Understanding Parkinson's Disease

Pharmacological treatment options for Parkinson's disease

Dopaminergic agents:

  • Levodopa is a dopamine precursor which, once it crosses the blood-brain barrier, is converted to dopamine1,2
  • Dopamine agonists:
    • Dopamine agonists have been available for the treatment of Parkinson's disease (PD) for more than ten years1
    • A dopamine agonist mimics the effect of natural dopamine in the body and produces dopamine-like effects. Dopamine agonists are categorised into ergot and non-ergot subclasses
    • Mirapexin®/Sifrol® (pramipexole) is a non-ergot dopamine agonist and differs from ergot dopamine agonists (such as pergolide and cabergoline) by virtue of its chemical structure and its receptor affinities, specificities and selectivities. Studies have suggested that ergot-derived dopamine agonists can cause fibrotic reactions at the heart valve, whilst results from different studies suggest no increased risk with the non-ergot dopamine agonists such as Mirapexin®/Sifrol®3
    • Guidelines for the management of PD recommend the initiation of PD treatment with a dopamine agonist as first line treatment option1,4
  • Among the approved treatments for PD, Mirapexin®/Sifrol® (first approved as immediate release formulation in 1997) is worldwide to date the most prescribed dopamine agonist for the treatment of all stages of PD, with or without levodopa, with over five million patient-years exposure*
  • Marking a new advance for the established Mirapexin®/Sifrol®, in October 2009, a new Mirapexin®/Sifrol® prolonged-release, once daily tablet was granted marketing authorisation by the European Commission in all EU/EEA countries** for the treatment of idiopathic PD
  • The new Mirapexin®/Sifrol® prolonged-release formulation has demonstrated the combination of the trusted clinical benefits of Mirapexin®/Sifrol® immediate release with the convenience of a single daily dose5-12

* The pramipexole immediate release formulation is also approved for the symptomatic treatment of moderate to severe idiopathic Restless Legs Syndrome

** All 27 Member States of the European Union plus Norway and Iceland

Further information about pramipexole can be found at: www.emea.europa.eu/humandocs/PDFs/EPAR/Sifrol/H-133-PI-en.pdf.
Last accessed October 2009

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  1. Schapira AHV et al. Treatment options in the modern management of Parkinson disease. Arch Neurol 2007; 64(8): 1083-1088.
  2. Ahlskog JE. Parkinson's disease: medical and surgical treatment. Neurol Clin 2001; 19(3): 579-605.
  3. Andersohn F et al. Cardiac and noncardiac fibrotic reactions caused by ergot- and nonergot- derived dopamine agonists. Movement Disorders 2009; 24(1): 129-133.
  4. Miyasaki JM et al. Practice parameter: initiation of treatment for Parkinson's disease: an evidence-based review. Neurology 2002; 58: 11-17.
  5. Hauser R et al. Double-blind evaluation of pramipexole extended-release (ER) in early Parkinson's disease. Abstract S43.003 presented at AAN 61st Annual Meeting 2009, Seattle, USA.
  6. Salin L et al. Double-blind evaluation of maintenance of efficacy of pramipexole extended-release in early Parkinson's disease. Abstract P06.150 presented at AAN 61st Annual Meeting 2009, Seattle, USA.
  7. Schapira A et al. Efficacy and safety of pramipexole extended-release for advanced Parkinson's disease. Mov Disord Vol. 24, Suppl. 1, 2009: S1-S653.
  8. Poewe W et al. Pramipexole Extended-Release is Effective in Early Parkinson's Disease. Mov Disord Vol. 24, Suppl. 1, 2009: S1-S653.
  9. Poewe W et al. 33-week non-inferiority of extended- vs immediate-release pramipexole tablets in treatment of early Parkinson's disease. Abstract SC202 presented at 13th EFNS Congress 2009, Florence, Italy.
  10. Schapira A et al. Decrease in off-time for extended- and for immediate-release pramipexole in advanced Parkinson's disease. Abstract SC203 presented at 13th EFNS Congress 2009, Florence, Italy.
  11. Rascol O et al. Dosage, safety, and tolerability for overnight switching from immediate- to extended-release pramipexole in early Parkinson's disease. Abstract SC205 presented at 13th EFNS Congress 2009, Florence, Italy.
  12. Rascol O et al. Easy switching from immediate- to extended-release pramipexole in early Parkinson's disease at the same daily dosage. Poster TH-255 presented at Movement Disorders Society's 13th International Congress of Parkinson's Disease and Movement Disorders 2009, Paris, France.

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