Rotigotine skin patch for the treatment of fluctuating Parkinson's disease—how does it compare with pramipexole?

Rajesh Pahwa

This article has no abstract so we have provided the first paragraph of the full text.

Levodopa is the gold standard for the treatment of PD, but long-term therapy with levodopa is complicated by the development of motor fluctuations and dyskinesia. Dopamine agonists are frequently prescribed as add-on therapy to levodopa to reduce off time.¹ Pramipexole and ropinirole are the two most commonly used nonergot dopamine agonists; these agents reportedly reduce off time by 15–31% and 12–23%, respectively.¹ Data regarding the relative efficacies of the various dopamine agonists are scarce. A study comparing pramipexole and bromocriptine—an ergot dopamine agonist that is rarely used in clinical practice because of ergot-related side effects—found no significant difference between pramipexole (mean dose 3.4 mg/day) and bromocriptine (mean dose 22.6 mg/day) in terms of off-time reduction (15% vs 8%).¹ There were no differences in adverse event profiles between the two groups. In another study comparing ropinirole with bromocriptine, ropinirole (mean dose 10 mg/day) reduced off time by 17.7% compared with 4.8% reduction with bromocriptine (mean dose 18 mg/day).¹ Again, adverse event profiles were similar in the two groups, although ropinirole caused a higher rate of nausea, whereas bromocriptine caused a higher rate of hallucinations.¹

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