Monday, January 15, 2007

Parkinson's Disease Medications Associated with Cardiac Valve Dysfunction

Two commonly used medications for Parkinson's disease, pergolide (Permax) and cabergoline (Dostinex), have been shown to be associated with cardiac-valve dysfunction in 2 recent studies published in last week's The New England Journal of Medicine.

In one of the studies, 31 cases of new-onset cardiac-valve regurgitation were detected among 11,417 patients who were prescribed anti-Parkinson's-disease agents from 1988 to 2005.
Of the 31 cases, 6 had been receiving pergolide and 6 had been taking cabergoline in the previous 12 months. "Their adjusted valve-disease incidence rates were sharply and significantly increased compared with the remaining 19 cases who had not been receiving either drug or any other dopamine agonist ."

The other study
also showed that the prevalence of clinically significant valvular leakage and of valve-leaflet thickening was significantly increased among patients taking either pergolide or cabergoline, but not those receiving nonergot-derived agents compared with those in the control group.

Both of these drugs are dopamine agonists. Pergolide has been in use for many years and carbegoline is a relatively newer medication. However, unlike other dopamine agonists they also block the serotonin receptor 5-hydroxytryptamine 2B (5-HT2B). This is the same mechanism involved for the cardiac-valve dysfunction that was associated with the weight loss agent fenfluramine in the 1990's.

References: N Engl J Med. 2007;356:6-9, 29-38, 39-46.

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