Permax (pergolide) is an ergoline agonist used to help reduce the severity of motor function symptoms resulting from Parkinson's disease (PD).

Most patients start treatment for PD with levodopa/carbidopa. Permax is generally used when levodopa/carbidopa is not effective for an individual, or when levodopa/carbidopa begins to lose effectiveness, as often happens after long-term treatment as the disease progresses.

Permax produces similar effects as levodopa/carbidopa, but the medications are not interchangeable. Treatment with levodopa/carbidopa usually continues after Permax therapy has begun, but in smaller doses. As with any drug being taken for PD, use should not start or end abruptly.

What to Expect from Permax

Permax is a dopamine agonist, meaning it mimics dopamine in the brain. Levodopa is not an agonist; it is converted to dopamine once it is in the brain. While the mechanism of action is different, the results patients experience are similar:

• Reduced muscle rigidity
• Reduced tremor
• Improved coordination
• Improved speed

Some patients who experience "off episodes" after long-term levodopa use may find the episodes occur less frequently after several weeks of treatment with Permax.

Like other PD medications, treatment should start gradually and with close doctor supervision:

• Patients are usually started with 50 mcg (0.05 mg) for 2 days.
• Dosage may be increased every 3 days by 100 or 150 mcg (0.1 or 0.15 mg) over the following 12 days.
• Dosage may then be increased by 250 mcg (0.25 mg) every three days until an effective dose has been found.
• Dosage should not exceed 6000 mcg (6 mg) per day.

Once an effective dose has been found, administration is more straightforward:

• The total daily dose should be divided into 3 smaller doses taken throughout the day.
• Doses should be spread as evenly apart as possible and taken at the same time each day to maximize the drug's presence in the body.
• The medication may be taken with or without food according to preference.

Some patients notice improvements within days of starting an effective dose, but it may take several weeks of continuous treatment for full benefits to be realized.

Treatment usually lasts for as long as the medication is providing benefit and not producing serious side effects. If treatment needs to stop, dosage should be gradually reduced over several weeks. Abrupt cessation can produce potentially serious side effects.

Warnings & Adverse Reactions

Patients with any preexisting medical condition, including mental health disorders, may be at greater risk of experiencing potentially serious side effects from Permax. Speak with a doctor before starting treatment.

Similarly, Permax may interact with other medications, including the non-prescription variety, as well as some nutritional supplements. Speak with a doctor of pharmacist if unsure of the consequences of mixing Permax with any other medications being taken.

Most patients who take Permax experience only mild side effects, which often disappear entirely as treatment continues:

• Nausea or vomiting
• Diarrhea or constipation
• Indigestion
• Insomnia
• Drowsiness
• Runny or irritated nose

The above side effects are only cause for concern if severe or persistent. Rarely more serious side effects develop, which should be brought to the attention of a doctor at earliest convenience:

• Delusions
• Hallucinations
• Compulsive behavior
• Dyskinesia (involuntary movements)
• Excessive drowsiness

Use of Permax and other ergoline agonists is controversial in some areas, most notably the U.S., where the drug has been discontinued. This is because some studies suggest there is a significant risk that patients taking ergoline agonists will develop heart valve disease.

Use of Permax continues in many parts of the world, however, and some patients find it is considerably more effective than non-ergoline agonists. Whether not the benefits are worth the risks is a personal decision every patient should make for his or her self, preferably after discussing the issue with a trusted doctor.