2ND-GENERATION OF DOPAMINE AGONISTS - PROS AND CONS

Dopamine agonists (DAGs) were first used in patients with moderate or advanced Parkinson's disease (PD). At that time, it was thought that D AGs could replace levodopa (LD) with fewer side effects. However, it s oon became clear that while they could not replace LD, they did allow reduction of the dose of LD and diminished its side effects. Since the use of DAGs reduces response fluctuations as well as dyskinesias, the re is a tendency to introduce them in the first stages of the disease, trying to delay motor fluctuations. While many DAGs have been develop ed, only four have been marketed and are used extensively for the trea tment of Parkinson's disease: apomorphine, bromocriptine, lisuride and pergolide. In the present chapter, following a review of the ''old'' DAGs, the experience with three new promising DAGs is reported: caberg oline, ropinirole and pramipexole.