Ropinirole and pramipexole, the new agonists

Ropinirole and pramipexole are non-ergoline dopamine agonists which are rel atively specific for the D2 family of dopamine receptors. They have side-ef fect profiles linked to peripheral and central dopaminergic stimulation, am enable to tolerance through a slow titration or the addition of domperidone in sensitive patients. They do not have the uncommon but problematic ergot -related side effects of bromocriptine and pergolide, Ropinirole and pramip exole have both been shown to be efficacious when used as monotherapy in ea rly Parkinson's disease (PD), and have been suggested as being less likely than levodopa to lead to the early development of motor fluctuations and dy skinesias in this clinical setting. They have also been shown to be useful as adjunctive therapy to levodopa in advanced PD and to have a levodopa-spa ring effect in these patients. Dose equivalents amongst the available dopam ine agonists is difficult to know with certainty but has been estimated as follows: 30 mg of bromocriptine, 15 mg of ropinirole, 4.5 mg of pramipexole , and 3.0 mg of pergolide.