Pergolide Disease Interactions

Dopamine agonists may impair the systemic regulation of blood pressure, with resultant orthostatic hypotension, especially during dose escalation. Therapy with dopamine agonists should be monitored carefully in patients with Parkinson's disease since they may have an impaired ability to respond to an orthostatic challenge, and also in patients receiving antihypertensive drugs.

The use of dopamine agonists is contraindicated in patients with neuroleptic malignant syndrome (NMS). NMS is characterized by hyperthermia, muscle rigidity, altered mental status, irregular pulse or blood pressure, tachycardia, and diaphoresis. The syndrome may rarely be precipitated by abrupt discontinuation of the dopamine agonist.

The use of dopamine agonists has been associated with psychiatric effects such as hallucinations, psychosis, confusion, anxiety, mania, hypomania, depression, rapid mood cycling, nightmares, and hypersexuality. Therapy with dopamine agonists should be administered cautiously in psychotic patients and all patients should be carefully observed for development of depression and suicidal tendencies.

Ordinarily, patients with major psychotic disorder should not be treated with dopaminergic antiparkinson agents, because of the risk of exacerbating psychosis. Hallucinations and psychotic-like behavior have been reported with dopaminergic medications. In addition, certain medications used to treat psychosis may exacerbate the symptoms of Parkinson's disease and may decrease the effectiveness of these drugs.

The use of pergolide has been shown to increase the risk of cardiac valvular disease involving one or more valves. Some patients have required valve replacement, and deaths have been reported. Specific risk factors predisposing patients to developing cardiac valvular disease with pergolide have not been identified. Cardiac valvulopathy has been reported with all doses of pergolide; however, available data suggest that the risk may be greater with higher doses. Pergolide is not recommended for use in patients with a history of cardiac valvulopathy. Additionally, caution should be exercised when administering pergolide to patients prone to cardiac dysrhythmias. Before initiating treatment with pergolide, all patients should undergo a cardiovascular evaluation, including an echocardiogram, to determine whether valvular disease is present and to provide a baseline for subsequent monitoring.