Adult Dosing
Management of the signs and symptoms of Parkinson's disease
Monotherapy
- 50 mcg PO qhs on day 1, 50 mcg bid on days 2-4, gradually increase the dose by 100-250 mcg every 3–4 days to 1500 mcg daily in 3 divided doses on day 28; after day 30, increase the dose by about 250 mcg q3-4 days
- Maintenance dose: 2100-2510 mcg qd
- Max: 3000 mcg/day
Adjunctive therapy with levodopa
- Start 50 mcg PO qd x 2 days; gradually increase the dose by 100-150 mcg/day q3 days over the next 12 days; further increase the dose by 250 mcg/day q3 days until an optimal therapeutic dosage is achieved
- Max: 3000 mcg/day
Notes:- Drug must be given in divided doses 3 times per day
- During titration, dose of concurrent levodopa must be reduced cautiously
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
[Outline]
See Supplemental Patient Information
- Prolonged use may cause fibrotic and serosal inflammatory disorders, including pleuritis, pleural effusion, pleural fibrosis, pulmonary fibrosis, pericarditis, pericardial effusion, cardiac valvulopathy involving one or more valves (aortic, mitral and tricuspid), or retroperitoneal fibrosis. Improvement in symptoms of cardiac valvulopathy occurred on discontinuation of therapy
- Before initiating therapy, patients must undergo cardiac evaluation, including echocardiogram, to assess the risk of asymptomatic valvular disease; monitor echocardiogram frequently during the treatment. If fibrotic valvular disease is detected, the patient should not be treated with pergolide
- Prior to initiation of therapy, it is appropriate to perform ESR or other inflammatory markers, lung function/chest X-ray and renal function
- During treatment, monitor patients regularly for signs of progressive fibrosis and pleuro-pulmonary disease
- Therapy may cause retroperitoneal fibrosis manifested by renal insufficiency or ureteral/abdominal vascular obstruction that may occur with pain in the loin/flank and lower limb edema, as well as any possible abdominal masses or tenderness
- A symptom complex resembling the neuroleptic malignant syndrome (NMS) has been reported during rapid dose reduction, withdrawal of, or changes in antiparkinson therapy. Carefully monitor patients during abrupt reduction of dosages or discontinuation of therapy; avoid abrupt withdrawal
- Patients and their families should be informed of the common adverse events of the therapy and the risk of hypotension; monitor for symptoms of orthostatic hypotension
- Therapy has been associated with somnolence; occasionally, sudden onset of sleep during daily activities may occur without awareness or warning signs. Consider dose reduction or discontinuation of therapy in such patients
- Incidence of increased libido and hyper-sexuality, pathological gambling may occur during therapy
- Pergolide is not recommended in patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption
Cautions: Use cautiously in
- Cardiovascular disease
- History of psychosis
- Geriatric patients
- Long-term use
- Significant valvular disease
- Endocrine disease
- Pulmonary disease
Supplemental Patient Information
- Advise patients to promptly inform their physician if they become pregnant or intend to become pregnant during therapy and also tell their doctor if they are breastfeeding
- Instruct patients to refrain from activities requiring rapid and precise responses, such as driving an automobile or operating machinery while on therapy
Pregnancy Category:NR
Breastfeeding: According to manufacturer’s data, because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
