Medications for the Management of Parkinson’s Disease Part 2 – Agonists

Medications for the Management of Parkinson’s disease Part 2 – Agonists


The second “miracle drug” for PARKINSON’S DISEASE  are the dopamine agonists.  Agonists work by making the receptor neurons think they are getting enough dopamine and by keeping available dopamine in the synapse between neurons a little longer.  In the early stages of PARKINSON’S DISEASE , use of agonists alone may be beneficial, but as the disease progresses, they are not as useful alone as they are together with carbi/levodopa.  Agonists can be helpful in managing fluctuations in symptoms from carbi/levodopa treatments.  There are side effects, and they can exacerbate the side effects of the other medications. Some of the more serious side effects have been with impulse control.  Problems such as gambling, impulsive shopping and hyper sexuality have been blamed on these medications.  Excessive sleepiness has also been reported.  It takes an experienced, PARKINSON’S DISEASE  trained neurologist to “fine tune” dosage and timing of all the PARKINSON’S DISEASE  medications.  Dosage of agonists should be started low and built up; if symptoms warrant a withdrawal from agonists, they must be decreased slowly.  The most common agonists are pramipexole (Mirapex) and ropinerole (Requip).  Long acting versions of both are also available as Mirapex ER and Requip XL.

Several other pharmaceutical products have become available for treatment of PARKINSON’S DISEASE .  While they are not the mainstream medications, they can be very, very useful in certain situations.  A fast dissolving form of carbi/levodopa is available for situations when it would take too long for a regular pill to be effective.  This is Parcopa, and it is now available as a generic.  Another “rescue drug” is apomorphine (Apokyn)  This is an injectable drug, and a patient or a caregiver has to be trained to give the injection.  This is a short acting drug, in the agonist class, but if someone suffers from sudden “off” periods, this can get them going again very quickly.  It does cause nausea, so anti-nausea agents must be taken at the same time.

The rotigotine transdermal patch (Neupro) was hailed as another “miracle” when it first came out.  It delivered a steady dose of medication which was easily and readily absorbed through the skin.  Patients were thrilled to wear a patch instead of taking a regimen of drugs.  And it was effective for many of them, but it had problems, particularlly with the adhesive and the FDA forced it to be recalled from the market for several years.  It is now back.  It is in the agonist class, and while it is very useful, it  too, has side effects, some of which can be quite serious.  Sensitivity to sulfites is one drawback, but among people with PARKINSON’S DISEASE  this is not a common issue.  Drowsiness, nausea and the other side effects noted for drugs in the agonist class apply to this one, too.  Skin irritations can develop from either the ingredients or the adhesive in the patch and care must be taken not to expose the patch to either heat or water.  It comes in various doses.

If PARKINSON’S DISEASE  were the only disease a person needed treatment for, it would still be a very complex matter.  But because PARKINSON’S DISEASE  usually starts later in life, there probably are some other medical issues to consider, complicating the situation even further.  Seeking the advice of a neurologist who is both trained and experienced in movement disorders and especially in PARKINSON’S DISEASE  is essential.  The attention of a caring and dedicated primary care physician is also a high priority, especially if multiple medications for multiple medical issues are involved.  A good primary care physician can treat infections which  cause a person with PARKINSON’S DISEASE  extra distress and disrupt the benefit of the PARKINSON’S DISEASE  meds as well as oversee all the combinations of medications a person is taking to avoid serious drug interactions.

Although there is no cure for Parkinson’s disease, the symptomatic treatments that are available today are able to improve the quality of life and reduce the symptoms better than at any time in the past.  Of course, research is ongoing, new drugs will come along and perhaps that elusive cure will be found.  Living one’s life to the fullest and living well with PARKINSON’S DISEASE  can be possible with the help of a good neurologist and modern medications.

Side Effects


For a full list please see the information at:

Applies to pramipexole: oral tablet, oral tablet extended release

Along with its needed effects, pramipexole (the active ingredient contained in Mirapex) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking pramipexole:

More common

  • Dizziness, lightheadedness, or fainting, especially when standing up
  • drowsiness
  • hallucinations (seeing, hearing, or feeling things that are not there)
  • nausea
  • trouble with sleeping
  • twitching, twisting, or other unusual body movements
  • unusual tiredness or weakness

Some side effects of pramipexole may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Constipation
  • dryness of the mouth
  • headache
  • heartburn, indigestion, or acid stomach

Less common

  • Abnormal dreams
  • decreased sexual drive or ability
  • general feeling of discomfort or illness
  • increased cough
  • increased sweating
  • itching
  • joint pain
  • loss of appetite
  • runny nose
  • skin problems, such as rash or itching weight loss


For complete information please see:

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

  • feeling like you might pass out;
  • fever, stiff muscles, confusion, sweating, fast or uneven heartbeats (especially if you stop taking Requip or use a lower dose);
  • hallucinations;
  • tremors (uncontrolled shaking); or
  • tight feeling in your chest, trouble breathing.

Call your doctor promptly if you fall asleep during a daily activity, if you faint, or if you have hallucinations (hearing or seeing something that is not there). Your doctor may want you to stop taking Requip, or take a lower dose.

Less serious Requip side effects may occur, such as:

  • mild nausea, vomiting, stomach pain, or loss of appetite;
  • worsened RLS symptoms early in the morning;
  • diarrhea or constipation;
  • dry mouth, sweating;
  • headache;
  • dizziness, drowsiness;
  • sleep problems (insomnia); or
  • agitation or anxiety.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Requip side effects (in more detail) 


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