What is your monitoring plan for dopamine agonist therapy? The Living with Parkinson's Tip of the Day
Plan Photo from Stock-Adobe
One of the most worrisome aspects of clinical care for those living with Parkinson’s disease has been the emergence of dopamine agonist related impulse control disorder.
The honest truth is that many of us in the field have prescribed these drugs— and in the early days we were largely unaware of the emergence of potential adverse effects in the area of impulse control disorders.
Three common dopamine agonists are pramipexole, ropinirole, and rotigotine. All of these agents are similarly effective in treating the motor symptoms of Parkinson’s disease, either as monotherapy (meaning, this is the only Parkinson’s disease drug administered) or in combination with other drugs. Another agent, piribedil is also a dopamine agonist, but is not available in the U.S.
Some of the impulse control disorders that may emerge from dopamine agonist use include:
Hypersexuality
Binge Eating
Excessive Shopping
Gambling
Excessive Internet Use
TIPS TO KNOW ABOUT THE USE OF DOPAMINE AGONISTS
◆ Experts no longer uniformly recommend that a dopamine agonist must be used before levodopa.
◆ Dopamine agonists can be used alone in monotherapy or in combinations with other medications.
◆ Dopamine agonists are longer-acting when compared to levodopa.
◆ The most concerning side effect to monitor in dopamine agonist therapy is impulse control disorder (ICD).
◆ Another concerning side effect is sudden sleepiness (which may affect driving).
The Importance of a Monitoring Plan and Engagement of the Healthcare Team
Knowing that dopamine agonist use can result in an ICD (in approximately 1 in every 5 to 6 people taking dopamine agonists for Parkinson’s disease) is important and actionable information.
There are other alternatives to dopamine agonists and this information should be used in shared decision-making.
We cannot assume that once a person with Parkinson’s experiences an ICD that they will have complete or even partial insight as to what is going on.
A monitoring program/plan should ideally include a spouse, care-partner, care-giver or close friend. This person needs to be given permission to communicate with the health care team in case any behavior emerges unexpectedly (after starting the agonist).
It is important that practitioners spend a lot of time educating persons with Parkinson, family members and others engaged in a potential monitoring plan. We cannot assume that a tyoical quick 15-30 minute doctor’s appointment will be enough time to safely administer a dopamine agonist.
We need to be sensitive to the needs of the person with Parkinson’s and the caregiver and we (healthcare practitioners) need to be available and willing to chat during and after hours. We need to be generous with our time when prescribing— and also patient in helping to personalize a monitoring plan for dopamine agonist therapy.
A personalized plan should be sensitive to the needs of every person with Parkinson’s— and practitioners should understand that needs may be different from individual to individual— and that needs and situations can shift over time.
