Grimes J D, Hassan M N
Can J Neurol Sci. 1983 May;10(2):86-90. doi: 10.1017/s0317167100044693.
Thirty-seven patients with advanced Parkinson's disease who initially tolerated, and responded to bromocriptine therapy were followed for 12 to 50 (mean 28) months. Using a method of gradual increase of bromocriptine, with concomitant levodopa reduction, the peak effect of the drug was apparent by three months, at which time the mean daily dose of bromocriptine was 23.9 mg and Sinemet (levodopa + carbidopa) had been reduced by 34 percent. Eight patients had sustained improvement without further drug changes for an average of 29 (range 14-50) months. After periods of improvement varying between 3 and 30 months, 29 patients had a fall-off from peak effect. Peak effect was regained in 21 of these 29 patients for an average of 16 additional months by initially increasing bromocriptine or Sinemet, or by eventually increasing both drugs. The main adverse effect was a confusional state which necessitated late withdrawal of bromocriptine in four patients. The best results were in younger patients with end-of-dose deterioration and levodopa induced dyskinesias. With cautious introduction, and intermittent dosage adjustment, bromocriptine can be of long-term benefit to patients with advance Parkinson's disease. The majority of patients have a gradual late fall-off in effect which can frequently be reversed with dosage adjustment.
37例晚期帕金森病患者最初耐受溴隐亭治疗且有反应，随访12至50（平均28）个月。采用逐渐增加溴隐亭剂量并同时减少左旋多巴用量的方法，3个月时药物达到最大效应，此时溴隐亭平均日剂量为23.9mg，息宁（左旋多巴+卡比多巴）已减少34%。8例患者持续改善，未再调整药物，平均持续29（14至50）个月。在3至30个月不等的改善期后，29例患者从最大效应下降。这29例患者中有21例通过最初增加溴隐亭或息宁，或最终同时增加两种药物，平均又恢复最大效应16个月。主要不良反应是意识模糊状态，4例患者因此不得不停用溴隐亭。效果最佳的是有剂末恶化和左旋多巴诱发异动症的年轻患者。谨慎用药并间断调整剂量，溴隐亭对晚期帕金森病患者可产生长期益处。大多数患者效应会逐渐后期下降，常可通过调整剂量逆转。
