Pergolide Mesylate

A to Z Drug Facts

 Action Directly stimulates postsynaptic dopamine receptors in nigrostriatal system.

 Indications Adjunctive treatment to levodopa-carbidopa in management of Parkinson's disease.

 Contraindications Hypersensitivity to ergot derivatives.

 Route/Dosage

Administer in divided doses tid. ADULTS: PO 0.05 mg/day first 2 days. Gradually increase dose by 0.1 to 0.15 mg/day q 3 days over next 12 days. Dose may then be increased by 0.25 mg/day q 3 days until optimum therapeutic dosage is achieved (mean therapeutic dose is 3 mg/day; maximum 5 mg/day). During titration cautiously decrease levodopa-carbidopa (average daily concurrent dose is 650 mg/day of levodopa).

 Interactions

Dopamine antagonists (eg, butyrophenones, metoclopramide, neuroleptics, phenothiazines, thioxanthenes): May diminish effectiveness of pergolide.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Orthostatic hypotension; vasodilation; palpitations; hypotension; syncope; hypertension; arrhythmia; MI. CNS: Dyskinesia; dizziness; hallucinations; dystonia; confusion; somnolence; insomnia; anxiety; personality disorder; psychosis; extrapyramidal syndrome; incoordination; akinesia; hypertonia; neuralgia. DERM: Rash; sweating. EENT: Abnormal vision; diplopia; glaucoma; eye hemorrhage; photophobia; visual field defect; taste perversion. GI: Nausea; constipation; diarrhea; dyspepsia; anorexia; dry mouth; vomiting. GU: Hematuria. RESP: Rhinitis; shortness of breath; epistaxis; hiccoughs. OTHER: Pains; accidental injury; flu syndrome; chills; peripheral edema; facial edema; edema; weight gain; anemia; bursitis; myalgia; twitching.

 Precautions

Pregnancy: Category B. Lactation: Unknown. Children: Safety and efficacy not established. Carcinogenesis: Uterine neoplasia has been observed with high doses of pergolide in animal models and was probably a result of prolactin inhibition. Cardiac arrhythmias: Exercise caution in patients with arrhythmias because of possible atrial premature contractions and sinus tachycardia. Hallucinosis: Hallucinations may occur in some patients. Symptomatic hypotension: Either symptomatic or orthostatic hypotension may occur, especially during initial treatment. With gradual titration, tolerance to hypotension usually develops.

 Administration/Storage

• Administer in divided doses 3 times/day.
• Store at room temperature.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note reports of syncope, irregular heart beats, or palpitations.
• If symptomatic orthostatic or sustained hypotension occurs, take safety precautions. As dosage is gradually titrated, tolerance to hypotension usually develops.
• Provide regular ophthalmic exams.

 Patient/Family Education

• Inform patient of risk of hypotension and teach safety measures to prevent falls from orthostatic hypotension (eg, dangling legs before getting out of bed, gradually rising from chairs).
• Instruct patient to report the following symptoms to physician: Symptomatic orthostatic or sustained hypotension, hallucinations, dyskinesia, somnolence, insomnia, nausea, constipation, diarrhea, dyspepsia, and rhinitis.
• Tell patient to take sips of water frequently, suck on ice chips or sugarless hard candy, or chew sugarless gum if dry mouth occurs.
• Advise patient that drug may cause drowsiness, and to use caution while driving or performing other tasks requiring mental alertness.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts