What are the side effects of agonists

Nausea. Nausea is the most common side effect of the agonists and can be avoided or minimized by starting with a low dose and gradually building up as tolerance to nausea develops. Some people benefit from an antinausea drug such as Tigan. Tigan, unlike the anti-nausea drugs Compazine or Reglan, does not aggravate the symptoms of PD. By starting with a low dose of an agonist you are not as likely to experience as quick and as dramatic an improvement as on Sinemet. But by starting low, and going slowly, within several weeks substantial improvement will occur and you will maintain it longer.

Orthostatic hypotension a condition in which the body's blood pressure regulating mechanism fails to respond adequately to abrupt changes, e.g., when a person experiences dizziness upon standing up.

Dizziness Upon Standing. Dizziness or lightheadedness upon standing usually indicate a drop in blood pressure. This is called postural or orthostatic hypotension. Postural or orthostatic hypotension may occur because you are dehydrated, diabetic, taking drugs to lower your blood pressure, taking diuretics ("water" pills), or have PD and are taking a dopamine agonist and/or Sinemet. Diabetes and PD affect the autonomic nervous system (see Question 57), the region that regulates the tone of your blood vessels— and by doing so regulating, in part, your blood pressure. If simple measures do not help this condition—such as sitting on the edge of the bed for a few minutes before standing up, taking your blood pressure drugs and your PD drugs at different times, stopping your diuretic, and being certain to drink enough fluid to prevent dehydration—other medications may. The most commonly used drugs are Flurinef, a type of steroid that causes you to retain fluid, and Midodrine, which "tightens" the tone of your blood vessels.

Drowsiness. Periods of unexpected daytime drowsiness, sometimes accompanied by falling asleep, occur in people with PD who are not on any treatment as well as in people with PD who are taking Sinemet or an agonist. The periods of drowsiness may be more frequent in people who are taking an agonist. The periods of unexpected drowsiness, sometimes accompanied by falling asleep may be embarrassing, (especially if you fall asleep while a friend is talking to you), and, sometimes, may be dangerous, such as if they occur while you are driving. If you experience drowsiness while taking an agonist, do not drive until you have talked to your doctor. The periods of unexpected drowsiness usually disappear. Pro-vigil, a drug that promotes alertness, may help.

Edema. Edema, or swelling of the legs, occurs in less than 5% of people on an agonist. It is usually mild. Rarely, however, it can be marked, will not respond to diuretics, and is a reason for stopping the agonist. A side effect that occurs with one agonist usually, but not always, occurs with the others. However, there are enough differences that if you have to stop one agonist because of a side effect, you may not have the same side effect on another agonist.

If you experience drowsiness while taking an agonist, do not drive until you have talked to your doctor.

Another side effect, psychosis, is discussed in Question 27. Delusions, hallucinations, or compulsive behavior may be more common with agonists than with Sinemet in older people or in people "incubating" or harboring a dementia that was previously undiagnosed (see Question 55).

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