Parkinson's Drugs: Heart Damage Link?
Researchers Raise Concerns About Damage to Heart Valves From 2 Parkinson's Drugs
Jan. 3, 2007 -- Two drugs used in the treatment of Parkinson's
disease appear to increase the risk of heart valve disease,
according to new research that also raises safety questions about
The drugs pergolide, marketed as Permax, and cabergoline, sold as Dostinex,
were associated with heart valve damage in two European studies published in
the Jan. 4 issue of the New England Journal of Medicine.
Both drugs are in a class known as ergot-derived dopamine receptor agonists,
and both have been linked to heart valve issues in earlier case reports.
"We showed that treatment with either pergolide or cabergoline for more
than six months was strongly associated with an increase in valve-related heart
disease," Edeltraut Garbe, MD, PhD, tells WebMD. "No
increase in risk was seen in patients treated with other dopamine
Heart Valves and Parkinson's Drugs
Garbe and colleagues from a German research center compared treatment
histories among Parkinson's disease patients who did and did not develop heart
Heart valves are one-way valves that keep blood flowing in the right
direction through your heart. If people have problems with their heart valves
then blood may not move the way it should.
The study involved more than 11,000 patients prescribed anti-Parkinson drugs
from the U.K. registered in a nationwide database.
The rate of heart valve disease was seven times higher than the rate in a
matched comparison group of patients from the group who didn't develop heart
valve disease among current pergolide-treated patients -- and five times higher
among patients being treated with cabergoline. No increase was seen among
current users of other types of dopamine-directed drugs.
Checking for Heart Valve Disease
In a separate study from Italy, researchers performed echocardiograms on
Parkinson's patients being treated with either ergot-derived or
nonergot-derived dopamine-targeting drugs. An echocardiogram is an ultrasound
of the heart which can provide information on the heart's chambers and valves
and how well blood is pumping through the heart.
Compared with an age-matched group without Parkinson's
disease, patients taking pergolide or cabergoline had significantly
more evidence of heart valve disease.
Clinically important evidence of valve damage was seen in roughly 5% of the
comparison group, compared with 23% of patients taking pergolide and 28% of
patients taking cabergoline.
Garbe says it is clear from the two studies that patients taking either
pergolide or cabergoline should be monitored closely for heart valve
"We aren't saying that these drugs should not be used," she says.
"I think if patients are appropriately followed they can be prescribed. But
neurologists and other treating physicians have to be made aware of the
A spokesman for pergolide manufacturer Valeant Pharmaceuticals International
tells WebMD that the company would have no direct comment on the two new
studies. But a company statement reaffirmed the safety of the drug.
"Permax (pergolide) is a safe and effective treatment for patients with
Parkinson's disease," the statement reads. "Although Valeant no longer
promotes the product, we still make it available for those who prescribe it. We
also routinely communicate with the FDA and recently worked with the agency to
modify the label to advise physicians that the product, like other dopamine
agonists, should be used with caution."