Pergolide for Parkinson's disease

About pergolide

Pergolide is used to treat Parkinson's disease although other treatments are often preferred to it because it is associated with a small risk of fibrotic reactions, as a side-effect of the treatment. Fibrotic reactions can lead to breathing difficulties, a persistent cough, chest pain, and tummy (abdominal) pain or tenderness (see the side-effects table below).

Parkinson's disease affects the way your brain co-ordinates the movements of your muscles. A number of cells in a small part of your brain called the substantia nigra become damaged and die. These brain cells pass messages down nerves in the spinal cord by producing a chemical called dopamine, and it is these messages which control the muscles of the body. As the cells in the brain are damaged, the amount of dopamine that is produced is reduced. A combination of the reduction of cells and a low level of dopamine in the cells in this part of the brain, causes nerve messages to the muscles to become slowed and abnormal. This produces the main symptoms of Parkinson's disease, which are stiffness, shaking (tremor), and slowness of movement.

Pergolide is a dopamine-receptor agonist which means that it acts on the same receptors in your brain as dopamine. In effect, it acts like a substitute for dopamine and this helps to ease your symptoms. It may be used alone, or in combination with other medicines to treat Parkinson's disease.

Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken. For these reasons, before you start taking pergolide it is important that your doctor knows:

• If you are pregnant or breastfeeding.

• If you have a heart condition or an unusual heart rhythm.

• If you have ever had a mental health problem that has caused you to be confused, or to see or hear things that are not real (hallucinations).

• If you have any muscle movements of your face or body which you can't prevent (dyskinesia).

• If you have been told you have scar tissue which affects your heart, lungs or abdomen.

• If you have a rare inherited blood disorder called porphyria.

• If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.

• If you have ever had an allergic reaction to a medicine.

• Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack and any additional information your doctor has given to you. These will give you more information about pergolide, and will also provide you with a full list of side-effects which you could experience from taking it.

• The dose you are prescribed will depend upon your symptoms and whether you are also taking other medicines for Parkinson's disease. Your doctor will tell you how many tablets to take, and how often to take them. This information will also be printed on the label of the pack of tablets to remind you about what the doctor said to you. Read the directions from your doctor carefully so that you know what dose is right for you each day, and take the tablets exactly as you have been told.

• If you are taking pergolide for the first time, your doctor will give you a small dose to begin with, and then gradually increase this over the first few weeks. Slowly increasing your dose like this will help to reduce side-effects such as dizziness and low blood pressure, which can occur when you first start treatment.

• There are several different strengths of pergolide. Each time you collect a prescription, please check the strength on the box to make sure that you have been given the strength you are expecting. Ask your pharmacist to check for you if you are unsure about anything.

• Try to get into a habit of taking your doses at the same times of day each day, as this will help you to remember to take them regularly. If you forget to take a dose, take it as soon as you remember. Try to take the correct number of doses each day, but do not take two doses at the same time to make up for a missed dose.

• Try to keep all your regular appointments with your doctor. This is so your doctor can check on your progress. Pergolide has occasionally caused heart and lung problems, particularly in people who take it over a long period of time. In order for your doctor to check for this, you will need to have a heart tracing (electrocardiography, or ECG), lung function tests, blood tests, and an X-ray from time to time.

• Keep taking the tablets until your doctor tells you otherwise. Stopping suddenly can cause problems and your doctor will want you to reduce your dose gradually if you need to stop treatment.

• Sometimes people taking medicines like pergolide can fall asleep suddenly during the day with little or no warning of being tired beforehand. Until you know how you react, take extra care if you drive, or if you operate machinery. If you do find yourself falling asleep suddenly, you should see your doctor as soon as possible for advice, and avoid using tools and machines or driving in the meantime.

• Treatment with medicines like pergolide can sometimes cause problems with impulsive types of behaviour. If you notice any changes in your behaviour, such as an increased desire to gamble, binge eat, or spend excessively, or an increased sex drive, you must let your doctor know as soon as possible.

• Stay as active as possible and exercise regularly as much as you are able. You may walk more slowly than before, but a daily walk is good exercise and may help to loosen up stiff muscles.

• If you are a driver you should tell the DVLA and your insurance company if you have Parkinson's disease. Depending on the severity of symptoms and the medicines that you are taking, you may still be allowed to drive following a medical assessment.

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the common ones associated with pergolide. You will find a full list in the manufacturer's information leaflet supplied with the tablets. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

If you experience any other symptoms which you think may be due to the medicine, please speak with your doctor or pharmacist for further advice.

• Keep all medicines out of the reach and sight of children.

• Store in a cool, dry place, away from direct heat and light.