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Piribedil and bromocriptine in Parkinson's disease: a single‐blind crossover study
Author(s) -
Tan E. K.,
Ratnagopal P.,
Han S. Y.,
Wong M. C.
Publication year - 2003
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1034/j.1600-0404.2003.02104.x
Subject(s) - tolerability , nausea , bromocriptine , adverse effect , medicine , levodopa , parkinson's disease , epworth sleepiness scale , lethargy , psychology , anesthesia , physical therapy , disease , polysomnography , apnea , prolactin , hormone
– Clinicians switch from one dopamine agonist to another for various reasons. However, each change may inadvertently result in certain potential risks such as decreased medication efficacy or new side‐effects. Objective – We evaluated the tolerability of a switch of bromocriptine to piribedil using two conversion ratios as a primary outcome measure, with motor function as a secondary outcome measure, in patients with mild to moderate Parkinson's disease (PD). Methods – Twenty consecutive patients with mild to moderate PD (Hoehn and Yahr, stage II–III) on treatment with stable doses of bromocriptine and levodopa were randomized to two groups of 10 patients each, to receive piribedil based on 1:5 or 1:10 conversion ratios. Blinded evaluations were performed: 1) United Parkinson's Diseased Rating Scale (UPDRS) scores both in ‘on’ and ‘off’, 2) Open‐ended interviews for adverse events, 3) Epworth Sleepiness Scale, 4) Purdue Pegboard assessment during ‘on’ and ‘off’, 5) Hand‐arm movement test during ‘on’ and ‘off’, and 6) Walking test during ‘on’ and ‘off’. Results – Major adverse events included ‘sleep attacks’ in one patient and minor side‐effects included giddiness, nausea, hallucinations, sleepiness and lethargy. However, these were mild and 19 (95%) of the 20 patients completed the study. There was a significant improvement in both the UPDRS ‘off’ total and motor scores at 1 month compared with baseline for the group on 1:10 ratio. The walking times during the ‘off’ state at 1 and 2 months were significantly better compared with baseline in the 1:5 group. There were otherwise no significant differences in the rating tests during both ‘off’ and ‘on’ states before and after the bromocriptine switch. Conclusions – We demonstrated that patients with mild to moderate PD who were on relatively low doses of bromocriptine can be safely switched to piribedil based on a conversion ratio of either 1:5 or 1:10. However, the higher conversion ratio has to be carried out with caution in patients with daytime somnolence.