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Advanced Neurology Piribedil for Parkinson’s disease

moreover, the use of dopaminergic agonists is considered Acknowledgments
one of the main pathogenic factors [62-64] . Among
dopaminergic agonists, pramipexole was more frequent The authors acknowledge Dr. Sunita Rana and Dr. Amit
with ICD . Impulse behaviors caused by piribedil are Bhat, PhD of Indegene Pvt Ltd for providing medical
[62]
rarely reported and also tended to be dose-related [65,66] . writing and editorial services.
According to epidemiological survey and spontaneous Funding
reports system of adverse reactions in France, no obvious
increased risk of ICDs was observed after piribedil intake, None.
and the risk was lower than other DR agonists, such as
ropinirole or pramipexole [63,67] . Conflict of interest
Although the risk of ICDs with piribedil might not be as The authors declare no financial or other conflicts of
important as with other DR agonists, definite conclusions interest.
can only be achieved with head-to-head comparisons due Author contributions
to the method limitations of the study.
Conceptualization: Cheng Jie Mao, Chan Piu, Li Rong Jin
The hazard for switching to another DR agonists is
unknown and needs further investigation. Only in some Writing – original draft: Cheng Jie Mao, Chan Piu, Li Rong Jin,
infrequent cases, symptoms were relieved by dose reduction Li Juan Wang
or switching to another drug. Dose reduction to cessation Writing – review & editing: Olivier Rascol, Chun Feng Liu
of DR agonists, compensated by a concomitant increase in Ethics approval and consent to participate
levodopa dose, is a preferred option to resolve ICD . For
[68]
patients who have developed impulse behaviors, caution Not applicable.
must be taken before resuming piribedil, considering the
potential risk of ICD relapse [62,63,69] . Consent for publication
Not applicable.
5. Drug interactions
Combination treatment with any drug that blocks DA Availability of data
receptors is contraindicated. Antiemetic drugs that do Not applicable.
not cross the blood-brain barrier (e.g., domperidone)
should be recommended. Using antiemetics that can References
cross blood-brain barrier in patients with PD is generally 1. Ascherio A, Schwarzschild MA, 2016 The epidemiology
contraindicated due to worsening of Parkinsonism. As PD of Parkinson’s disease: Risk factors and prevention. Lancet
patients with psychosis or hallucination are difficult to be Neurol, 15: 1257–1272.
managed, antipsychotics, such as quetiapine, clozapine, https://doi.org/10.1016/S1474-4422(16)30230-7
and pimavanserin, have been approved for treating PD
psychosis . DRA must be tapered gradually until the 2. Pringsheim T, Jette N, Frolkis A, et al., 2014, The prevalence
[70]
complete discontinuation of the drug . of Parkinson’s disease: A systematic review and meta-
[53]
analysis. Mov Disord, 29: 1583–1590.
6. Conclusion https://doi.org/10.1002/mds.25945
Piribedil is the first and unique non-ergoline, primarily 3. Delamarre A, Meissner WG, 2017, Epidemiology,
partial D2/D3 receptor agonist among the first generation environmental risk factors and genetics of Parkinson’s
of DRA. It is the only drug used for about half of the disease. Presse Med, 46: 175–181.
century, which has unique pharmacodynamic profiles https://doi.org/10.1016/j.lpm.2017.01.001
with α2-adrenoreceptor antagonistic effects. Many clinical
studies have demonstrated that both piribedil monotherapy 4. Li G, Ma J, Cui S, et al., 2019, Parkinson’s disease in
or combination of piribedil and levodopa may effectively China: A forty-year growing track of bedside work. Transl
improve the motor and some non-motor symptoms of Neurodegeneration, 8: 22.
PD patients at any stage, with a good safety and tolerance. 5. Zheng Z, Zhu Z, Zhou C, et al., 2022, Burden of Parkinson
Hereby, piribedil is recommended by multiple authoritative disease in China, 1990-2019: Findings from the 2019 Global
guidelines as the first-line therapy for patients with PD. This Burden of Disease Study. United States: NED. p.1–13.
clinical suggestion may help neurologists to appropriately 6. GBD 2016 Parkinson’s Disease Collaborators, 2018, Global,
use piribedil in patients with PD. regional, and national burden of Parkinson’s disease, 1990-

Volume 2 Issue 1 (2023) 10 https://doi.org/10.36922/an.290