Dolores Buente wrote: > I'm taking Requip 10mg/day...for 5 months now. Have seen a gradual but very > noticeable change in my hair which has become thin & the texture "spider > webbish". I would like to hear from anyone on the List who has had this > problem and, if so, what they have done about it. Dolores, here's an article I recently wrote on alopecia: === News Bite: Parkinson's Disease and Hair Loss (Alopecia) Kathrynne Holden, MS, RD Copyright 2002, Five Star Living, Inc. Several people have written to "Ask the Parkinson Dietitian" reporting that their hair began thinning and falling out, and wondering why it occurs. It's not widely realized that some medications, including some of the Parkinson medications, have alopecia (hair loss) as a rare, but possible, side effect. Researchers discovered years ago that the agonists bromocriptine and pergolide, and the dopamine precursor, levodopa, caused hair loss in a few people.1,2,3,4 Now, a more recent article, published in the journal "Neurology," describes hair loss in two women with Parkinson's disease (PD) who used the agonists pramipexole and ropinerole.5 One woman, age 66, had been taking amantadine, and later added pramipexole. Two months after beginning the pramipexole regimen, she began to experience hair loss. After tests for thyroid function, nutrient deficiencies, and other possible causes turned out negative, the pramipexole was discontinued and ropinerole was substituted. The hair thinning stopped, and new hair growth began in about four weeks. The second woman, age 68, had been using selegiline and amantadine successfully, and later pramipexole was added. Twelve months after beginning use of pramipexole, which had recently been increased to 3.5 mg per day, she began to notice hair loss. She also switched from pramipexole to ropinerole, but in her case the hair loss continued. She then discontinued ropinerole, switching to carbidopa/levodopa. The hair thinning stopped, and gradually her hair began to regrow, but did not completely grow back. The study notes that both women were being treated with amantadine as well as the agonists, and speculates that the combination of amantadine and agonists could be the cause of the hair loss. Causes of alopecia If you notice hair thinning, you should be aware that there are many possible causes besides Parkinson medications. 1. Nutrient deficiencies: extreme deficiencies of biotin, pantothenic acid, iron , and/or zinc can result in hair loss. Malnutrition, and lack of protein can also be causes. 2. Too much vitamin A or vitamin E can lead to hair loss. 3. Medications (the following is a partial list of other medications that, rarely, can lead to alopecia): Parkinson medications: Levodopa (Sinemet, Madopar, Dopar, Larodopa, Syndopa, etc.) Agonists (pergolide, pramipexole, ropinerole, bromocriptine Amantadine – possibly Cholesterol-lowering drugs - clofibrate, gemfibrozil Ulcer drugs - cimetidine, ranitidine, famotidine Anticoagulents - warfarin, heparin Antigout medications - Allopurinol Antiarthritics - auranofin, indomethacin, naproxen, sulindac, methotrexate Antihypertensive - lisinopril; Beta blocker drugs - atenolol, metoprolol, nadolol, propranolol, timolol Drugs derived from vitamin-A - isotretinoin, etretinate Anticonvulsants - trimethadione Antidepressants - tricyclics, amphetamines; bupropion, selegeline Antithyroid agents - carbimazole, Iodine, thiocyanate, thiouracil Also - blood thinners, male hormones (anabolic steroids) 4. Stress 5. Hormonal changes 6. Thyroid disease, both underactive and overactive 7. Heredity 8. Pressure on the scalp from hats, caps, wigs or tightly-pulled hairstyles 9. A fever of 103 degrees Fahrenheit or more may result in hair loss weeks later. 10. Cancer treatments. 11. Seborrheic dermatitis (sometimes occurs among people with PD) If you, or someone you know, has noticed hair thinning, consider the above possibilities. Having more than one of the conditions increases the likelihood of hair loss; for example, thyroid disease, stress, low serum iron levels, and use of one or more of the above listed medications makes it more likely that hair loss could occur. Can alopecia be treated? Most cases of hair loss can be reversed. However, treatment for alopecia will depend on its cause; for this, you should see a dermatologist, who can determine why the hair thinning has occurred and can recommend the appropriate treatment, whether dietary, stress, thyroid, medication, or other condition is the cause. If the cause is seborrheic dermatitis, a dermatologist may suggest a special shampoo or other cleanser. If the cause appears to be Parkinson medications, however, then you must also discuss this with your neurologist. Your doctor may be able to recommend a different medication or combination of medications, particularly if you are using amantadine along with an agonist. The important thing is to get a correct diagnosis of the cause of the hair loss, and seek the treatment that will best address this cause. (The above article may not be reproduced in any form except with permission from the author.) References: 1. Fabre N, et al.: Alopecia: an adverse effect of bromocriptine. Clin Neuropharmacol. 1993; 16:266-268. 2. Blum I, Leiba S: Increased hair loss as a side effect of bromocriptine treatment. N Engl J Med. 1980; 303:1418. 3. Marshall A, Williams MJ. Alopecia and levodopa. BMJ. 197; 2:47. 4. Factor SA et al.: Parkinson's disease: an open label trial of pergolide in patients failing bromocriptine therapy. J Neurol Neurosurg Psychiatry. 1988;51:529-533. 5. Tabamo RE, Di Rocco A. Alopecia induced by dopamine agonists. Neurology 2002 Mar 12;58(5):829-30. 6. Martignoni E, Godi L, Pacchetti C, Berardesca E, Vignoli GP, Albani G, Mancini F, Nappi G. Is seborrhea a sign of autonomic impairment in Parkinson's disease? J Neural Transm. 1997;104(11-12):1295-304. === -- Kathrynne Holden, MS, RD "Ask the Parkinson Dietitian" http://www.parkinson.org/ "Eat well, stay well with Parkinson's disease" "Guidelines for Medical Nutrition Therapy for Parkinson's disease" http://www.nutritionucanlivewith.com/ ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn