Combination Of Dopamine Agonists Research Articles

Pregnancy and acromegaly: clinical outcomes of retrospectively analysed data from the German acromegaly registry

ContextAcromegaly is a rare disease caused by excessive growth hormone (GH) secretion, mostly induced by pituitary adenomas. The care of pregnant women with acromegaly is challenging, in part due to existing clinical data being limited and not entirely consistent with regard to potential risks for mother and child.ObjectiveTo retrospectively examine data on pregnancy and maternal as well as neonatal outcomes in patients with acromegaly.Design & methodsRetrospective data analysis from 47 pregnancies of 31 women treated in centers of the German Acromegaly Registry.Results87.1% of the studied women underwent transsphenoidal surgery before pregnancy. In 51.1% a combination of dopamine agonists and somatostatin analogs were used before pregnancy. Three women did not receive any therapy for acromegaly. During pregnancy only 6.4% received either somatostatin analogs or dopamine agonists. In total, 70.2% of all documented pregnancies emerged spontaneously. Gestational diabetes was diagnosed in 10.6% and gravid hypertension in 6.4%. Overall, no preterm birth was detected. Indeed, 87% of acromegalic women experienced a delivery without complications.ConclusionPregnancies in women with acromegaly are possible and the course of pregnancy is in general safe for mother and child both with and without specific treatment for acromegaly. The prevalence of concomitant metabolic diseases such as gestational diabetes is comparable to the prevalence in healthy pregnant women. Nevertheless, larger studies with more data in pregnant patients with acromegaly are needed to provide safe and effective care for pregnant women with this condition.

Combination of dopamine agonist and prostaglandin administration for pregnancy termination in bitches – a novel approach

ABSTRACT Pregnancy termination is a required procedure in companion animal practice. In healthy bitches with confirmed pregnancy, good results are obtained with the combination of prostaglandin F2 and dopamine agonist, followed by regular sonographic examination until confirmed abortion. The aim of this study was to establish a simple and easily applicable procedure, with different dynamics of application of dinoprost and cabergoline. Dinoprost was administered intramucousally in the vestibule of vagina. Twenty bitches were divided into four equal groups. Group A received dinoprost and cabergoline daily; group B received dinoprost every 48 h and cabergoline daily; group C received dinoprost daily and cabergoline every 48 h, and group D received both cabergoline and dinoprost every 48 h. The treatment lasted until abortion was sonographically confirmed. The pregnancy was successfully terminated in all bitches, and side effects appeared in 90% animals, though they were of strong intensity in only 15% of bitches. Dinoprost administered intramucousally was effective with fewer undesirable, strong, systemic side effects. Drug administration every 48 h also induced abortion, with negligible side effects, but with slightly longer duration of treatment. This combination could be interesting in cases with time-limited owners and in countries where other drugs are unavailable.

Abstract #956: Successful Debulking of Pituitary Macroadenoma with Pasireotide Lar and Dopamine Agonist Combination Theory

Abstract #956: Successful Debulking of Pituitary Macroadenoma with Pasireotide Lar and Dopamine Agonist Combination Theory

Agonist and antagonist coast

The use of GnRH-a in ovarian stimulation permitted stronger stimulation resulting in an increased incidence of OHSS. The first Cochrane review comparing GnRH agonist and GnRH antagonist protocols for ovarian stimulation showed no significant difference in OHSS rate between the two protocols, however, a recent Cochrane review showed a highly significant decrease in the incidence in OHSS rate in the antagonist protocol. Coasting is a commonly used procedure for preventions of OHSS. The optimum time to start coasting is when the lead follicle reaches 16 mm in diameter and hCG should be given when E2 level drops below 3000 pg/ml. Coasting may act by diminishing the functioning granulosa cell cohort. Administration of daily GnRH antagonist in high risk patients for OHSS who were down-regulated by GnRH-a resulted in rapid drop of E2 and decrease in incidence of OHSS. A series of patients who developed early OHSS were treated by daily GnRH antagonist injections, all embryos were cryopreserved. No progression to severe OHSS was observed.

High dose dopamine agonist treatment and combination of dopamine agonists

Moving towards a more dopamine agonist based therapy is often an effective way to counteract motor fluctuations in patients with advanced Parkinson's disease. It is thereby an impression that higher doses of dopamine agonists than those normally recommended can lead to further improvements compared to treatment with dopamine agonists in the normal dose range. There are now a number of open-label clinical studies with different dopamine agonists confirming that this might be an effective strategy. There are also single studies indicating that combining different dopamine agonists might be a further treatment alternative with similar effects compared to high dose dopamine agonist treatment. In line with this we performed a study comparing the use of high doses of the dopamine agonist cabergoline with normal-dose treatment. Thirty-four patient with idiopathic Parkinson's disease were included in the study and 32 of these performed the whole study. Cabergoline was raised from a mean daily dosis of 6.4mg to a daily dosis of 13.7mg over a period of up to 20 weeks. The doses were then held constant for at least 6 weeks. Clinical evaluations were performed after 0, 1, 8, 16, 26 and 27 weeks. The time per day with dyskinesia and dystonia was shortened and the maximum dyskinesia/dystonia intensity was reduced with high dose cabergoline. Also part of the day with severe „off“ symptomatology and the symptomatology in „worst off“ improved. The mean L-dopa dose was reduced from 606 mh/day to 370mg/day. Evaluation with clinical global impression scales confirmed a clear improvement in a majority of the patients. Also the health related quality of life scale PDQ-39 showed an improvement regarding total score and all subscales appart from congnition. The most common side effect was hallucinations. There is now an urgent need for controlled studies and long-term studies, to investigate to what degree this treatment strategy shall be an option for Parkinson patients. Especially it will be important to further explore the risk for side effects. This concerns especially hallucinations and other psychotic symptoms. It also concerns cardiac valvular fibrosis, where it is still unclear which dopamine agonists that are at risk and if this side effect is dose-dependent. Until further information is available high dose dopamine agonist treatment and combination of dopamine agonists shall be handled by physicians with profound experience in Parkinson treatment and the patients shall regularly be monitored for the mentioned side effects. It seems clear that both these treatment options can be highly effective regarding improvement of motor symptomatology and can be considered especially in patients with motor fluctuations in spite of otherwise optimized p.o. therapy and low tendency to psychotic side effects.