Judith Richards just sent this article--it refers to speed of titration in
ADVANCED PWPs---FYI.
*******
Rapid titration of dopamine agonists safe in advanced
Parkinson's disease
WESTPORT, Apr 29, 1999 (Reuters Health) - Introducing a new
dopamine agonist at its full converted dose improves the efficacy
and safety of the drug for patients with advanced Parkinson's
disease, according to study results published in the April 12th issue
of Neurology.
Dr. Christopher G. Goetz and colleagues from Rush University,
Chicago, Illinois, examined two titration regimens for switching
patients with advanced Parkinson's disease from bromocriptine or
pergolide to pramipexole.
The slow titration regimen was administered in accordance with
the package insert for pramipexole, "...with weekly increases in
dosage to reach their equivalent dosage." Patients assigned to the
rapid titration approach received the full converted dose the day
after stopping the former agonist, and the dose was adjusted
weekly thereafter as needed.
Every week a blinded observer assessed Unified Parkinson's
Disease Rating Scale (UPDRS) scores and asked the patients
about any adverse effects. "The mean time to reach a UPDRS
score that was superior to baseline without increased adverse
effects was significantly shorter in the rapid-titration group (mean
2.1 weeks versus 5.3 weeks)," the investigators report.
Dr. Goetz's group found increased parkinsonian features
exclusively among patients in the slow-titration group, leading the
clinicians to conclude that "...rapid conversion is safer than a slow
titration in patients with advanced disease."
By the end of the 8-week study, UPDRS scores had improved
significantly in both titration groups, and the average final doses of
pramipexole in the two groups were similar.
The researchers recommend that clinicians use "...a 1:1 conversion
for pergolide to pramipexole and 10:1 for bromocriptine to
pramipexole."
Neurology 1999;52:1227-1229.
--
Judith Richards, London, Ontario, Canada
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Camilla Flintermann, CG for Peter 80/70/55
Oxford, Ohio
http://www.newcountry.nu/pd/members/camilla/one.htm
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