Some PD clinics in other countries use the old dopamine agonist, apomorphine,
administered by the patient using an injection device called a "penjet." I
believe this drug acts like other agonists (bromocriptine, pergolide, and
lisuride) in that, used in combination with Sinemet, it helps prevent the
"on-off" syndrome often seen in long time use of Sinemet. Agonists sort of
"squeeze" a little extra dopamine from the brain's receptors to sort of
bridge the times when Sinemet is given but hasn't yet kicked in.
Apomorphine given by penjet would act quickly.
Canadians can check this with Susan Calne RN at UBC in Vancouver as I
believe their movement disorders clinic have used apomorphine in the past.
I'd be interested to hear what Donald Calne MD thinks of dopamine agonists.
There seems to be a movement in the states towards using agonists -
particularly pergolide (Permax) - early, before dyskinesias or on-off
fluctuations start. Apparently less Sinemet (L-dopa) is required so less
dopamine accumulates on the receptors thereby causing less side effects.
(sort of like yellow wax buildup on floors - or fouled spark plugs)
On the other hand I've heard that using agonists early is hype and that
the side effects are just as bad.
I don't want to miss something here, so don your thinking caps, talk to
your specialists, and study the neurology journals and let's compile our
research and come up with a sensible solution using all the divergent
confusing messages we get. I take only Sinemet CR. Am I wrong or what? Or
do we know yet?
Yours for a better solution through patient empowerment.
Barbara Yacos, RN
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