improving certain non-motor symptoms such as depression. Pramipexole is free of the severe side effects (fibrosis and valve disease) linked with ergotic dopaminergic agonists and causes fewer digestive and dysautonomic alterations. Other undesirable side effects of treatment with non-ergotic agonists, such as hallucinations, the appearance of oedemas and drowsiness, can be minimised by carefully selecting the patients. Further studies need to be conducted to help define the long-term effects of dopaminergic agonists on the progress of the disease and also to show the differences between non-ergotic agonists in clinical practice.