Pergolide is a dopamine receptor ag...

Pergolide is a dopamine receptor agonist that is used in the treatment of Parkinson's disease and restles leg syndrome This unsalable article an ergotamine derivative, has been associated with retroperitoneal, pleural, and pericardial fibrosis similar to that caused according to other drugs in this class (such as methysergide and ergot-amine). More lately restrictive valvular heart disease has been reported in patients taking pergolide, however the incidence was only individual in 20,000 patients. Van Camp and colleagues sought to establish the common occurrence severity, and reversibility of pergolide-associated restrictive valvular heart disease and to examine the possibility of dose dependency

The researchers invited patients with Parkinson's disease who were attending outpatient neurology clinics at four Dutch hospitals to participate in the contemplation Persons with a history of coronary or valvular heart disease were exclud from the application of mind Patients also were excluded if they had been receiving ergot-derived medications, anorectic medicines or Chinese herbs. All studious mood participants were examined by transthoracic echocardiography with special attention to the cardiac valves. The same technician using the same equipment performed the echocardiography. Interpretations were made by means of an independent sonographer who was masked to the patient's treatment.

A total of 78 patients who had been treated with pergolide were enlisted in the study, along with 18 bodily substances who had never been treated with an ergot-derived dopamine agonist. in succession average, the patients receiving pergolide were a little younger than those in the curb group (mean ages, 70.9 and 728 years, respectively). single in kind half of the patients in the direct group were women, but and nothing else 33 of the 78 patients receiving pergolide were women Evidence of restrictive valvular heart disease was not establish in any of the 18 mastery patients. Twenty-six patients in the pergolide dispose had evidence of restrictive valvular heart disease, with the mitral valve being the in the greatest degree commonly affected (26 percent of patients), followed by the agency of the aortic valve (9 percent) and the tricuspid valve (8 percent) Clinically significant disease was not past nor future in 15 patients (19 percent) receiving pergolide nevertheless in none of the patients in the manage group. Restrictive valvular disease was more frequent in patients taking high-dose pergolide versus low-dose pergolide (42 and 29 percent respectively), and a significant correlation was demonstrated between the cumulative doses of pergolide and the tenting areas of the mitral valves. Pergolide therapy was discontinued in six patients; sum of two units showed significant regression of mitral valve disease within six month Mean systolic pulmonary artery compressings also were increased significantly in patients receiving pergolide. These influences remained elevated after exclusion of patients with relevant mitral valve disease.

The authors infer that restrictive valvular cardiac disease is usual in patients receiving pergolide for Parkinson's disease. They believe the underlying pathology to be fibrotic changes in leaflets and subvalvular apparatus of valves that causes stiffening of the valves and distortion of their normal functioning. In older patients with Parkinson's disease, changes in the tricuspid valve may be most numerous diagnostic, because the aortic and mitral valves may display age-related changes. Pergolide also may cause pulmonary hypertension as it interacts with the serotonin 5-HT receptor implicated in the induction of heart disease according to appetite-suppressing drugs.

Van Camp G et al. Treatment of Parkinson's disease with pergolide and relation to restrictive valvular heart disease. Lancet April 10 2004;363:1179-83

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