How to succeed in using dopamine agonists in Parkinson's disease

Dopamine receptor agonists are assuming increased importance in the treatme nt of both early and advanced symptoms of Parkinson's disease (PD). However , tolerability of these drugs can be a problem. Identifying patients who ar e at increased risk of adverse effects is central to using dopamine agonist s in PD. The newer agonists, pramipexole and ropinirole, are generally adeq uate without levodopa for early symptoms and carry the hope for a more acce ptable profile of long-term side-effects. In the patient with advanced dise ase, all four dopamine agonists significantly augment the response to levod opa, which reduces the problems of motor fluctuations and drug related dysk inesia. Understanding the common pitfalls when prescribing these drugs will facilitate their safety and efficacy.