Chemistry:Pergolide

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Pergolide, sold under the brand name Permax and Prascend (veterinary) among others, is an ergoline-based dopamine receptor agonist used in some countries for the treatment of Parkinson's disease. Parkinson's disease is associated with reduced dopamine synthesis in the substantia nigra of the brain. Pergolide acts on many of the same receptors as dopamine to increase receptor activity.

It was patented in 1978[1] and approved for medical use in 1989.[2] In 2007, pergolide was withdrawn from the U.S. market for human use after several published studies revealed a link between the drug and increased rates of valvular heart disease.[3] However, a veterinary form of pergolide, marketed under the trade name Prascend, is permitted for the treatment of pituitary pars intermedia dysfunction (PPID) also known as equine Cushing's syndrome (ECS) in horses.[4]

Medical uses

Pergolide is available for veterinary use. Under the trade name Prascend, manufactured by Boehringer Ingelheim,[5] it is commonly used for the treatment of pituitary hyperplasia at the pars intermedia or Equine Cushing's Syndrome (ECS) in horses.[4]

Pharmacology

Pharmacodynamics

Pergolide acts as an agonist of dopamine D2 and D1 and serotonin 5-HT1A, 5-HT1B, 5-HT2A, 5-HT2B, and 5-HT2C receptors. It may possess agonist activity at other dopamine receptor subtypes as well, similar to cabergoline. Although pergolide is more potent as an agonist of the D2 receptor, it has high D1 receptor affinity and is one of the most potent D1 receptor agonists of the dopamine receptor agonists that are clinically available.[6] The agonist activity of pergolide at the D1 receptor somewhat alters its clinical and side effect profile in the treatment of Parkinson's disease. Pergolide has been said to be hallucinogenic due to activation of 5-HT2A receptors.[7][8] However, other sources have stated that the drug is non-hallucinogenic.[9] It has been associated with cardiac valvulopathy due to activation of 5-HT2B receptors.[10]

Activities of pergolide at various sites[11][12][13][14][15]
Site Affinity (pKi [nM]) Efficacy (Emax [%]) Action
D1 6.47 ± 0.04 ? ?
D2S 8.30 ± 0.08 112 Full agonist
D2L 7.59 ± 0.06 52 Partial agonist
D3 0.9 71 Partial agonist
D4 7.23 ± 0.09 56 Partial agonist
D5 7.48 ± 0.21 ? ?
5-HT1A 8.72 ± 0.13 63 Partial agonist
5-HT1B 6.55 ± 0.10 90 Partial agonist
5-HT1D 7.88 ± 0.11 86 Partial agonist
5-HT2A 8.08 ± 0.06 103 Full agonist
5-HT2B 8.15 ± 0.04 113 Full agonist
5-HT2C 6.53 ± 0.06 87 Partial agonist
5-HT6 30 ? ?
5-HT7 1.0–18 ? ?
α1A 5.98 ± 0.11 ? ?
α1B 6.16 ± 0.08 ? ?
α1D 6.53 ± 0.19 ? ?
α2A 5.39 ± 0.29 31 Partial agonist
α2B 7.30 ± 0.09 70 Partial agonist
α2C 7.49 ± 0.8 16 Partial agonist
α2D 7.17 ± 0.01 ? ?
β1 >10,000 – –
β2 >10,000 – –
H1 1,698 ? ?
M1 >10,000 – –
σ1 >10,000 – –
σ2 923 ? ?
Notes: All receptors are human except α2D-adrenergic, which is rat (no human counterpart), and 5-HT6, 5-HT7, σ1, and σ2, which are all rodent (rat or guinea pig).[11][14]

Side effects

The drug is in decreasing use, as it was reported in 2003 to be associated with a form of heart disease called cardiac fibrosis.[16] In 2007, the United States Food and Drug Administration announced a voluntary withdrawal of the drug by manufacturers due to the possibility of heart valve damage.[17] Pergolide is not currently available in the United States for human use. This problem is thought to be due to pergolide's action at the 5-HT2B serotonin receptors of cardiac myocytes, causing proliferative valve disease by the same mechanism as ergotamine, methysergide, fenfluramine, and other serotonin 5-HT2B agonists, including serotonin itself when elevated in the blood in carcinoid syndrome. Pergolide can rarely cause Raynaud's phenomenon. Among similar antiparkinsonian drugs, cabergoline, but not lisuride, exhibit this same type of serotonin receptor binding.[18] In January 2007, cabergoline (Dostinex) was also reported to be associated with valvular proliferation heart damage.[19] In March 2007, pergolide was withdrawn from the U.S. market for human use due to serious valvular damage that was shown in two independent studies.[20]

Pergolide has also been shown to impair associative learning.[21]

Addictive behaviors

At least one British pergolide user has attracted some media attention with claims that it has caused him to develop a gambling addiction.[22][23] In June 2010, it was reported that more than 100 Australian users of the drug are suing the manufacturer over both gambling and sex addiction[24] problems they claim are the result of the drug's side effects.

Society and culture

Brand names

Brand names of pergolide include Permax and Prascend (veterinary), among others.[25]

Research

Pergolide has been studied in the treatment of social anxiety disorder in one small study but was found to be ineffective.[26][27]

See also

References

  1. ↑ Kornfeld EC, Bach NJ, "6-n-propyl-8-methoxymethyl or methylmercaptomethylergolines and related compounds", US patent 4166182A, published 1979-08-28, issued 1979-08-28, assigned to Eli Lilly and Co
  2. ↑ (in en) Analogue-based Drug Discovery. John Wiley & Sons. 2006. pp. 533. ISBN 978-3-527-60749-5. https://books.google.com/books?id=FjKfqkaKkAAC&pg=PA533. 
  3. ↑ "Pergolide (marketed as Permax)". FDA Public Health Advisory. https://www.fda.gov/cder/drug/advisory/pergolide.htm. 
  4. ↑ 4.0 4.1 "Pergolide for Veterinary Use". https://www.wedgewoodpetrx.com/learning-center/professional-monographs/pergolide-for-veterinary-use.html. 
  5. ↑ "Prascend for Horses". Boehringer Ingelheim. Valley Vet Supply. http://www.valleyvet.com/ct_detail.html?pgguid=e0f4888c-86de-4ce9-9013-6d947df697a8&gas=pergolide%20mesylate. 
  6. ↑ "Pergolide treatment of cognitive deficits associated with schizotypal personality disorder: continued evidence of the importance of the dopamine system in the schizophrenia spectrum". Neuropsychopharmacology 35 (6): 1356–1362. May 2010. doi:10.1038/npp.2010.5. PMID 20130535. 
  7. ↑ "Triptans, serotonin agonists, and serotonin syndrome (serotonin toxicity): a review". Headache 50 (2): 264–272. February 2010. doi:10.1111/j.1526-4610.2009.01575.x. PMID 19925619. 
  8. ↑ "Agonist-directed trafficking of signalling at serotonin 5-HT2A, 5-HT2B and 5-HT2C-VSV receptors mediated Gq/11 activation and calcium mobilisation in CHO cells". European Journal of Pharmacology 594 (1–3): 32–38. October 2008. doi:10.1016/j.ejphar.2008.07.040. PMID 18703043. 
  9. ↑ "Psychedelics: preclinical insights provide directions for future research". Neuropsychopharmacology 49 (1): 119–127. January 2024. doi:10.1038/s41386-023-01567-7. PMID 36932180. 
  10. ↑ "Safety Pharmacology assessment of drugs with biased 5-HT(2B) receptor agonism mediating cardiac valvulopathy". Journal of Pharmacological and Toxicological Methods 69 (2): 150–161. 2014. doi:10.1016/j.vascn.2013.12.004. PMID 24361689. 
  11. ↑ 11.0 11.1 "Differential actions of antiparkinson agents at multiple classes of monoaminergic receptor. I. A multivariate analysis of the binding profiles of 14 drugs at 21 native and cloned human receptor subtypes". The Journal of Pharmacology and Experimental Therapeutics 303 (2): 791–804. November 2002. doi:10.1124/jpet.102.039867. PMID 12388666. 
  12. ↑ "Differential actions of antiparkinson agents at multiple classes of monoaminergic receptor. II. Agonist and antagonist properties at subtypes of dopamine D(2)-like receptor and alpha(1)/alpha(2)-adrenoceptor". The Journal of Pharmacology and Experimental Therapeutics 303 (2): 805–814. November 2002. doi:10.1124/jpet.102.039875. PMID 12388667. 
  13. ↑ "Differential actions of antiparkinson agents at multiple classes of monoaminergic receptor. III. Agonist and antagonist properties at serotonin, 5-HT(1) and 5-HT(2), receptor subtypes". The Journal of Pharmacology and Experimental Therapeutics 303 (2): 815–822. November 2002. doi:10.1124/jpet.102.039883. PMID 12388668. 
  14. ↑ 14.0 14.1 "PDSP Database - UNC". https://pdsp.unc.edu/databases/pdsp.php?testFreeRadio=testFreeRadio&testLigand=Pergolide&doQuery=Submit+Query. 
  15. ↑ "Differential actions of antiparkinson agents at multiple classes of monoaminergic receptor. I. A multivariate analysis of the binding profiles of 14 drugs at 21 native and cloned human receptor subtypes". The Journal of Pharmacology and Experimental Therapeutics 303 (2): 791–804. 2002. doi:10.1124/jpet.102.039867. PMID 12388666. https://www.sciencedirect.com/science/article/pii/S0022356524360033. 
  16. ↑ "Cardiac valvulopathy with pergolide". Aust Adv Drug React Bull 23 (4). August 2004. http://www.tga.gov.au/adr/aadrb/aadr0408.htm. 
  17. ↑ "Pergolide (marketed as Permax)". Public Health Advisory. https://www.fda.gov/Drugs/DrugSafety/PublicHealthAdvisories/ucm051285.html. 
  18. ↑ Jähnichen S, Horowski R, Pertz H. ""Pergolide and Cabergoline But not Lisuride Exhibit Agonist Efficacy at Serotonin 5-HT2B Receptors".". https://userpage.fu-berlin.de/~hpertz/Presentation001.pdf.  (515 KiB) Presentation. Retrieved on 2007-03-30.
  19. ↑ "Dopamine agonists and the risk of cardiac-valve regurgitation". The New England Journal of Medicine 356 (1): 29–38. January 2007. doi:10.1056/NEJMoa062222. PMID 17202453. 
  20. ↑ "MedWatch - 2007 Safety Information Alerts. Permax (pergolide) and generic equivalents". U.S. Food and Drug Administration. March 29, 2007. https://www.fda.gov/medwatch/safety/2007/safety07.htm#Pergolide. 
  21. ↑ "Tonic dopaminergic stimulation impairs associative learning in healthy subjects". Neuropsychopharmacology 31 (11): 2552–2564. November 2006. doi:10.1038/sj.npp.1301167. PMID 16880771. 
  22. ↑ "Drug 'caused' gambling addiction". BBC TV. 24 January 2008. https://news.bbc.co.uk/1/hi/england/merseyside/7207850.stm. 
  23. ↑ "Parkinson's Gambler". ITV.com. 5 February 2008. http://www.itv.com/Lifestyle/ThisMorning/Health/Parkinsonsgambler/default.html. 
  24. ↑ "Parkinson's treatment linked to sex, gambling". The Age. 4 June 2010. https://www.theage.com.au/national/parkinsons-treatment-linked-to-sex-gambling-20100603-x6y7.html. 
  25. ↑ "Pergolide". Drugs.com. http://www.drugs.com/international/pergolide.html. 
  26. ↑ "Drugs in development for social anxiety disorder: more to social anxiety than meets the SSRI". Expert Opinion on Investigational Drugs 9 (10): 2215–2231. October 2000. doi:10.1517/13543784.9.10.2215. PMID 11060802. 
  27. ↑ "Treatment of social phobia with the dopamine agonist pergolide". Depression and Anxiety 11 (1): 45–47. 2000. doi:10.1002/(sici)1520-6394(2000)11:1<45::aid-da8>3.0.co;2-8. PMID 10723636. 



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