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Pharmacological Management of Parkinson’s Disease
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Newman Osafo, Samuel Obeng, David D. Obiri, Oduro K. Yeboah, Leslie B. Essel
Piribedil extensively undergoes first-pass metabolism, resulting in poor oral bioavailability. Its metabolic pathways, primarily demethylation, p-hydroxylation, and N-oxidation, give rise to numerous metabolites, with 1-(3,4-dihydroxybenzyl) 4-(2-pyrimidinyl)-piperazine, being the pharmacologically active one (Sarati et al., 1991). Jenner et al. (1973) identified that, the metabolites are renally excreted with no amount of the parent compound excreted unchanged in the urine.
Dopamine and Hypertension
Published in M.D. Francesco Amenta, Peripheral Dopamine Pathophysiology, 2019
J. L. Montastruc, C. Damase-Michel, P. Montastruc
Several other neuroendocrine abnormalities were reported in SHR: increased plasma levels of vasopressin12 or thyrothrophic hormone;13 increased levels of immunoreactive beta-endorphin in the neurointermediate lobe of the pituitary and decreased plasma levels of immunoreactive beta-endorphin.14 These observations and the fact that levodopa decreased blood pressure in SHR rats after pretreatment with the peripheral acting inhibitor of dopa decarboxylase, carbidopa,15 are in agreement with the hypothesis of a functional central dopaminergic insufficiency in SHR. However, in these last experiments, one cannot exclude the fact that levodopa (through active metabolite DA or noradrenaline) acts on central α2 adrenoceptors. In fact, in anesthetized cats and rats, central administration of DA or DA receptor agonists reduces blood pressure by direct activation of DA receptors because this effect is selectively blocked by dopamine receptor antagonists.16-18 However, in conscious cats or dogs, central injections of dopamine did not significantly change blood pressure.19,20 In acute neurogenic or normotensive anesthetized dogs, we failed to find any evidence for a centrally mediated hypotensive effect of three dopaminergic agonists, bromocriptine,21,22 apomorphine,23 and mesulergine.24 We obtained similar results in normotensive volunteers but not in hypertensive patients: the acute hypotensive effect of apomorphine observed in normotensive volunteers was suppressed by domperidone, a dopaminergic antagonist devoid of any central effect;25 in contrast, the antihypertensive effect of bromocriptine in hypertensive Parkinsonians was not antagonized by domperidone suggesting a central site of action for bromocriptine in man.26 A similar result concerning the central hypotensive action of piribedil was also obtained in patients with Parkinson’s disease.27
Pontine warning syndrome and restless legs syndrome secondary to paramedian pontine infarction: a case report
Published in International Journal of Neuroscience, 2022
Guo-Mei Shi, Xiao-Rong Wang, Wu Xu, Min-Wang Guo, Chun-Qin Ding, Ru-Juan Zhou
Currently, there is no consensus on optimal treatment for PWS. General treatment includes hydration, antiplatelet agents, anticoagulation, intravenous thrombolysis as well as intracranial artery angioplasty [1, 5, 6]. We initially treated our patient with aspirin, clopidogrel and atorvastatin. However, these therapies were ineffective in the acute phase of PWS, and cerebral infarctions ultimately occurred. We used argatroban, which was effective and safe in stopping recurrent and fluctuating symptoms in patients with PWS. For RLS, dopamine agonists and calciumα2δ ligands are first-line therapy. In our case, piribedil was used early in the course of RLS onset and the effect was satisfactory. At the 12-month follow-up, there was no relapse of RLS or PWS.
Treatment for cognitive and neuropsychiatric non-motor symptoms in Parkinson’s disease: current evidence and future perspectives
Published in Expert Review of Neurotherapeutics, 2023
Elisa Mantovani, Chiara Zucchella, Andreas A. Argyriou, Stefano Tamburin
Piribedil, a D2/D3 dopamine agonist, is rated as likely efficacious and clinically useful for apathy in PD, while data on other dopamine agonists with similar pharmacodynamic profile are negative or lacking [115]. The ChEI rivastigmine has been suggested as possibly useful for apathy in PD [115]. Robust evidence for non-pharmacological treatment of apathy is lacking, and there are no ongoing studies, either pharmacological or non-pharmacological, on this NMS.
‘Dopamine agonist Phobia’ in Parkinson’s disease: when does it matter? Implications for non-motor symptoms and personalized medicine
Published in Expert Review of Neurotherapeutics, 2020
Silvia Rota, Iro Boura, Lucia Batzu, Nataliya Titova, Peter Jenner, Cristian Falup-Pecurariu, K Ray Chaudhuri
The safety profile of piribedil is similar to that of other DAs, including central dopaminergic effects, such as hallucinations, delusions, ICDs, daytime somnolence, sleep attacks, reduced prolactin secretion and aggravation of levodopa-induced dyskinesia.