ergoline and Disorders-of-Excessive-Somnolence

Excessive daytime somnolence is a common adverse effect of dopamine-agonist treatment of Parkinson's disease (PD). Many factors, such as age and sleep disturbances, could be involved in the pathogenesis of this phenomenon. However, pharmacokinetic factors have never been considered. In this open, prospective, pilot study, nine consecutive non-demented PD patients in early disease stages on monotherapy treatment with dopamine agonists and with no significant sleep problems, were enrolled. They were selected based on the presence of excessive daytime sleepiness induced by the dopaminergic treatment. A fast switch-over from the dopamine agonist currently used to a single equivalent dose of cabergoline, a long-acting dopamine agonist, administered at bedtime was performed. All patients were evaluated by means of UPDRS and Epworth Sleepiness Scale (ESS). A significant 70% reduction of daytime sleepiness was observed during the 3-month study compared with baseline. Data from this study suggest that both pharmacodynamic and pharmacokinetic mechanisms are involved in the pathophysiology of dopamine agonist-induced sleepiness.

Topics: Aged; Antiparkinson Agents; Cabergoline; Disorders of Excessive Somnolence; Dopamine Agonists; Drug Administration Schedule; Drug Interactions; Ergolines; Female; Humans; Male; Mental Status Schedule; Middle Aged; Parkinson Disease; Pilot Projects; Prospective Studies; Psychomotor Performance; Time Factors

To determine if therapy with an ergot and a non-ergot dopamine agonist and levodopa confers an increased risk of excessive daytime sleepiness and secondary "sleep attacks" in Parkinson's disease (PD).. Comparative study of three clinical groups taking, pramipexole (Group 1, n = 19, 8 monotherapy), cabergoline (Group 2, n = 22, 10 monotherapy), and levodopa monotherapy (Group 3, n = 14). Clinical and demographic characteristics, occurrence of "sleep attacks", and assessment of daytime sleepiness [using the Epworth Sleepiness Scale (ESS)], recorded.. No patients reported "sleep attacks". Mean ESS scores: Group 1 (pramipexole) 8.0 +/- 4.5 (range 0-16), Group 2 (cabergoline) 8.1 +/- 3.9 (range 0-19), Group 3 (levodopa), 8.1 +/- 5.5 (range 1-18). There was no significant difference between groups (p = 0.897). Scores of > or = 16 indicating excessive daytime sleepiness (EDS) were evenly distributed throughout treatment groups, particularly in older patients with more advanced disease.. a) EDS is not unique to pramipexole therapy and occurs with both cabergoline and levodopa. b) Increasing age, advanced disease, and higher treatment dose appear important predictors for EDS. c) Driving regulations should be reviewed accordingly.

Topics: Adult; Aged; Aged, 80 and over; Antiparkinson Agents; Benzothiazoles; Cabergoline; Disorders of Excessive Somnolence; Drug Therapy, Combination; Ergolines; Female; Humans; Levodopa; Male; Middle Aged; Parkinson Disease; Pramipexole; Retrospective Studies; Thiazoles