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Uses of the different dopamine agonists

early stage dopamine agonists

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#1 rappleman

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Posted 26 May 2013 - 01:31 PM

Two related questions re early stage (before levodopa) use dopamine agonists (RequipXL, MirapexER, Neupro, any others?) First, could you please compare/contrast differences relative to each other, things like side effect profile, why choose one vs another. Second, some types of meds there is benefit to lower doses of two different drugs producing more benefit with less side effect than a larger dose of either one alone (sort of 2+2=5 if you will) while others the dangers of more meds on board tend to dictate the opposite approach (sort of 2+2=3)....so in the case of dopamine agonists, is there ever any benefit to use of more than one at the same time such as perhaps lower total dose or less side effect risk? Thanks very much!

#2 MComes RPH

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Posted 30 May 2013 - 03:02 PM

As far as the profiles of all of the meds in this class, you will see they are all very similar.
Except for Neupro, due to the fact it is not taken orally, so as far as when and what you can eat, this one will not be in play. It will have very little, usually no effect on what other med are taken, what time they are taken, and what food are eaten at what time. That is a big plus for many people who take many different meds or are still able to have an active life style. Put it on in the morning, and depending on the side effects, take it off at night or the next morning. The side effect of obsessive compulsive issue arises with all these meds, so with Neupro, some patients take it off at night to avoid this, instead of waiting for the next morning.
As i said, the profiles are almost identical. From a professional stand point, I have seen less patients have the obsessive issue with requip than with mirapex. There is really no answer as to why, that is just what I has seen and heard from many patients. With that in mind, it is usually at the higher doses of mirapex where they see it and not with the higher doses of requip.
As with any PD medication, everyone has a different dose to take care of their symptoms. They also have different times when they are worse. Usually younger PD patients can use the regular acting of any of the agonists 3 times daily or the XL (ER) version once daily. I usually see the more severe younger patients or older patients have to use the regular strength multiple times daily. This mainly has to due to severity of symptoms and attempting to get exact control at certain times of the day.
Since all of these meds act the same way, if you were to add mirage with requip, you would not get any more relief, but you would experience all of the side effects. This is where you get the 1+1=3 effect when it comes to the medicine. A good example of this is Extra Strength Tylenol. The max relief you will receive is by taking 2 tablets. If you take 3 or 4, you will not receive any more pain relief, but you will get more of the side effects. Now if you were to add a 2 Tylenol with 1 over the counter Motion, you will get more pain relief, but you probably will not get any more side effects.
This is the same with PD meds, once you start experiencing side effects or max'd out the dose (and have no relief), it is time to switch to a different class of meds. With new symptoms may come a new med.
Many people may take 2-4 meds for PD, because they all work on specific symptoms of the disease. Usually if you have a "bad" experience with one med, you will probably have the same experience with all the meds in that class. But, like I said, there are some unique circumstances (like with mirapex and requip).
Lastly, it is highly unlikely to see someone on an XL version of a med then also see them take the regular version in between the XL doses. It is usually a different med that is used in between the XL dose. This way you don't get too high of a dose of whatever the XL med may be, opening yourself up for the side effects.
Hope this helps.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#3 rappleman

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Posted 11 June 2013 - 08:49 PM

Very comprehensive answer. Very much appreciated!

#4 MComes RPH

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Posted 12 June 2013 - 03:29 PM

No problem. When it comes to Medication and PD, you can never be too careful or too noninclusive.
Thanks
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org




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