The two common dopamine agonists used in practice are pramipexole (Mirapex) and ropinerole (Requip).  They are often used in the management of restless leg syndrome and also sometimes utilized in Parkinson’s disease.  Here’s a few clinical pearls on these medications that you should definitely know!

1. Dopamine agonist can cause hypotension.  This is probably more likely to happen in patients who are taking other antihypertensive or already have a lower end blood pressure.
2. Assess for iron deficiency first.  It is easy to add new medications to try to solve a problem.  The harder thing to do is to investigate why a patient is having problems in the first place.  Iron deficiency can cause symptoms of restless legs and checking a ferritin to assess iron stores is critical.  I would say that a target for ferritin of 50 ng/mL is probably what most clinicians recommend, but I have heard some say 75 ng/mL. Reference
3. Other side effects, beside orthostasis include GI upset and edema.
4. There is a rare reported side effect with dopamine agonists that has made the news. These drugs have been associated with unusual compulsive type behaviors. Gambling, shopping, eating, and hypersexuality have all been reported.
5. There aren’t a ton of drug interactions with these agents, but it is important to recognize drugs that may oppose the activity of dopamine agonists.  Dopamine blockers like antipsychotics and Reglan can potentially blunt the effects of dopamine agonists. Example:  If you have a patient that is doing well on ropinerole for RLS and Reglan is added; there is a possibility that restless legs could get worse.
6. When reviewing medication lists, it is usually easy to tell when these drugs are being used for RLS.  For many patients, RLS symptoms are often only bothersome at night.  If you see the dopamine agonist dosed once daily at night, you can be pretty confident that it is being used for RLS.  If you see these drugs dosed multiple times per day, they could be being used for Parkinson’s or RLS.  If you’d like to learn more about the dopamine agonists, be sure to check out the podcast! Here’s the link on iTunes

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