Dopamine Agonists: Uses, most common brand names, and safety information
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Dopamine deficiency was first introduced as a possible cause of Parkinson’s disease (PD) in 1960. Throughout most of the 1960s levodopa was used as a treatment for PD, although the results were not consistent. In 1967, the effectiveness of levodopa in PD was reported after using increased dosages over long periods. Levodopa can cause major side effects such as dyskinesias and motor fluctuations. Because of this, a dopa decarboxylase inhibitor (carbidopa) was added to help reduce the occurrence of adverse events.
Dopamine agonists started to be routinely used in the treatment of PD after Parlodel (bromocriptine) was discovered in 1974. Today, we use dopamine agonists as monotherapy or in combination with Sinemet (carbidopa/levodopa).
The list below includes the best dopamine agonists approved by the U.S. Food and Drug Administration (FDA) and their pricing:
List of Dopamine Agonists
Apokyn is indicated to treat “off” episodes associated with advanced Parkinson’s disease.
Kynmobi is indicated to treat “off” episodes associated with advanced Parkinson’s disease.
Neupro is indicated to treat symptoms of Parkinson’s disease and restless legs syndrome.
Parlodel is indicated to treat hyperprolactinemia, Parkinson’s disease, and acromegaly.
Cycloset is indicated along with diet and exercise to treat type 2 diabetes mellitus.
Mirapex is indicated to treat symptoms of Parkinson’s disease and restless legs syndrome.
Mirapex ER (pramipexole)
Mirapex ER is indicated to treat symptoms of Parkinson’s disease and restless legs syndrome.
Requip is indicated to treat symptoms of Parkinson’s disease and restless legs syndrome.
Requip XL (ropinirole)
Requip XL is indicated to treat symptoms of Parkinson’s disease and restless legs syndrome.
Dostinex is indicated to treat hyperprolactinemia.
What are dopamine agonists?
Dopamine is a key neurotransmitter that helps with functions such as voluntary movement, behavior, mood, learning, and memory. It also inhibits the production and release of prolactin from the pituitary gland. Damage to the dopaminergic neurons in the brain may be the cause of Parkinson’s disease.
Dopamine receptor agonists are a class of drugs used to treat the motor symptoms of Parkinson’s disease and other movement disorders, such as restless legs syndrome. Dopamine agonist medications are also the first-line treatment for hyperprolactinemia.
Dopamine agonists are available in formulations such as immediate-release tablets, extended-release tablets, transdermal patches, and subcutaneous (under the skin) injections.
How do dopamine agonists work?
Dopamine agonists mimic the actions of dopamine in the brain by binding to the D1 and D2 groups of dopamine receptors in the brain and central nervous system (CNS).
D1 and D2 dopamine receptors are involved in the control of voluntary movement, addictive behavior, memory, and learning. D2 receptors are also important in the psychosis associated with schizophrenia and bipolar disorder. The majority of dopamine agonists used in the treatment of Parkinson’s disease are D2 receptor agonists.
Dopamine agonists can be classified as:
- Ergot-derived alkaloids. The early dopamine agonists were derived from ergoline. They typically have a higher affinity for the D2 group of dopamine receptors. Ergot derivatives also interact with other receptors such as serotonin. They are rarely used for Parkinson’s disease because of the risk of fibrosis. Pergolide was taken off the U.S. market because of an increased risk of cardiac fibrosis.
- Non-ergot alkaloids. The newer non-ergoline dopamine agonists interact more with the D2 and D3 groups of receptors. They are considered first-line treatment for patients with early Parkinson’s disease or restless legs syndrome.
What conditions are dopamine agonists used to treat?
Dopamine agonists are used to treat conditions such as:
- Parkinson’s disease
- Restless legs syndrome
Are dopamine agonists safe?
When taken as prescribed, dopamine agonists are safe and effective. Make sure your healthcare provider is aware if you have any of the following:
- Cardiovascular disease
- Liver impairment
- Kidney impairment
- Peptic ulcer disease
- Impulse control issues
- Are pregnant, plan on becoming pregnant, or are breast-feeding
You should also tell your healthcare provider about all of the prescription drugs, over-the-counter medications, and supplements you are taking, including:
- 5-HT3 antagonists including Zofran (ondansetron)
- Antipsychotic medications such as Seroquel (quetiapine)
Consult your healthcare provider for other possible drug interactions.
Can you take dopamine agonists while you are pregnant or breastfeeding?
There is not enough sufficient data on the developmental risk associated with the use of dopamine agonists in pregnant women. Animal studies have shown an increased risk in some of these medications.
This is also not enough data on whether dopamine agonists are found in breast milk and what effects they may have on the infant. However, inhibition of lactation is expected with dopaminergic medications.
You should discuss the need for any medication with your doctor if you are pregnant, plan on becoming pregnant, or are breastfeeding.
What are the common side effects of dopamine agonists?
Some common adverse effects of dopamine agonists include:
- Daytime sleepiness or sudden sleep attacks
- Orthostatic hypotension (low blood pressure upon standing)
Dopamine agonists can sometimes cause severe adverse events, including:
- Heart disease including arrhythmias
- Pulmonary fibrosis
- Stomach ulcers
- Peripheral edema
- Liver dysfunction
- Depression or mania
- Hypersexuality and other impulse control disorders with long-term use
This is not a complete list of side effects and we encourage you to consult with your healthcare professional for medical advice about any possible side effects.
How much do dopamine agonists cost?
Dopamine agonists are very expensive with an average cost of around $5,000-10,000 per year.
You can purchase dopamine agonists for $49 per month from NiceRx if eligible for assistance. Prices at the pharmacy vary by location, strength, and quantity, as well as your insurance status.
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