Pergolide

Pergolide is an ergot-derived dopamine agonist used in the treatment of Parkinson's disease. Unlike other members of this drug group, it acts on both D1 and D2 receptors.

It is used as a second-line adjunct to levodopa where dyskinesias and motor variability have emerged. There is no evidence that pergolide is superior to bromocriptine for this task.

Fibrotic reactions are recognised adverse effects of ergot derivatives such as Pergolide. On the basis on adverse events reporting (Yellow Card data), pergolide seems to be associated with a higher reporting rate of such reactions in the UK compared with the other ergot-derivatives e.g. bromocriptine, cabergoline. Thus, before starting treatment with pergolide it may be appropriate to perform baseline investigations such as ESR, U and Es and a chest Xray; also if possible, especially if long-term treatment with Pergolide is envisaged, then it may be helpful to perform lung function tests (1).

• trials suggest that using ergot-derived dopamine agonists such as cabergoline and pergolide in the treatment of Parkinson's disease is associated with an increased risk of valvular heart disease (1)
  • population studies of patients with Parkinson's disease compared with non-parkinsonian controls have reported that pergolide and cabergoline have a similar risk of inducing fibrotic changes in cardiac valve leaflets. The fibrotic changes cause thickening, retraction, and stiffening of valves, which result in incomplete leaflet coaptation and clinically significant regurgitation, and have necessitated surgical valve replacement in some patients

Consult summary of product characteristics before prescribing this drug.

Reference:

1. Current Problems in Pharmacovigilance (2002), 28, 1-3.
2. Antonini A, Poewe W. Fibrotic heart-valve reactions to dopamine-agonist treatment in Parkinson's disease. Lancet Neurol. 2007 Sep;6(9):826-9