Dopamine agonist

Dopamine agonists are active substances that, like dopamine, are able to stimulate dopamine receptors (D-receptors). Depending on the selectivity for different subtypes of dopamine receptors, they can be divided into D _1/5 agonists and D _2/3/4 agonists.

While selective D _1/5 agonists such as B. Dihydrexidine and SKF 81297 , have no therapeutic value , play agonists with a selectivity for the D ₂ receptor family, such as. B. piribedil , pramipexole , ropinirole and rotigotine , an important role in the therapy of Parkinson's disease , amenorrhea , acromegaly , restless legs syndrome and hyperprolactinemia . The ergot alkaloid derivatives used in the therapy of Parkinson's disease , such as. B. bromocriptine , cabergoline , dihydroergocryptine , lisuride and pergolide are agonists at D ₂ receptors. In Parkinson's disease, apomorphine is used in rare cases .

Side effects

In addition to vegetative symptoms such as nausea / vomiting or orthostatic hypotension up to syncope, psychological effects such as hallucinations or confusion can also occur.

By stimulating the reward system, about 13-17% of patients can experience obsessive-compulsive disorder or decreased impulse control . This manifests itself, for example, in gambling addiction (5%), buying frenzy (5.7%), binge eating (4.3%), internet addiction or a stressful increased sex drive (3.5%). In the course of hypersexuality, sexual behavior can also change, including exhibitionism , sexual acts with children or changes in sexual preference. Treatment with dopamine alone increases the prevalence of OCD. However, they often only become noticeable after treatment with dopamine agonists.

Another side effect is the occurrence of daytime sleepiness up to microsleep, which often occurs without a sign. Patients must be informed about this and a driving ban may have to be issued.

Symptoms almost always go away after stopping the drug. However, discontinuation of therapy is often not tolerated because on the one hand the original symptoms of Parkinson's disease increase and on the other hand withdrawal symptoms such as cocaine addiction can occur after prolonged use of higher doses .

Hypersexuality was described for the active ingredient pergolide as early as 1983. In a 2002 study, hypersexuality was identified as a "known complication in the dopaminergic treatment of people with Parkinson's disease". In a drug telegram from 2004 it was pointed out that there is no reference to this disruptive effect in any specialist information on a dopamine agonist.

With Requip , information on the risk of hypersexuality has been included on the package insert since 2006. In a lengthy lawsuit against GlaxoSmithKline in France, a family man who took the drug from 2003 to 2005 sued because of the occurrence of side effects such as Internet gambling, selling his children's toys and stealing from his friends to finance them, searching for same-sex people Sexual contacts on the internet, cross-dressing , rape, suicide attempts and a trauma caused by the whole thing. In November 2012, an appeals court upheld GlaxoSmithKline's conviction.

literature

• DE Riley: Reversible transvestic fetishism in a man with Parkinson's disease treated with selegiline. In: Clinical Neuropharmacology . July-August 2002, Vol. 25, No. 4, pp. 234-7, PMID 12151912 .
• JJ Worthington, NM Simon, NB Korbly, et al .: Ropinirole for antidepressant-induced sexual dysfunction. In: International Clinical Psychopharmacology . Nov. 2002, Vol. 17, No. 6, pp. 307-10, PMID 12409684 .

Individual evidence

1. ↑ Bromocriptine . In: Drug A-Z . Thieme, 2014.
2. ↑ Withdrawal symptoms on dopamine agonists .  ( Page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. aerzteblatt.de, January 12, 2010  
3. ↑ Obsessive- compulsive disorder is common with dopamine agonists .  ( Page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. aerzteblatt.de, May 11, 2010  
4. ↑ Hypersexuality and addiction to gambling among dopamine agonists . ( Memento of the original from April 13, 2009 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. aerzteblatt.de, April 9, 2009 
5. ↑ Addiction to gambling due to dopamine agonists .  ( Page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. aerzteblatt.de, February 13, 2007  
6. ↑ CG Goetz et al .: Pergolide in Parkinson's disease. In: Archives of Neurology . December 1983, Vol. 40, No. 13, pp. 785-787, PMID 6639407 .
7. ↑ Hypersexuality with the dopamine agonist pramipexole . In: arznei-telegramm , 3/2004, 35, p. 36
8. ↑ Father claims that drugs triggered his homosexuality . lesbian.or.at, December 11, 2007
9. ↑ Man claims Glaxo drug made him gay sex addict, says report . CBS News January 31, 2011
10. ↑ Court decides: drug led to gay sex addiction . queer.de, November 30, 2012

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !