ABSTRACT
ABSTRACT Aripiprazole is an atypical antipsychotic agent which has a partial agonistic effect on dopamine D2 and D3 receptors. It is effective in the treatment of schizophrenia and bipolar disorder. Owing to its partial agonistic effect, hyperactivity of dopamine may occur in the mesolimbic pathway. In the literature, there are few case reports about pathological gambling due to aripiprazole. In this article, there are two case reports of patients who showed pathological gambling behaviour and alcohol abuse and who were under treatment with aripiprazole. The patient had a history of gambling in the past. With the use of aripiprazole, pathological gambling behaviour occurred quickly and with discontinuation of aripiprazole it ended completely. Aripiprazole causes pathological gambling by forming a hyperdopaminergic condition in the mesolimbic dopaminergic pathway. Aripiprazole should be recommended cautiously and carefully to patients who are impulsive and have a history of alcohol/substance abuse.
Subject(s)
Humans , Male , Adult , Middle Aged , Antipsychotic Agents/adverse effects , Dopamine Agonists/adverse effects , Aripiprazole/adverse effects , Gambling/chemically inducedABSTRACT
The main adverse effects of dopaminergic drugs used in Parkinson's disease are hypotension, somnolence, hallucinations and impulse control disorder. Less common is leg edema. We report on a 68-year-old male receiving levodopa and pramipexole consulting for severe leg edema lasting two years, whose etiology was not ascertained with multiple lab tests. This edema subsided substantially when pramipexole was discontinued and the dose of levodopa was increased to treat motor symptoms.
Subject(s)
Humans , Male , Aged , Parkinson Disease/drug therapy , Dopamine Agonists/adverse effects , Edema/chemically induced , Edema/pathology , Benzothiazoles/adverse effects , Leg/pathology , Levodopa/adverse effects , Pramipexole , Antiparkinson Agents/adverse effectsABSTRACT
La enfermedad con cuerpos de Lewy incluye 2 entidades que podrían ser consideradas variantes clínicas de una misma patología: la demencia con cuerpos de Lewy y la demencia en enfermedad de Parkinson. Con la finalidad de describir correctamente lo que sucede en la evolución de la enfermedad se divide el cuadro en etapa prodrómica y de demencia propiamente dicha. La primera está clínicamente representada por aquel período en el cual, si bien el paciente exhibe algunos signos y síntomas propios de la enfermedad, no reúne criterios de demencia. A pesar de ser difícil de definir y por carecerse todavía de contundentes datos clínicos y biomarcadores, se caracteriza principalmente por deterioro leve selectivo en función atencional visuoespacial, trastorno del sueño REM y disautonomíaâ. La segunda etapa está claramente caracterizada en los criterios de consenso del año 2005. Recientemente hemos publicado la validación de un instrumento llamado ALBA Screening Instrument, que permite diagnosticar con alta sensibilidad y especificidad la enfermedad aun en etapas tempranas y diferenciarla de otras patologías semejantes. La tomografía por emisión de positrones (PET) para transportador de dopamina es el procedimiento de referencia (gold standard) del diagnóstico. El tratamiento sintomático con anticolinesterásicos y neurolépticos atípicos favorece una buena evolución de la enfermedad y es fundamental tener en cuenta evitar medicamentos que pueden dañar gravemente a los pacientes como los anticolinérgicos y antipsicóticos típicos. Los avances en el diagnóstico y la difusión del impacto de esta enfermedad en la población contribuirán a generar mayores esfuerzos de investigación para hallar un tratamiento eficaz, preventivo o curativo o de ambas características. (AU)
Lewy body disease includes 2 entities that could be considered clinical variants of the same pathology: Dementia with Lewy bodies and Parkinson's disease Dementia. Two stages of the disease are described in this review, a prodromal stage and one of explicit dementia. The first one is clinically represented by that period in which, the patient exhibits some typical features of the disease, but not dementia criteria. Despite being difficult to define the prodromal stage and that strong clinical data and biomarkers are still lacking, there is evidence to characterize it mainly by mild selective impairment in attention and visuo-spatial function, REM sleep disorder and dysautonomia. The second stage is clearly characterized in the known consensus criteria of 2005. We have recently published the validation of an instrument called ALBA Screening Instrument which showed a high sensitivity and specificity for diagnosis of the disease even in the early stages. It´s useful to differentiate the disease from other similar pathologies. Positron Emission Tomography for dopamine transporter is the gold standard of diagnosis in life. Symptomatic treatment with anticholinesterases and atypical neuroleptics help patients in their evolution of the disease. Anticholinergics and typical antipsychotics are agents to avoid in the treatmen of the disease because can severely damage patients. Future advances in the diagnosis and dissemination of the knowledge of the disease will contribute to generate greater research efforts to find an effective preventive and / or curative treatment. (AU)
Subject(s)
Humans , Lewy Body Disease/drug therapy , Lewy Body Disease/diagnostic imaging , Parkinson Disease/pathology , Attention , Signs and Symptoms , Antipsychotic Agents/adverse effects , Antipsychotic Agents/therapeutic use , Benztropine/adverse effects , Biperiden/adverse effects , Carbidopa/administration & dosage , Carbidopa/therapeutic use , Levodopa/administration & dosage , Levodopa/therapeutic use , Trihexyphenidyl/adverse effects , Cholinesterase Inhibitors/therapeutic use , Clozapine/administration & dosage , Clozapine/therapeutic use , Muscarinic Antagonists/adverse effects , Dopamine Antagonists/adverse effects , Dopamine Agonists/adverse effects , Cholinergic Antagonists/adverse effects , Risperidone/adverse effects , Lewy Body Disease/diagnosis , Lewy Body Disease/etiology , Lewy Body Disease/genetics , Lewy Body Disease/pathology , REM Sleep Behavior Disorder/complications , Dementia , Primary Dysautonomias/complications , Prodromal Symptoms , Rivastigmine/administration & dosage , Rivastigmine/therapeutic use , Quetiapine Fumarate/administration & dosage , Quetiapine Fumarate/therapeutic use , Olanzapine/adverse effects , Donepezil/administration & dosage , Donepezil/therapeutic use , Haloperidol/adverse effects , Histamine Antagonists/adverse effects , Hypnotics and Sedatives/adverse effects , Antidepressive Agents, Tricyclic/adverse effectsABSTRACT
La cabergolina y la bromocriptina son fármacos agonistas dopaminérgicos utilizados para tratar la hiperprolactinemia, así como la enfermedad de Parkinson. Entre sus efectos adversos considerados como muy raros se ha descrito la capacidad de inducir cambios fibróticos en el aparato valvular cardiaco, inicialmente descritos en pacientes con enfermedad de Parkinson, en quienes se emplean dosis superiores a las que de manera habitual se emplean en el tratamiento de la hiperprolactinemia. Varios estudios han señalado la evidencia de estos hechos y de los posibles mecanismos por los cuales la afectación valvular ocurre. Existen hasta el momento pocas investigaciones sobre el asunto en pacientes con hiperprolactinemia, pero la mayoría de ellos indican que su empleo en este tipo de pacientes no produce afectación valvular clínicamente relevante, hecho que pudiera estar en relación con las dosis empleadas (como promedio 10 veces inferiores a las usadas en la enfermedad de Parkinson); sin embargo, se han detectado algunas anomalías subclínicas en el aparato valvular. Dado lo novedoso del tema y la poca evidencia de estos hechos en pacientes tratadas por hiperprolactinemia se ofreció una amplia revisión sobre el tema(AU)
Cabergoline and bromocriptine are dopaminergic agonists drugs used in hyperprolactinemia treatment, as well as in patients with Parkinson's disease. Among its adverse effects considered as very inusual is included the ability to induce fibrotic changes in cardiac valvular tract first described in patients with Parkinson disease using doses higher than those usually used in hyperprolactinemia treatment. Some studies have mentioned the evidence on these facts and of the possible mechanisms causing the valvular affection. Until now, there are not much researches on this subject in patients with hyperprolactinemia, but most indicated that its use in this kind of patient can not to produce a clinically relevant valvular afection, fact tha may to be related to the dose used (on average 10 times lower than those used in Parkinson's disease); however, some subclinical anomalies have been detected in valvular tract. Due to this novel subject and the scarce evident of these facts in patients treated by hyperprolactinemia, we offered an review of the subject(AU)
Subject(s)
Humans , Hyperprolactinemia/drug therapy , Dopamine Agonists/adverse effects , Dopamine Agonists/therapeutic use , Heart Valve Diseases/chemically inducedABSTRACT
Apresentamos breve revisão da literatura sobre os agonistas dopaminérgicos. Referimos os cinco receptores conhecidos e onde estão localizados, as vantagens e as desvantagens de sua utilização nos pacientes com a doença de Parkinson. Introduzidos com o objetivo principal de controlar as limitações da levodopa, aumentando a janela terapêutica, analisamos a farmacocinética, a eficácia e os efeitos colateria da cabergolina, do ropinirole e do pramipexole.
Subject(s)
Humans , Antiparkinson Agents/therapeutic use , Dopamine Agonists/therapeutic use , Levodopa/therapeutic use , Parkinson Disease, Secondary/drug therapy , Antiparkinson Agents/adverse effects , Antiparkinson Agents/pharmacokinetics , Dopamine Agonists/adverse effects , Dopamine Agonists/pharmacokinetics , Dopamine Antagonists/therapeutic useABSTRACT
Advances in medical treatment of prolactinomas and acromegaly in the last 20 years are analyzed. Dopaminergic drugs as bromocriptine, lisuride, pergolide and terguride successfully control hyperprolactinemia, reduce tumor size and cause clinical improvement. New long lasting medications with less adverse effects such as cabergoline, with oral weekly administration, and the repeatable monthy injectable form of bromocriptine (Parlodel LAR, Sandoz) may be the treatment of choice for prolactinomas. Dopaminergic medications are less effective in acromegaly. The higher doses required induce more collateral effects. An important step has been the incorporation of long lasting somatostatin analogues such as octreotide (for sbc use tid) intramuscular every 28 days injectable Sandostatin LAR and lanreotide SR (Somatuline, Ipsen Biotech), injectable every 10 to 14 days. Medical treatment of acromegaly is not, at the present, an alternative to surgery. However, the development of long lasting specific drugs may become, in the future, the choice or an alternative in the treatment of acromegaly