Second generation of dopamine agonists: Pros and cons

Dopamine agonists (DAGs) were first used in patients with moderate or advanced Parkinson's disease (PD). At that time, it was thought that DAGs could replace levodopa (LD) with fewer side effects. However, it soon became clear that while they could not replace LD, they did allow reduction of the dose of LD and diminished its side effects. Since the use of DAGs reduces response fluctuations as well as dyskinesias, there is a tendency to introduce them in the first stages of the disease, trying to delay motor fluctuations. While many DAGs have been developed, only four have been marketed and are used extensively for the treatment of Parkinson's disease: apomorphine, bromocriptine, lisuride and pergolide. In the present chapter, following a review of the 'old' DAGs, the experience with three new promising DAGs is reported: cabergoline, ropinirole and pramipexole.