Pramipexole, a nonergot dopamine agonist, is effective against rest tremorin intermediate to advanced Parkinson's disease

We evaluated the efficacy of the nonergot dopamine receptor agonist pramipe xole in 16 patients with advanced Parkinson's disease and marked rest tremo r during an "on" period. The patients were drawn from a larger placebo-cont rolled, double-blind, randomized trial, which was not originally designed t o investigate the effect of pramipexole on tremor. Eleven patients received pramipexole. The first effects were seen with a pramipexole dose of 0.75 m g/d with a reduction of the tremor item A of Unified Parkinson's Disease Ra ting Scale (UPDRS III, "on" state) by 25% and of rigidity and akinesia by 2 2%. Under the highest dose, 4.5 mg/d, the tremor score was improved by 61% over baseline (p < 0.0056, Wilcoxon signed rank) and the sum of rigidity an d akinesia items by 66% (p < 0.0038, Wilcoxon signed rank). Five patients r eceived placebo and did not improve. Based on this sample of patients, the nonergot dopamine receptor agonist pramipexole appears to have a potent ant i-rest tremor action while being effective against akinesia and rigidity.