Ron Herstell <[log in to unmask]>
Hi Ron: There has been quite a discussion of Permax on the List. A few
conclusions I have come to: Each of us who take Permax have different
benefits and side effects. It would be great if we had a record of everyone
on the list who takes a "Dopamine Agonist" and their experience, but
unfortunately all we have is the comments of a few. I had to increase very
slowly because it caused orthostatic hypotension (low blood pressure and
dizziness). I fell several times at night when I got up. Currently I am
attempting to take .25 (i.e. 1/4) mg 3 times a day with meals, but it is
still causing the side effects. Without it my restless legs keep me awake at
night. I am probably getting and increased reaction from Permax because I
take Triamterene Hydrochlorithyazide (sp.) Maxide, a diuretic for edema of
the right foot and ankle. The edema, which I have had for years, may be
caused partly by PD and by the meds I take. In addition to Permax and
Maxide, I take Sinemet CR 25/100 X3 and Eldepryl 5mg X 2. Some Parkies on
this list take 1mg x 3 or more of Permax and do not have the reactions I do.
One person I remember, who also has edema, reported needing to switch to
Parlodel every 6 months or so.
For you and others who may not have this information I have decided to copy a
quote from "Parkinson's Disease Handbook" by Lieberman, et al. Since
experienced Parkies on this list surf and skim with ease, those of you who
know all about Dopamine Agonists - skim now.
"Dopamine Agonists are drugs which mimic the effects of dopamine and can be
used at any stage of PD. Dopamine agonists may help to improve Parkinson's
symptoms by bypassing the degenerating cells in the substantia nigra, and
stimulating the dopamine receptors directly.
The most useful dopamine agonists are derived from the ergot alkaloids.
The first of these to be used in PD was Parlodel. In patients with mild or
moderate disease, good therapeutic results have been achieved with low doses
of Parlodel (5-20 mg. per day), built up gradually over several weeks. By
using a combination of Sinemet and Parlodel, in mildly to moderately impaired
patients, good symptom control can be achieved at a lower dose of each drug.
Specific patient problems, such as morning regidity, bradykinesea, or leg
cramping may be helped with Parlodel. Adverse reactions are infrequent with
low doses. Parlodel can also be used in patients with advanced PD. In these
patients, Parlodel in low doses, when added to levodopa, has better
antiparkinson effect. Although Parlodel in higher doses may have a better
antiparkinson effect, these higher doses result in more frequent adverse
reactions.
Permax is a newer synthetic dopamine agonist that is longer acting than
Parlodel. Clinical trials indicated that pergolide ...(Permax)... is an
effective antiparkinson drug in patients with advanced disease who are no
longer satisfactorily responding to levodopa. The antiparkinson effect of
pergolide is comparable to that of Parlodel. However, since pergolide is
longer acting than Parlodel, it is more effective in improving the daily
changes in performance. The adverse effects of pergolide are similar to those
of Parlodel.
Lisuride is another synthetic dopamine agonist. It is useful in patients
with all degrees of disease severity, and the antiparkinson activity is
similar to that of Parlodel and pergolide.
Despite their chemical differences, the dopamine agonists (when used
alone or with levodopa) improve symptoms in the same number of PD patients.
However, individual patients react differently to these drugs; some improve
much more on one drug, and some develop side effects on a particular drug and
not on another. Moreover, in most patients when the response to one dopamine
agonist decreases, symptoms improve when another agonist is substituted."
(pp. 20-21)
Good luck with Permax, Fred
