Eight patients with severe Parkinsonian motor oscillations have been treated with the dopamine receptor agonist apomorphine by intermittent subcutaneous self-injection as an adjunct to oral anti-Parkinsonian medication. The dopamine receptor antagonist domperidone was also given by mouth to prevent nausea. Six patients remain on chronic treatment (mean period 6.5 months) with improved control of motor function in each case. Four have had major enhancement of their quality of life. Benefits of this treatment stem from the training of patients to use intelligent behaviour to administer a promptly acting and effective pharmacological agent, thereby exercising a degree of direct control over previously unpredictable variations in motor performance.
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This study was performed to clarify factors that might influence short-term side effects occurring within 96 hours after administration of 131I for patients with thyroid carcinoma.
Epinine (N-methyl-dopamine, the active metabolite of ibopamine), is a full agonist at dopamine (DA)-receptors and alpha- and beta-adrenoceptors. To study whether in vivo DA-receptors mediated effects can be separated from alpha- and beta-adrenoceptor effects we compared in 10 male volunteers the effects of i.v. epinine (0.5; 1; 2; 4 micrograms/kg/min for 15 min each) on DA-receptor (changes in serum prolactin)- and alpha- and beta-adrenoceptor (changes in systolic [Psyst] and diastolic blood pressure [Pdiast] and heart rate)-mediated effects with those of dopamine before and after propranolol (5 mg i.v. 45 min pre-infusion), bisoprolol (15 mg p.o. 2 h pre-infusion) and domperidone (10 mg p.o. 1 h pre-infusion). At the 0.5 and 1 microgram doses of dopamine and epinine did not effect Psyst, Pdiast and heart rate but significantly decreased prolactin levels. At the higher dose both dopamine and epinine significantly increased Psyst and heart rate, while only epinine significantly increased Pdiast. In addition, both dopamine and epinine significantly increased diuresis and natriuresis; in contrast, only dopamine, but not epinine dose-dependently increased plasma noradrenaline levels. Domperidone did not affect dopamine- and epinine-evoked blood pressure- and heart rate-changes, but antagonized their prolactin-effects (at least at the lower doses). Bisoprolol and propranolol significantly reduced dopamine-induced Psyst- and heart rate-increases to about the same extent. Propranolol enhanced epinine-induced Psyst- and Pdiast-increases while bisoprolol reduced epinine-evoked Psyst-increase but not Pdiast-increase. Epinine-induced heart rate-increase was abolished by bisoprolol and was converted into heart rate-decrease by propranolol. We concluded that in 0.5 and 1 microgram doses (plasma levels of 20-80 nmol/l)epinine acts only at DA-receptors. Thus, ibopamine in therapeutically recommended doses (3 x 100 mg/day with peak plasma epinine-levels of 50-80 nmol/l) very likely activates only DA-receptors. In higher doses, however, epinine-like dopamine-activates alpha- and beta-adrenoceptors whereby epinine has a stronger alpha-adrenoceptor agonistic activity than dopamine. Moreover, part of the dopamine-effects are indirect via release of endogenous noradrenaline whereas epinine-effects do not appear to include an indirect component.
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Phenoxybenzamine, the classic alpha-adrenergic receptor alkylating agent, also acts as an irreversible antagonist of the binding of [3H]spiroperidol, a D-2-selective dopaminergic ligand, to bovine caudate membranes. Doses completely eliminating the binding of this ligand leave the binding of [3H]dopamine to D-3 sites virtually unaffected. The binding sites for these two ligands thus represent distinct subtypes of dopamine receptors, not interconverting states of a single receptor. This phenoxybenzamine-mediated inhibition proceeds via a dose-dependent (pseudo-IC50 = 1 microM) decrease in Bmax with little or no change in affinity for 3H-ligands at the D-2 site. The effect is site-directed, as the dopaminergic agonists dopamine and apomorphine and the antagonist domperidone are able to protect against phenoxybenzamine-mediated attack in proportion to their affinities for D-2 sites. Epinephrine, norepinephrine, and serotonin are much less effective in protecting these sites. The sensitivity of [3H]apomorphine binding is intermediate to that of [3H]spiroperidol and [3H]dopamine. [3H]Apomorphine binding can be resolved into a phenoxybenzamine-labile population of binding sites which have equal phenoxybenzamine sensitivity, selectivity among protecting agents, and butyrophenone affinity to those of D-2 sites labeled by 3H-butyrophenones, and a separate phenoxybenzamine-stable population of sites which have an affinity for dopamine comparable to that of D-3 sites labeled by [3H]dopamine. [3H]Apomorphine therefore appears to label a portion of D-2 receptor sites in addition to D-3 receptors.
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The involvement of 5-hydroxytryptamine (5-HT) 5-HT3 receptors in the mechanisms of severe emesis evoked by cytotoxic drugs or by total body irradiation have been studied in ferrets. Anti-emetic compounds tested were domperidone (a dopamine antagonist), metoclopramide (a gastric motility stimulant and dopamine antagonist at conventional doses, a 5-HT3 receptor antagonist at higher doses) and BRL 24924 (a potent gastric motility stimulant and a 5-HT3 receptor antagonist). Domperidone or metoclopramide prevented apomorphine-evoked emesis, whereas BRL 24924 did not. Similar doses of domperidone did not prevent emesis evoked by cis-platin or by total body irradiation, whereas metoclopramide or BRL 24924 greatly reduced or prevented these types of emesis. Metoclopramide and BRL 24924 also prevented emesis evoked by a combination of doxorubicin and cyclophosphamide. These results are discussed in terms of a fundamental role for 5-HT3 receptors in the mechanisms mediating severely emetogenic cancer treatment therapies.
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Sodium valproate (DPA or Na-dipropylacetate), an anticonvulsant drug activating the endogenous GABAergic system, was administered orally at the dose of 400 mg to seventeen normal women 1 h before intravenous injections with three drugs which stimulate prolactin (PRL) release: TRH (200 micrograms bolus; six subjects); domperidone (5 mg bolus; six subjects); and sulpiride (5 mg bolus; five subjects). DPA pretreatment significantly blunted PRL response to both domperidone and sulpiride injections without affecting the PRL response to TRH. In particular, the quantitative PRL secretion (areas under curves) following domperidone and sulpiride tests appeared significantly reduced after DPA treatment in comparison to placebo (P less than 0.02 and P less than 0.01 for domperidone and sulpiride respectively). These results indicate that the pharmacological enhancement of the endogenous GABAergic system by DPA may blunt PRL response to both central and peripheral dopamine receptor blockade. These observations suggest that a GABAergic pathway inhibiting PRL secretion at the hypothalamic level competes, at least in part, with the dopaminergic system. Conversely, the lack of any effect of DPA on PRL response to TRH seems to suggest that pituitary TRH receptors are independent of any GABAergic control.
Partition coefficients, Kp of dopamine antagonists, spiperone, haloperidol, domperidone and pimozide were determined in caudate nucleus microsomal membranes and in liposomes from membrane lipids. Kp values were measured as a function of temperature and the thermodynamics parameters for the transfer of the drugs from the aqueous medium to the lipid bilayer were evaluated. Partition in native membranes or in liposomes formed from the membrane lipids is not strongly dependent on temperature over the range from 8 to 37 degrees. The Kp values for spiperone, haloperidol and domperidone in membrane are 32 +/- 6, 192 +/- 11 and 308 +/- 40 respectively, whereas the equivalent values in liposomes are much higher: 195 +/- 12, 558 +/- 16 and 316 +/- 16. In contrast, for pimozide, the Kp values in membranes are higher than in liposomes: 1097 +/- 11 for microsomes and 662 +/- 10 for liposomes. Partition values in natural membranes decrease sequentially as follows: pimozide greater than domperidone greater than haloperidol greater than spiperone. Membranes rich in cholesterol show lower partition coefficients for haloperidol. The interaction of the antagonists with the bilayer is associated with small enthalpy changes and large increases in entropy, as expected for hydrophobic interactions. We conclude that the partition coefficients of the drugs studied for membranes and membranes lipids are very different from those reported for octanol/water and the latter values should not be used to estimate drug partition into membranes.
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Mice were administered the dopaminergic antagonists haloperidol or domperidone in their drinking water for 2 or 21 days. Serum prolactin levels and striatal 3H-spiperone-binding sites (D-2 receptors) were compared to vehicle-treated controls. While only domperidone elevated serum prolactin levels, only haloperidol increased the density of striatal 3H-spiperone-binding site. The failure of domperidone, a potent D-2 receptor antagonist, to increase striatal receptor number is attributed to its poor penetration of the blood-brain barrier. These results indicate that peripheral effects of neuroleptic drugs, including prolactin elevation, are not sufficient for the development of dopaminergic supersensitivity in the central nervous system.
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- Breast milk is the best diet for all newborns, especially premature newborns.- In case of insufficient production of breast milk, feeding and extraction techniques should be optimized first, preferably supported by a lactation consultant. When supportive measures fail, domperidone to promote milk production can be considered.- The risk of side effects in newborns is negligible. The risk of maternal arrhythmias associated with QTc prolongation is low as long as domperidone is prescribed in low doses (10 mg tds).- In the absence of risk factors it is not necessary to routinely perform an ECG and, therefore, general practitioners can safely prescribe domperidone.- The effect of the treatment should be evaluated after 2 weeks. In case of prolonged treatment or use of higher dosages, it is recommended to perform an ECG to exclude QTc prolongation.