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• W2014124398 abstract "<h3>Background</h3> Treatment of Parkinson disease commonly includes levodopa and dopamine agonists; however, the interaction of these 2 drugs is poorly understood. <h3>Objective</h3> To examine the effects of a dopamine agonist on the motor response to levodopa. <h3>Design</h3> Double-blind, randomized, placebo-controlled, crossover clinical trial. <h3>Setting</h3> Ambulatory academic referral center. <h3>Patients</h3> Thirteen patients with idiopathic Parkinson disease taking levodopa and experiencing motor fluctuations and dyskinesia. <h3>Interventions</h3> Eligible individuals were randomly assigned to receive pramipexole dihydrochloride or placebo for 4 weeks followed by a 2-hour intravenous levodopa infusion on consecutive days at 2 rates and with blinded assessments. They were then crossed over to the alternate oral therapy for 4 weeks followed by levodopa infusion and reassessment. <h3>Main Outcome Measures</h3> Change in finger-tapping speed, measured using the area under the curve (AUC) for finger taps per minute across time; peak finger-tapping speed; duration of response; time to “ON” (defined as a 10% increase in finger-tapping speed above baseline); walking speed; and dyskinesia AUC. <h3>Results</h3> Pramipexole with levodopa infusion increased finger-tapping speed beyond the change in baseline by a mean (SE) of 170 (47.2) per minute × minutes (<i>P</i> = .006) and more than doubled the AUC for finger-tapping speed. Pramipexole increased peak finger-tapping speed by a mean (SE) of 18 (8.5) taps per minute (<i>P</i> = .02) and improved mean (SE) walking speed (15.9 [0.70] vs 18.9 [0.70] seconds,<i>P</i> = .004). Pramipexole prolonged duration of response after levodopa infusion and shortened time to ON. Pramipexole increased mean (SE) baseline dyskinesia scores (26.0 [5.85] vs 12.1 [5.85] points,<i>P</i> = .05) and peak dyskinesia scores with levodopa infusion. <h3>Conclusions</h3> Pramipexole augmented the motor response to levodopa beyond a simple additive effect and increased the severity of levodopa-induced dyskinesia. When considering a combination of these therapies, an appropriate balance should be maintained regarding gain of motor function vs worsening of dyskinesia. <h3>Trial Registration</h3> clinicaltrials.gov Identifier:NCT00666653" @default.
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• W2014124398 date "2010-01-01" @default.
• W2014124398 modified "2023-09-27" @default.
• W2014124398 title "Effects of a Dopamine Agonist on the Pharmacodynamics of Levodopa in Parkinson Disease" @default.
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• W2014124398 doi "https://doi.org/10.1001/archneurol.2009.287" @default.
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