Appropriate dosing of pergolide in monotherapy and adjunctive therapy in Parkinson's disease

Pergolide is one of the most well-tested and widely used dopamine agonists for the treatment of Parkinson's disease; however, there is worrying evidence that sub-therapeutic dosing of pergolide is widespread in clinical practice. Clinical studies in Caucasians suggest that a pergolide dose of 3 mg/day provides the optimal efficacy to tolerability ratio and that, in Japanese patients, a dose in excess of 2.25 mg/day may be ideal. Whether pergolide is used early in patients with de-novo Parkinson's disease or as adjunctive therapy later in the disease, in order to optimize its clinical efficacy, it is recommended that practitioners aim to achieve at least these doses, or higher ones, if the drug is well tolerated.