Magazine article Clinical Psychiatry News

Two Parkinson's Drugs Linked with Valve Damage

Magazine article Clinical Psychiatry News

Two Parkinson's Drugs Linked with Valve Damage

Article excerpt

Patients with Parkinson's disease who received the drugs pergolide or cabergoline had profoundly higher rates of clinically significant valvular heart disease than did those taking other dopamine agonists, in two European studies.

An Italian echocardiographic prevalence study of 155 patients with Parkinson's disease detected moderate to severe (grade 3 or 4) valvular regurgitation in 23.4% of patients who had taken pergolide and 28.6% of those who had taken cabergoline for at least 12 months, compared with none of the patients taking a non-ergot-derived dopamine agonist (pramipexole or ropinirole) and 5.6% of 90 control patients who did not have Parkinson's disease.

A significant association was seen between the cumulative dose of pergolide or cabergoline and the severity of valve regurgitation, according to Dr. Renzo Zanettini and associates in the cardiac rehabilitation unit and Parkinson Institute of the Istituti Clinici di Perfezionamento, Milan.

In the United States, pergolide carries a Food and Drug Administration warning of possible cardiac valvulopathy and fibrotic complications that discourages its use in patients with a history of valvular heart disease and recommends a baseline cardiovascular evaluation and periodic echocardiograms.

Cabergoline, which is prescribed for hyperprolactinemic disorders as well as Parkinson's disease, has been the subject of case reports and one case-control study from Japan (Neurology 2006;67:1225-9), suggesting an association with valvulopathy.

Other dopamine agonists may also have an impact on cardiac valves, although the clinical implications are unclear.

Dr. Zanettini and colleagues noted the presence of increased mitral tenting, a geometric measure of the position of the leaflets that can be an early indicator of valvular dysfunction, in patients receiving ergot-derived dopamine agonists such as pergolide and cabergoline. Patients receiving non-ergot-derived dopamine agonists also had increased mitral tenting.

Although the latter patients did not have evidence of elevated rates of frank regurgitation, this finding "suggests that follow-up echocardiographic monitoring is advisable in all patients with Parkinson's disease who are treated with dopamine agonists," they said (N. …

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