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Effects of dopamine agonists bromocriptine, pergolide, cabergoline, and SKF-38393 on GDNF, NGF, and BDNF synthesis in cultured mouse astrocytes.

We examined the stimulatory effects of the dopamine agonists bromocriptine, pergolide, cabergoline, and SKF-38393 on the synthesis and secretion of neurotrophic factors (nerve growth factor, NGF; brain-derived neurotrophic factor, BDNF; and glial cell line-derived neurotrophic factor, GDNF) in cultured mouse astrocytes, and clarified the role of dopamine D1 and D2 receptors in these effects. Bromocriptine, a D2 agonist, elevated NGF levels in the culture medium 6.8-fold vs. control, and significantly decreased GDNF and BDNF levels, at 24 h. Both pergolide, a D1/D2 agonist, and cabergoline, a D2/weak D1 agonist, rapidly elevated NGF and GDNF levels at 4-6 h, respectively to 21- and 1.5-fold, respectively, and 84- and 9-fold, respectively, of control levels at 24 h. SKF-38393, a D1 agonist, elevated NGF and GDNF levels to 20- and 2.8-fold of controls, respectively, at 24 h. Relative levels of NGF and GDNF mRNA detected by Northern blot analysis or semiquantitative reverse transcriptase-polymerase chain reaction confirmed that increases in levels of the 2 proteins in culture medium were due to overexpression as opposed to leakage from cells. Cabergoline rapidly increased GDNF mRNA expression at 4 h, producing a potent and long-lasting increase in GDNF levels. Bromocriptine significantly suppressed GDNF synthesis. These findings suggest that stimulation of dopamine D1 receptors may be required for GDNF synthesis and secretion, and that concurrent stimulation of dopamine D1 and D2 receptors may augment synthesis and secretion of NGF and GDNF. These dopamine agonists may play a role in neuronal survival by stimulating NGF and GDNF synthesis in the brain, and as drugs are good candidates as NGF and GDNF inducers.

2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-ben↗

Long-term effects of pergolide and (-)-deprenyl on 3H-mazindol and 3H-spiperone binding in rat brain.

The effects of long-term administration of the putative neuroprotective agents pergolide and (-)-deprenyl was assessed by studying 3H-mazindol and 3H-spiperone binding at 12 and 20 months in the major dopamine brain regions. Male Wistar rats were treated from 3 to 20 months, together with their respective untreated and saline injected control groups. The main findings were: 1) there was a decrease in both 3H-mazindol and 3H-spiperone binding with age between 12 and 20 months; 2) there were no differences at 20 months between the pergolide or the (-)-deprenyl treated groups and their controls, thus providing no evidence for long-term neuroprotection; and 3) there was a marked decrease in 3H-mazindol binding in the injected controls compared with the untreated controls at both 12 and 20 months. This raises the possibility that mild chronic stress may accelerate the aging of the dopamine system.

Animals↗

Cardiac effects of pergolide.

We examined the effect of pergolide, a semisynthetic ergot alkaloid, alone or combined with carbidopa and levodopa (Sinemet), on the cardiac rhythm of 12 patients with Parkinson's disease. The patients were selected on the basis of severe Parkinson's disease and stable cardiac rhythm as determined by 1 to 5 days of Holter monitoring. Monitoring was then carried out for an additional period of between 2 and 10 wk while the patients were on pergolide. Seven of the 12 patients had repetitive ventricular rhythms (RVRs). These were isolated, infrequent, and not associated with increases in premature ventricular contractions. The dose at which the RVRs occurred may be a function of the presence or absence of heart disease, but the significance of RVRs remains to be determined.

Aged↗

Pergolide as adjuvant therapy to amisulpride in the treatment of negative and depressive symptoms in schizophrenia.

Negative and cognitive symptoms of schizophrenia are associated with a hypodopaminergic state in the frontal cortex and do not respond to neuroleptics equally well as positive symptoms. Therefore pharmacological strategies, which increase dopamine metabolism in the mesocortical pathways, may prove beneficial to ameliorate these symptoms. We report on a case of a patient with paranoid schizophrenia, who still presented negative and depressive symptoms during treatment with amisulpride for more than 6 weeks. We prescribed pergolide (a mixed D1/D2 agonist) as adjuvant therapy to treat these symptoms. The patient showed an improvement of global psychopathology, decrease of negative and depressive symptoms, while no changes in positive symptoms nor EPS were present. For this patient, the adjuvant therapy of pergolide to amisulpride constituted a valid pharmacological approach to treat negative and depressive symptoms of schizophrenia, without increasing positive symptoms.

Adult↗

Use of dopamine agonist pergolide in outpatient treatment of cocaine dependence.

The dopamine agonist pergolide was evaluated in the treatment of 42 men who manifested cocaine dependence in a single-blind, 4-week-long placebo-controlled study, during 1998-1999 in São Paulo, Brazil. The patients were randomly assigned to two groups: the first group received pergolide (0.05-0.2 mg per day) and the second group received placebo (one to four tablets per day). Urine toxicology screens were obtained. The groups were compared in terms of depressive symptoms, "craving," use of cocaine, side effects of medications, results of urine tests, and retention in treatment. At 3 months' follow-up, the participants were reassessed. No differences were found between the two groups.

Adult↗

Pergolide therapy in Parkinson's disease: a double-blind, placebo-controlled study.

A double-blind, placebo-controlled study was conducted of pergolide as an adjunctive treatment to levodopa in 17 patients with advanced Parkinson's disease. There was a significant improvement (p less than 0.05) in total disability score, in gait, and in "wearing off" and "on-off" phenomena. Pergolide is a useful drug in patients with advanced Parkinson's disease.

Adult↗

Delayed visual loss following pergolide treatment of a prolactinoma.

A patient who had achieved marked improvement in vision and shrinkage of a prolactinoma following treatment with pergolide (0.1 mg/day) suffered a marked worsening of vision 7 months after continued treatment at the same dose. Brain magnetic resonance imaging (MRI) at the time of visual loss showed further shrinkage of the tumor and prolapse of the chiasm into the pituitary fossa. The dose of pergolide was cut in half (0.05 mg/day); 12 months later, vision had completely recovered. Brain MRI at the time of visual recovery showed no change in the position of the prolapsed chiasm. This is the 11th reported case of delayed visual loss following dopaminergic treatment of prolactinoma. Recovery of vision always occurs with reduction of the medication dosage. Many patients whose prolactinomas are treated in this fashion display chiasmal prolapse, and few suffer visual loss. Considering that visual recovery occurs without a visible change in the position of the chiasm, traction is an unlikely cause of delayed visual loss. Therefore, the term chiasmal traction syndrome, used to describe visual loss with prolapsed chiasm following surgical and radiation treatment of sellar tumors, should not be applied in this setting lest it prompt consideration of surgical chiasmapexy. The proper management is reduction of the dopaminergic agonist dosage.

Dopamine Agonists↗

Erythromelalgia following pergolide administration.

Two patients are described in whom treatment of Parkinson's disease with the ergot derivative pergolide was associated with the development of erythromelalgia. The possible mechanism of pergolide-induced erythromelalgia is briefly discussed.

Aged↗

Pergolide presynaptically inhibits calcium-stimulated release of gamma-aminobutyric acid.

The release of gamma-aminobutyric acid (GABA) in rat dorsolateral striatum was studied using in vivo microdialysis. Dialysis was conducted 2 days after probe implantation in awake, freely moving rats using a modified Ringer solution. Calcium induced a reversible increase in GABA release that was abolished by tetrodotoxin but was only slightly attenuated by a maximally effective dose of pergolide, a D2 receptor agonist. It was thus concluded that pergolide inhibits calcium-stimulated release of GABA presynaptically by a mechanism distinct from that of tetrodotoxin.

Animals↗

Rotational behaviour elicited by intracerebral injections of apomorphine and pergolide in 6-hydroxy-dopamine-lesioned rats. I: Comparison between systemic and intrastriatal injections.

Rotational behaviour in unilaterally 6-hydroxy-dopamine-denervated rats has been attributed to stimulation of dopamine receptors on striatal as well as limbic areas. In the present study the rotational behaviour elicited by local intrastriatal injections of apomorphine or pergolide was compared to the rotation elicited by systemic injections of the drugs. We found that intrastriatal injections induced rotational behaviour almost identical to the behaviour occurring after systemic treatment. Furthermore, studies of the spread of [3H]apomorphine in brain tissue showed that at the peak of rotation the radioactivity was confined within the limits of the striatum. Non-significant amounts of radioactivity was found in the nucleus accumbens. On the basis of these data we conclude that rotational behaviour elicited by systemic injections of apomorphine or pergolide originates from stimulation of striatal sites. The difference in rotational patterns elicited by these drugs is more likely to relate to differences in receptor stimulation within the striatum than differences in, for example, relative distribution between limbic and striatal areas.

Animals↗

Apomorphine and pergolide induce hypothermia by stimulation of dopamine D-2 receptors.

Studies in the male rat have shown that the dopamine D-2 receptor antagonists sulpiride and eticlopride, produce a dose-dependent prevention of the hypothermia induced by the D-1/D-2 receptor agonist apomorphine and the relatively selective D-2 agonist pergolide in the rat. In contrast, the D-1 antagonist SCH 23390 (given by the s.c. and i.p. route of administration) failed to prevent the hypothermic effect induced by both DA agonists, but tended to enhance the hypothermia caused by the two DA agonists. Thus, D-2 dopamine receptors appear to play a decisive role in the mediation of the hypothermic response of apomorphine and pergolide. There may also exist an interaction between D-1 and D-2 receptors in the expression of DA-agonist-induced hypothermia.

Animals↗

Mesulergine and pergolide in previously untreated Parkinson's disease.

Seventeen hitherto untreated patients with mild Parkinson's disease were given the dopamine agonists mesulergine or pergolide. Of the 10 patients who received pergolide (mean dosage 3.7 mg/day) five failed to improve, four showed slight improvement and one gained moderate benefit. Of the seven patients who received mesulergine (mean dose 6.4 mg/day) three patients derived no benefit, two slight benefit and two moderate benefit. The incidence of adverse side-effects was high with both drugs despite the use of a peripheral dopamine receptor antagonist, domperidone, when required. These results are less encouraging than those reported from other centres both in respect of response rate and the severity of unwanted effects.

Aged↗

Pergolide mesilate may improve fatigue in patients with Parkinson's disease.

OBJECTIVES: Fatigue is a complaint frequently encountered among patients with Parkinson's disease (PD). Considering the possible relationship between fatigue and dopaminergic dysfuncion, we investigated the effect of pergolide mesilate (a D2 and D1 dopamine receptor agonist) and bromocriptine (a D2 selective dopamine receptor) in patients with PD. METHODS: We evaluated 41 patients with PD and controls. We assessed the degree of fatigue by using a fatigue scale. The severity of PD was evaluated by the Hoehn and Yahr Scale and the unified Parkinson's disease rating scale (UPDRS). RESULTS: After five weeks from prescription, patients taking pergolide mesilate showed significant improvement in the fatigue scale (from 5.1 +/- 0.7 to 4.4 +/- 0.55, p < 0.05, ) but patients taking bromocriptine did not (from 4.8 +/- 0.9 to 4.7 +/- 0.8). CONCLUSIONS: Our study suggested the possibility of functional correlation between fatigue and D1 receptor in patients with PD.

Aged↗

Improvement of motor fluctuations in patients with Parkinson's disease following treatment with high doses of pergolide and cessation of levodopa.

The combination of levodopa and a dopamine agonist in the treatment of patients with Parkinson's disease often reduces the severity of motor fluctuations. In patients with very severe motor fluctuations, monotherapy with continuous subcutaneous infusions of the dopamine agonist apomorphine may result in a marked reduction of hyperkinesia and on-off phenomena. We report 3 patients with Parkinson's disease and motor fluctuations who received high doses of pergolide without levodopa resulting in a reduction of motor fluctuations. All patients received doses of pergolide exceeding the maximum recommended dose. One patient also required additional therapy with amantadine. These data show that in some patients oral treatment with high doses of a dopamine agonist may improve the severity of motor fluctuations and achieve a good control of parkinsonian signs without concomitant levodopa treatment.

Aged↗

Comparison of pergolide and bromocriptine therapy in parkinsonism.

Twenty-four parkinsonian patients compared pergolide and bromocriptine therapy in a randomized double-blind, two-period crossover study. Both drugs were adjusted to an optimal balance between benefits and side effects. The mean daily dose and dose range for pergolide and bromocriptine were 3.3 mg (0.7 to 7.2) and 42.7 mg (5.8 to 87.5), respectively. Adjunctive medications, which for most patients included levodopa (plus carbidopa), were not altered during the study. A similar spectrum of clinical effects was found with both drugs and with lisuride, which was used to treat 13 of the patients in a previous study. Despite neurochemical differences in the antiparkinsonian ergots, their clinical utility is quite similar. We draw attention to hepatotoxicity and pleural reactions that may occur rarely with these drugs.

Aged↗

Pergolide therapy for Parkinson's disease: neurobehavioral changes.

Pergolide mesylate, a long-acting dopamine agonist, is effective in treating Parkinson's disease. Behavioral change is said to be one adverse effect. We therefore studied 19 parkinsonian patients with neuropsychological tests before and after initiating pergolide therapy. Intellectual and behavioral changes were also monitored clinically for up to 2 years. There was no decline in performance on the neuropsychological tests. Six patients had transient psychiatric or intellectual changes that were controlled by reducing drug dosage. These changes were similar to those seen with other dopamine agonists.

Adult↗

Pergolide in the treatment of Parkinson's disease.

Pergolide, a long-acting central dopamine agonist, was used as monotherapy in 16 parkinsonian patients. A mean daily dose of 6.3 mg resulted in 73% improvement of parkinsonian disability. Clinical improvement after acute administration of one dose of pergolide was similar to that observed after levodopa plus a peripheral decarboxylase inhibitor but at a dose 100 times lower (2.2 mg and 200 mg, respectively). The effect lasted twice as long (5 1/2 hours and 2 1/4 hours, respectively).

Adult↗