ISSUE 2 OF THIS MESSAGE=20 My apologies to everyone for accidentally including Tolcapone in my list of Dopamine Agonists. It is of course a COMT inhibitor and has nothing to do with this subject. (Thanks for pointing it out Ron) I would be interested if anyone has additional material or experience relevant to this post. I recently had the opportunity of a long chat with my neurologist, who=20 is a specialist in Parkinson's Disease, and is certainly the most informed=20 of the many specialists who I have dealt with over the course of 19 years=20 with PD. We were discussing the relative merits of the various Dopamine=20 Agonists. I commented that I did not see any difference in the performance=20 of these drugs as far as performing their basic function of providing a=20 Dopamine substitute without provoking dyskinesias. I was somewhat surprised to find that he fully agreed with me! It appears that there is virtually no research being done or previously done comparing the performance of the=20 various agonists, and it appears that the drug manufacturers show no=20 enthusiasm for doing such tests. (There's a challenge for our researchers) =20 Since writing issue 1 of this note, I have discovered a reference to one=20 fairly serious comparative study, which compared the effectivness of=20 Bromocriptine and Permax when used in conjunction with levodopa.=20 (LeWitt PA, Ward CD, Larsen TA, et al:- Comparison of Pergolide and=20 Bromocriptine therapy in Parkinsonism. Neurology 1983:33; 1009-14). The conclusion of the test was "The 2 drugs were judged to be clinically=20 similar with respect to both antiparkinsonian efficacy and adverse effects. Although this was a double-blind study, the reviewer does make a number of=20 criticisms of the detail of the the experiment but, for what it's worth, it does support my basic point which is: =20 1) All the Dopamine agonists perform their basic function, and there is no difference in the performance of one versus the other. If you are trying to increase your On/Off margins, or reduce your Sinemet/Madopar dosage by increasing the agonist dosage, ALL the agonists will do the job, and one is=20 as good as another. =20 Ron responded to my first issue of this note with a lengthy account which I suspect came straight out of the drug makers press release. It makes my=20 point nicely which is that until proven by clinical tests, the sort of high-sounding claims quoted by Ron are best regarded as waffle or flute music (as we call it). =20 =20 2) Where the dopamine agonists DO differ is in the tendency to produce=20 unwanted side effects. Generalisation is impossible here: it is definitely a=20 case of 'One man's meat is=A0another man's poison'. All that can be done is, if=20 your particular Agonist is giving you trouble, try one of the others. This is the ONLY valid reason for changing agonists. With the number of options=20 now available, there are good grounds for expecting that one or more of them=20 will prove to be satisfactory for you. I have listed below the currently available agonists; let me know if I missed any. (Not all of these will be=20 available in a specific country) =20 Apomorphine Bromocriptine (Parlodel) Lisuride (Revanil) Pergolide (Permax, Celanse) Cabergoline (Cabaser) Ropinirole (Requip) Pramipexole (Mirapex) =20 =20 --=20 Brian Collins <[log in to unmask]>