CABERGOLINE IN PARKINSONS-DISEASE COMPLICATED BY MOTOR FLUCTUATIONS

Cabergoline is a long-acting D-2 dopamine (DA) agonist. We conducted a n open study to investigate the effectiveness and tolerability of cabe rgoline, administered once a day orally, in 50 consecutive patients wi th Parkinson's disease complicated by motor fluctuations and dyskinesi as. In 15 patients cabergoline replaced another direct DA agonist. Eva luation after 6 months of treatment (also including patients who dropp ed out during this period), showed an improvement in off or on hours, or both, in excess of 50% in 27 patients, comprising 20 of the 35 pati ents (57%) previously untreated with DA agonists and seven of the 15 p atients (47%) already on DA agonists when the study began. Of the 22 p atients who received the treatment for 1 year, the improvement was mai ntained up to final evaluation in the patients not on DA agonists at a dmission (n = 16), whereas a slight deterioration in clinical conditio n was observed in the patients already on DA agonists at admission (n = 6). Only six patients showed a detectable increase in dyskinesias. T he most common side effects were gastric upset (n = 12), orthostatic h ypotension (n = 3), and ankle edema (n = 3), all mild; also observed w ere two cases of pleural effusion/pulmonary fibrosis. Twenty patients (40%) failed to complete the treatment; of these, five (10% of total) dropped out because of adverse effects. It is concluded that once-dail y administrations of cabergoline are useful for treating patients with Parkinson's disease with motor fluctuations and may advantageously su bstitute other DA agonists. The side effects of the drug are generally mild, although two cases involving pleuropulmonary complications did emerge.