CNS Drug Reviews

Patients with idiopathic Parkinson’s disease respond to symptomatic treatment for only a limited period of time. Standard dopaminergic pharmacotherapy is often associated with multiple adverse effects that require discontinuation of treatment. Undoubtely, the approach to the therapy of Parkinson’s disease has changed significantly during the past few decades. These changes include the introduction of levodopa and, more recently, dopamine agonists including mesulergine. For the majority of patients with Parkinson’s disease, a single drug will not be sufficiently effective and drug combinations may have to be used. Many compounds that mimic or augment endogenous dopaminergic activity were, therefore, developed and are under clinical evaluation. Some of these compounds are likely to become components of effective drug combinations with, hopefully, less adverse reactions than the currently available drugs. One of these drugs is mesulergine. As adjuvant in the therapy of Parkinson’s disease, mesulergine has an interesting clinical profile. Its distinguishing feature is a relative lack of adverse effects. Mesulergine can also extend the effectiveness of levodopa. If mesulergine is added to levodopa, the patients may experience the benefits of levodopa for a longer period of time. As with all other dopamine agonists, mesulergine has antiprolactin activity and is capable of reducing the size of prolactin-secreting pituitary adenomas. In addition to its dopaminergic properties, mesulergine is also a serotonin antagonist. Pharmacological studies with mesulergine contributed to a better understanding of the neurotransmitter pathways of the human central nervous system (CNS) and led to new clinical indications of this drug. This