Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane, Washington 99217-6131, USA.
Drugs Aging. 2010 Apr 1;27(4):295-310. doi: 10.2165/11318330-000000000-00000.
Dopamine receptor agonists provide a viable alternative or adjunct to levodopa therapy in Parkinson's disease and are associated with fewer motor complications and dyskinesia. However, all available dopamine agonists may cause profound adverse effects in some patients. In many cases, these adverse effects amplify non-motor symptoms that people with Parkinson's disease may already be experiencing. Nausea from dopamine agonists generally lessens with time and may be responsive to both antiemetic therapy and complementary remedies, such as ginger, peppermint and chamomile. Unfortunately, compulsive behaviours, as well as peripheral oedema caused by dopamine agonists, are poorly responsive to pharmacological therapy and require a reduction or discontinuation of agonist therapy. Somnolence and associated sleep attacks generally require elimination of the agonist or the use of a stimulating agent. The necessity of treatment for hallucinations and psychosis associated with dopamine agonists must be thoroughly evaluated prior to initiating therapy. If a medication is initiated for hallucinations or psychosis, quetiapine or clozapine are agents of choice. Orthostatic hypotension, though not always symptomatic, responds well to nonpharmacological strategies and medications, including indometacin, midodrine and fludrocortisone. Care must be taken to educate patients with Parkinson's disease about the common adverse effects of dopamine agonists and what can be done to lessen them.
多巴胺受体激动剂为帕金森病的左旋多巴治疗提供了可行的替代或辅助方法，且与较少的运动并发症和运动障碍相关。然而，所有现有的多巴胺受体激动剂在某些患者中可能会引起严重的不良反应。在许多情况下，这些不良反应会加剧帕金森病患者已经存在的非运动症状。多巴胺受体激动剂引起的恶心通常会随着时间的推移而减轻，并且可能对止吐治疗和补充疗法（如生姜、薄荷和甘菊）有反应。不幸的是，强迫行为以及多巴胺受体激动剂引起的外周水肿对药物治疗反应不佳，需要减少或停止激动剂治疗。嗜睡和相关的睡眠发作通常需要消除激动剂或使用兴奋剂。在开始治疗之前，必须彻底评估与多巴胺受体激动剂相关的幻觉和精神病的治疗必要性。如果开始使用药物治疗幻觉或精神病，喹硫平和氯氮平是首选药物。体位性低血压虽然并非总是有症状，但对非药物治疗策略和药物（包括吲哚美辛、米多君和氟氢可的松）反应良好。必须注意教育帕金森病患者多巴胺受体激动剂的常见不良反应以及可以采取哪些措施来减轻这些不良反应。
