‘Dopamine agonist Phobia’ in Parkinson’s disease: when does it matter? Implications for non-motor symptoms and personalized medicine

ABSTRACT

Introduction

Dopamine agonists have been widely used to treat patients with Parkinson’s disease, but concerns related to their well-known side effects might prevent their use even when indicated. In this review, the authors describe for the first time the concept of ‘Dopamine Agonist Phobia’, a pharmacophobia that the authors believe might affect clinicians, and they provide evidence of the benefits of dopamine agonists, focusing on non-motor symptoms.

Areas covered

The authors performed an extensive literature research, including studies exploring the use of dopamine agonists for the treatment of non-motor symptoms. The authors indicate the highest level of evidence in each section.

Expert opinion

‘Dopamine Agonist Phobia’ may preclude valid therapeutic options in selected cases, specifically for the treatment of non-motor symptoms. Thus, the authors propose a personalized approach in Parkinson’s disease treatment, and encourage a thoughtful use of dopamine agonists, rather than an overall nihilism.

KEYWORDS:

• Parkinson’s disease
• dopamine agonists
• phobia
• non-motor
• personalized medicine

Article highlights

• ‘Dopamine Agonist Phobia’ is a PD-specific pharmacophobia characterized by the fear of complications related to the use of dopamine agonists (DAs).

• ‘DA Phobia’ leads clinicians to underprescribe DAs which can instead be beneficial for specific non-motor symptoms (NMS), especially in the context of ‘personalized medicine’.

• Pramipexole could be effectively used for the treatment of depressive symptoms in PD, as a mono- or an add-on therapy to levodopa and a potential effective role in improving REM sleep behavior disorder (RBD) has been demonstrated.

• Ropinirole is likely to be effective in the treatment of depression and possibly apathy in PD.

• Piribedil might be useful for the management of apathy in PD, without exacerbating excessive daytime sleepiness (EDS).

• Rotigotine has been shown to improve sleep dysfunction, included restless leg syndrome (RLS), periodic limb movement (PLM) and nocturnal pain and possibly RBD and early morning OFF (EMO) state.

• Apomorphine could improve PD nocturnal motor symptoms affecting sleep (RLS, PLM), EMO, nocturia as well as anhedonia and mood.

• When prescribing a DA, the NMS profile of the PD patient should be drawn, and the advantages of each specific formulations should be taken in consideration.

• Clinicians should aim for the lowest effective dose with a careful monitoring of side effects.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.