The Pharmaceutical Journal Vol 267 No 7174 p701-706
17 November 2001

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Licence extension for pramipexole

Patients with early or untreated Parkinson's disease can now be given pramipexole when the condition is first diagnosed, which may make a huge difference to prescribing practice.

So said Dr K. Ray Chaudhuri, consultant neurologist, King's College Hospital, London, announcing the granting of an extension to the licence for pramipexole by the European Commission on 13 November. Until now, pramipexole has only been licensed as an adjunct to levodopa, in the treatment of Parkinson's disease, but can now be prescibed as monotherapy.

Dr Chaudhuri discussed three placebo-controlled trials using pramipexole alone in early Parkinson's disease. The results showed that pramipexole significantly improved activities of daily living and was effective and safe.

A randomised, controlled trial comparing pramipexole with levodopa as the initial dopaminergic treatment for Parkinson's disease showed that pramipexole is effective in delaying the motor complications, such as dyskinesia, which are a feared side effect of levodopa. After two years, 28 per cent of patients on pramipexole experienced major motor complications, compared with 51 per cent of the patients on levodopa. There is also evidence to suggest that patients can be maintained on pramipexole for at least four years, without the need to add in levodopa.

Professor Anthony Schapira, professor of clinical neurosciences, Royal Free Hospital, London, stressed that the importance of pramipexole and other dopamine receptor agonists is that they can be used as initial treatment and throughout the course of the disease. Levodopa is effective but time limited because of problems such as dyskinesias and wearing off (where the dose has to be increased regularly to sustain the effect).

Dr Douglas MacMahon, consultant physician with special responsibility for the elderly, Camborne Redruth Hospital, Cornwall, said that life is not over for those with Parkinson's disease aged 65. "These patients could well have another 15 years left and whatever treatment we are designing must be appropriate for the older patient. For the elderly, a drug is needed that has relatively few side effects. If a direct agonist is prescribed, it makes sense to start with one, rather than to add one in later when the patient is older."
— Contributed by Diane Langleben, editor, Hospital Pharmacist.

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