Ropinirol en el tratamiento de la enfermedad de Parkinson: actualización / Ropinirole in the treatment of Parkinson’s disease: an update

Introducción. El ropinirol es un agonista dopaminérgicono ergótico con alta afinidad por los receptores dopaminérgicos D2,que proporciona una mejoría sintomática de la enfermedad de Parkinson(EP) y retrasa la aparición de las complicaciones motoras. Se diferencia de la primera generación de agonistas dopaminérgicos en que, al carecer de estructura ergolínica, no presenta los efectos secundarios que aparecen con este grupo farmacológico. Desarrollo. Recientes estudios con neuroimagen funcional invocan un posible efecto neuroprotector del fármaco, aunque este aspecto es foco de discusión. Desde hace años, la pregunta de cuándo y cómo debe iniciarse el tratamiento de la EP precoz continúa siendo un motivo de controversia. Los agonistas dopaminérgicos se han utilizado en monoterapia en pacientes con enfermedad de novo con la intención de retrasar el tratamiento con levodopa y, consecuentemente, diferir el comienzo de las complicaciones derivadas de su uso. El ropinirol se ha evaluado en diferentes estudios, tanto en monoterapia como en terapia añadida a la levodopa. Conclusiones. En losmúltiples ensayos clínicos realizados, parece constatado que el ropinirol puede administrarse durante años como tratamiento único dela EP precoz y que reduce notablemente la aparición de discinesias. Dada una relación lineal dosis-respuesta, el fármaco dispone de una amplia 'reserva terapéutica' que permite aumentar la dosis a medida que progresa la enfermedad (AU)

Introduction. Ropinirole is a non-ergot dopaminergic agonist with a high affinity for D2 dopaminergic receptors which improves the symptoms of Parkinson’s disease (PD) and delays the appearance of motor complications. It is different to the first generation of dopaminergic agonists in that, because it lacks an ergolinic structure, it does not have the side effects that usually appear with the use of this pharmacological group. Development. Recent functional neuroimaging studies suggest a possible neuroprotector effect of the drug, although this aspect is still under discussion. The question as to when and how early treatment of PD must be started has been a controversial issue for many years now. Dopaminergic agonists have been used in monotherapy in patients with de novo disease with the intention of deferring treatment with levodopa and, inconsequence, postponing the onset of the complications stemming from its use. Ropinirole has been evaluated in different studies both in monotherapy and as adjunctive therapy with levodopa. Conclusions. In the numerous clinical trials that were carried out, it would seem clear that ropinirole can be administered for years as sole early treatment for PD and that it offers a notable reduction in the appearance of dyskinesia's. Given the linear dose-response relation it presents, the drug has a wide 'therapeutic window' that allows the dosage to be increased as the disease progresses (AU)

Dopamine-1 receptor agonist: renal effects and its potential role in the management of radiocontrast-induced nephropathy.

Radiocontrast-induced nephropathy remains the third leading cause of hospital-acquired acute renal failure. Once established, this syndrome is associated with increased morbidity and mortality as well as increased health care costs. Recently, studies have been initiated to evaluate the potential of a selective dopamine-1 receptor agonist (fenoldopam) in ameliorating radiocontrast-induced renal failure. Selective dopamine-1 receptor agonists exhibit many desirable renal effects that support their use for the prophylaxis of radiocontrast-induced nephropathy, including decreases in renal vascular resistance and increases in renal blood flow, glomerular filtration, and sodium and water excretion. Several reports have documented a beneficial effect of fenoldopam administration in attenuating radiocontrast-induced nephropathy. In contrast, a recent multicenter, randomized study did not demonstrate a renoprotective effect of fenoldopam against radiocontrast-induced nephropathy. The presence of multiple confounders, however, precludes a definitive conclusion regarding the ability of fenoldopam to protect against radiocontrast-induced nephropathy. Additional studies are needed to properly evaluate the role of fenoldopam in radiocontrast-induced nephropathy prophylaxis.