Pergolide in the Treatment of Parkinson’s Disease

Pergolide, an ergot dopamine agonist with high affinity for dopamine receptors, was first approved as an adjunct to levodopa therapy in patients with Parkinson’s disease (PD) in the United States in 1988. Later, the efficacy of pergolide monotherapy was established for patients with early-stage PD. Since the 2000s, clinicians learned that idiopathic fibrosis, particularly of the heart valves, can be caused by long-term treatment with ergot dopamine agonists. Consequently, pergolide was withdrawn from the US market in 2007. The underlying mechanism for the development of fibrosis was thought to be associated with activation of serotonin receptor subtype 5-HT_2B. A meta-analysis reported that the risk of valvular regurgitation increased by 3.05 times in patients with PD taking pergolide. In addition, the mean cumulative dose of pergolide could be positively associated with the odds ratio concerning valvular regurgitation. Nevertheless, pergolide is still used as a treatment for PD in some countries but is considered as a second choice when patients do not respond well to other parkinsonian drugs. The recommended dose for pergolide is up to 3 mg/day, and it should be judiciously used with regular echocardiography, chest X-rays, and urine and blood tests.