dopamine agonists

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dopamine agonists

LLSA Medical Toxicology ReviewJames W. Rhee, MDFriday, May 1, 2009


T h e n e w e ng l a nd j o u r na l of m e dic i n eoriginal articleDopamine Agonists and the Riskof Cardiac-Valve RegurgitationRené Schade, M.D., Frank Andersohn, M.D., Samy Suissa, Ph.D.,Wilhelm Haverkamp, M.D., Ph.D., and Edeltraut Garbe, M.D., Ph.D.A bs tr ac tFrom the Depcology, CharitéE.G.), and theBackgroundCase reports and echocardiographic studies suggest that the ergot-derived dopamineagonists pergolide and cabergoline, used in the treatment of Parkinson’s dis-LLSA Medical Toxicology Reviewease and the restless legs syndrome, may increase the risk of cardiac-valve regur-Charité Campgitation.MethodsWe used data from the United Kingdom General Practice Research Database toidentify a population-based cohort comprising 11,417 subjects 40 to 80 years of ageFriday, May 1, 2009 who were prescribed antiparkinsonian drugs between 1988 and 2005. We con-té-Universitätsthe McGill Psearch Unit, Dology, RoyalUniversity HeaN Engl J Med


Friday, May 1, 20091%


Dopamine AgonistsRopiniroleLisuridePramipexolePergolideBromocriptineCabergolineFriday, May 1, 2009


UK General Practice Research Database6.3 million patients>350 general practicesFriday, May 1, 2009


Study Cohort11,417 patients31 cases663 contolsFriday, May 1, 2009


Exposureno. of pts. (%)Cases(n=31)Controls(n=663)Adjusted Incidence-Rate Ratio(95% CI)*No current or recent use of adopamine agonist‡19 (61) 530 (80) 1.0Bromocriptine 0 19 (3)Cabergoline 6 (19) 34 (5) 4.9 (1.5-15.6)Pergolide 6 (19) 26 (4) 7.1 (2.3-22.3)Lisuride 0 1 (0)Pramipexole 0 23 (3)Ropinirole 0 23 (3)*The incidence-rate ratio was adjusted for the use of other dopamine agonists or amantadine‡This is the reference category, defined as no use of dopamine agonist during the 12 months before the index date.Friday, May 1, 2009


Exposureno. of pts. (%)Cases(n=31)Controls(n=663)Adjusted Incidence-Rate Ratio(95% CI)*No current or recent use of adopamine agonist‡19 (61) 530 (80) 1.0Bromocriptine 0 19 (3)Cabergoline 6 (19) 34 (5) 4.9 (1.5-15.6)Pergolide 6 (19) 26 (4) 7.1 (2.3-22.3)Lisuride 0 1 (0)Pramipexole 0 23 (3)Ropinirole 0 23 (3)*The incidence-rate ratio was adjusted for the use of other dopamine agonists or amantadine‡This is the reference category, defined as no use of dopamine agonist during the 12 months before the index date.Friday, May 1, 2009


Exposureno. of pts. (%)CasePatientn=31Controln=663Adjusted Incidence-RateRatio(95% CI)*P ValueNo current or recent use ofa dopamine agonist† 19(61) 530(80) 1Last Daily DosePergolide3mg3(10)3(10)21(3)5(1)5.1(1.3-20.437.1(5.1-270.6) 0.07Cabergoline3mg2(7)4(13)31(5)3(0)2.6(0.5-12.8)50.3(6.6-381.4) 0.01*The incidence-rate ratio was adjusted for the use of other dopamine agonists or amantadine‡This is the reference category, defined as no use of dopamine agonist during the 12 months before the index date.Friday, May 1, 2009


Exposureno. of pts. (%)Case Patients(n=31 )Controls(n=663)Adjusted Incidence-RateRatio(95% CI)*No current or recent use of a dopamineagonist†19 (61) 530 (80) 1Cumulative duration of usePergolide


Risk factorsAdjusted incidence–rate ratio (95% CI)PergolideCabergolineCurrent use 7.1 (2.3 - 22) 4.9 (1.5-16)> 3 mg 37.1 (5.1-270.6) 50.3 (6.6-381.4)≥6 mo 9.8 (2.9 – 33.1) 7.8 (2.2 – 27.4)Friday, May 1, 2009


pergolide and cabergolinewas associated with anincreased riskof newly diagnosedcardiac-valve regurgitationFriday, May 1, 2009


iskisincreasedwithhigher dosesandprolonged exposureFriday, May 1, 2009


Dopamine AgonistsRopiniroleLisuridePramipexolePergolideBromocriptineCabergolineFriday, May 1, 2009


Friday, May 1, 2009

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