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Information: Parkinson's Disease and Hair Loss (Alopecia)

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Parkinson's Disease and Hair Loss (Alopecia)

Kathrynne Holden, MS, RD

Copyright 2008, Five Star Living, Inc.


A number of people have written to "Ask the Parkinson Dietitian"

reporting that their hair began thinning and falling out, and wondering

why it occurs. It's not widely realized that some medications, including

some of the Parkinson medications, have alopecia (hair loss) as a rare,

but possible, side effect.

Researchers discovered years ago that the agonists bromocriptine

and pergolide, and the dopamine precursor, levodopa, caused hair loss in a

few people.1,2,3,4 Now, a more recent article, published in the journal

"Neurology," describes hair loss in two women with Parkinson's disease

(PD) who used the agonists pramipexole and ropinerole.5

One woman, age 66, had been taking amantadine, and later added

pramipexole. Two months after beginning the pramipexole regimen, she began

to experience hair loss. After tests for thyroid function, nutrient

deficiencies, and other possible causes turned out negative, the

pramipexole was discontinued and ropinerole was substituted. The hair

thinning stopped, and new hair growth began in about four weeks.

The second woman, age 68, had been using selegiline and amantadine

successfully, and later pramipexole was added. Twelve months after

beginning use of pramipexole, which had recently been increased to 3.5 mg

per day, she began to notice hair loss. She also switched from pramipexole

to ropinerole, but in her case the hair loss continued. She then

discontinued ropinerole, switching to carbidopa/levodopa. The hair

thinning stopped, and gradually her hair began to regrow, but did not

completely grow back.

The study notes that both women were being treated with amantadine

as well as the agonists, and speculates that the combination of amantadine

and agonists could be the cause of the hair loss.


Causes of alopecia


If you notice hair thinning, you should be aware that there are

many possible causes besides Parkinson medications.

1. Nutrient deficiencies: extreme deficiencies of biotin,

pantothenic acid, iron , and/or zinc can result in hair loss.

Malnutrition, and lack of protein can also be causes.

2. Too much vitamin A or vitamin E can lead to hair loss.

3. Medications (the following is a partial list of other

medications that, rarely, can lead to alopecia):

Parkinson medications:

Levodopa (Sinemet, Madopar, Dopar, Larodopa, Syndopa, etc.)

Agonists (pergolide, pramipexole, ropinerole, bromocriptine

Amantadine ? possibly

Cholesterol-lowering drugs - clofibrate, gemfibrozil

Ulcer drugs - cimetidine, ranitidine, famotidine

Anticoagulents - warfarin, heparin

Antigout medications - Allopurinol

Antiarthritics - auranofin, indomethacin, naproxen,

sulindac, methotrexate

Antihypertensive - lisinopril; Beta blocker drugs -

atenolol, metoprolol, nadolol, propranolol, timolol

Drugs derived from vitamin-A - isotretinoin, etretinate

Anticonvulsants - trimethadione

Antidepressants - tricyclics, amphetamines; bupropion,


Antithyroid agents - carbimazole, Iodine, thiocyanate,


Also - blood thinners, male hormones (anabolic steroids)

4. Stress

5. Hormonal changes

6. Thyroid disease, both underactive and overactive

7. Heredity

8. Pressure on the scalp from hats, caps, wigs or tightly-pulled


9. A fever of 103 degrees Fahrenheit or more may result in hair

loss weeks later.

10. Cancer treatments.

11. Seborrheic dermatitis (sometimes occurs among people with PD)


If you, or someone you know, has noticed hair thinning, consider

the above possibilities. Having more than one of the conditions increases

the likelihood of hair loss; for example, thyroid disease, stress, low

serum iron levels, and use of one or more of the above listed medications

makes it more likely that hair loss could occur.


Can alopecia be treated?


Most cases of hair loss can be reversed. However, treatment for

alopecia will depend on its cause; for this, you should see a

dermatologist, who can determine why the hair thinning has occurred and

can recommend the appropriate treatment, whether dietary, stress, thyroid,

medication, or other condition is the cause.

If the cause is seborrheic dermatitis, a dermatologist may suggest

a special shampoo or other cleanser. If the cause appears to be Parkinson

medications, however, then you must also discuss this with your

neurologist. Your doctor may be able to recommend a different medication

or combination of medications, particularly if you are using amantadine

along with an agonist. The important thing is to get a correct diagnosis

of the cause of the hair loss, and seek the treatment that will best

address this cause.

(The above article may not be reproduced in any form except with

permission from the author.)




1. Fabre N, et al.: Alopecia: an adverse effect of bromocriptine. Clin

Neuropharmacol. 1993; 16:266-268.

2. Blum I, Leiba S: Increased hair loss as a side effect of bromocriptine

treatment. N Engl J Med. 1980; 303:1418.

3. Marshall A, Williams MJ. Alopecia and levodopa. BMJ. 197; 2:47.

4. Factor SA et al.: Parkinson's disease: an open label trial of pergolide

in patients failing bromocriptine therapy. J Neurol Neurosurg Psychiatry.


5. Tabamo RE, Di Rocco A. Alopecia induced by dopamine agonists. Neurology

2002 Mar 12;58(5):829-30.

6. Martignoni E, Godi L, Pacchetti C, Berardesca E, Vignoli GP, Albani G,

Mancini F, Nappi G. Is seborrhea a sign of autonomic impairment in

Parkinson's disease? J Neural Transm. 1997;104(11-12):1295-304.

7. Rushton DH. Nutritional factors and hair loss. Clin Exp Dermatol. 2002


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