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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by cumulative on November 29, 2007, at 19:52:11
Suppose I was going to trial the dopamine agonist piribedil, but was concerned that it may have too much activity at D2 as compared to D1. Functionally, in the worst case the effect may be to increase hyperactive, hedonic, impulsive behavior without giving much help with what I really need/want -- attention, focus, verbal fluency. Prefrontal dopamine might be more involved with D1. So I dunno, especially if I do end up wanting to block some of the adrenergic effects that trivastal has, with clonidine (preferably guanfacine if I can source it), both at nighttime for sleep and even in the morning to curb said effects. Constant norepinephrine stimulation is no way for this poster to live.
Happily, some of the people who have trialed this drug do describe sharpened focus and concentration -- but again, this may be related to the extra adrenergic stimulation piribedil causes (unlike most dopamine agonists).
So, I know all this is getting quite hypothetical, but supposing I wanted to stimulate D1...? What kind of things would I look at? Unfortunately, the obvious answer which is the classic psychostimulants is out of the question. 300mg/daily amineptine might be good too, but it's far, far out of my price range (which has already been breached) to get both trivastal and that much amineptine.
All the real here, I'm looking at you.
Low-dose amantadine? Hydergine? Pergolide? Is anyone in the world making dihydrexidine?
Posted by DStupid on November 29, 2007, at 22:16:43
In reply to D1 stimulation question, for the psychopharm buffs, posted by cumulative on November 29, 2007, at 19:52:11
I've been thinking along the same lines, although less specific than you have. I'm in the US and all of the anti-parkinson's drugs available here appear to have bad cardiac side effects. I haven't tried any, but I got that notion from reading their product descriptions. Pergolide was withdrawn from the US market earlier this year because it damaged heart valves.
I'm looking into a different type of drug altogether -- bronchodilators -- for improved flow of oxygen to my brain and, hopefully, better mood, improved concentration, etc. So far, I've tried Atrovent, but it was quite powerful for me and I stopped. Am searching for another one.
Posted by cumulative on November 29, 2007, at 22:26:28
In reply to Re: D1 stimulation question, for the psychopharm b » cumulative, posted by DStupid on November 29, 2007, at 22:16:43
Hey. Pramipexole (mirapex) and ropinirole (requip) are (somewhat expensive) non-ergoline DA agonists, that don't damage heart valves. These are both selective for D2 and D3 and there are some good threads here and some interesting literature elsewhere on the promising use of Mirapex for anhedonia, atypical depression, etc.
Probably not what I was looking for though, since they don't touch D1 much. Bromocriptine, another non-ergoline, actually antagonizes it.
Trivastal is also not derived from ergot. Not prescribed in the U.S. however.
The appearance of the heart valve problems is quite disappointing, since pergolide might have been what I was looking for.
As to your second thing, this might prove an interesting link for you, in particular Frangible's post:
http://www.mindandmuscle.net/forum/index.php?showtopic=31375
Posted by DStupid on November 30, 2007, at 21:08:38
In reply to Re: D1 stimulation question, for the psychopharm b, posted by cumulative on November 29, 2007, at 22:26:28
Thanks for the link. I actually tried swimming w/o knowing about its EPO-raising effects as stated in the linked thread, but felt worse afterwards. Not sure if taking EPO (I think it's through injections) is a good idea b/c EPO makes blood thicker by increasing hemoglobin and can potentially cause blood clots.
Posted by DStupid on November 30, 2007, at 21:19:04
In reply to Re: D1 stimulation question, for the psychopharm b » cumulative, posted by DStupid on November 30, 2007, at 21:08:38
What meds do you take, Cumulative? And what have you tried in the past? I've been trying to find a medication with the same effect that you've been looking for. I've tried Dexedrine (a stimulant), Ritalin (a stimulant), Pamelor (a TCA), Norpramin (a TCA), Wellbutrin (combo), and Lexapro. With the exception of Lexapro, I couldn't tolerate any of the meds for more than a month -- always some kind of a heart problem: palpitations, angina, tachycardia. Lexapro pooped out after about a year. Curious about your experience.
Posted by anonymoose on December 1, 2007, at 12:35:59
In reply to D1 stimulation question, for the psychopharm buffs, posted by cumulative on November 29, 2007, at 19:52:11
Don't know much about D1, but here's what I found about D1 agonists:
SKF 82958 - http://jpet.aspetjournals.org/cgi/content/abstract/273/1/309
SKF 38393 - http://www.jneurosci.org/cgi/content/abstract/14/7/4494
dihydrexidine - http://www.annalsnyas.org/cgi/content/abstract/777/1/427
http://findarticles.com/p/articles/mi_m0UFV/is_5_16/ai_89022324They all sound like experimental meds, may be difficult to get a hold of.
Posted by kingcolon on December 2, 2007, at 23:48:07
In reply to Re: D1 stimulation question, for the psychopharm b » cumulative, posted by DStupid on November 29, 2007, at 22:16:43
> I've been thinking along the same lines, although less specific than you have. I'm in the US and all of the anti-parkinson's drugs available here appear to have bad cardiac side effects. I haven't tried any, but I got that notion from reading their product descriptions. Pergolide was withdrawn from the US market earlier this year because it damaged heart valves.>
> I'm looking into a different type of drug altogether -- bronchodilators -- for improved flow of oxygen to my brain and, hopefully, better mood, improved concentration, etc. So far, I've tried Atrovent, but it was quite powerful for me and I stopped. Am searching for another one.I just posted a link to the recent article in the NEJM on mitral valve dysfunction with ergot agonists. However, if you look closely, the authors also found abnormal "mitral tenting" with the non ergots (eg, Requip, Mirapex, piribedil and others) which may be a precursor to frank regurgitation, and in their conclusions recommend monitoring patients on ANY dopamine agonist. Frankly, I think we are asking for trouble using even the non-ergots.
From:
Renzo Zanettini, M.D Valvular Heart Disease and the Use of Dopamine Agonists for Parkinson's Disease NEJM Volume 356:39-46 (2007)In conclusion, we found a significant increase in the risk of heart-valve regurgitation in patients taking ergot-derived dopamine-receptor agonists for Parkinson's disease. The finding of a significantly increased mean mitral tenting area, not only in patients receiving ergot-derived dopamine agonists but also in patients treated with non–ergot-derived dopamine agonists, suggests that follow-up echocardiographic monitoring is advisable in all patients with Parkinson's disease who are treated with dopamine agonists.
Posted by cumulative on December 3, 2007, at 0:48:01
In reply to Re: D1 stimulation question, for the psychopharm b » DStupid, posted by kingcolon on December 2, 2007, at 23:48:07
Short reply at the moment, I'm on a business trip but I should be getting back tomorrow (and trying out the new pills) so I'll get around to putting in my bit at some of these loose ends.
To my knowledge, the study you cite is the only study that indicated an increased risk for valvulopathy from nonergot drugs, compared to numerous studies that show no correlation. Compare to ergot agonists, which are shown in several studies to increase risk (although certain studies also managed to show no correlation in select groups). This research seems to be a direct response to the research you cite:
http://archneur.ama-assn.org/cgi/content/abstract/64/3/377?ck=nck
Given the major potential usefulness of these drugs, I don't think it's a good idea to promote fear at this point, with so much research indicating that this is not a problem with nonergots. Regular heart exams are a good idea for anyone.
http://www.drug-injury.com/druginjurycom/2007/03/parkinsons_drug.html
"Our practice of recommending non-ergot dopamine agonists as first-line therapy for patients needing a dopamine agonist appears to be relatively safe from the standpoint of cardiac valve function."
Posted by Sigismund on December 3, 2007, at 1:37:52
In reply to Re: kingcolon, posted by cumulative on December 3, 2007, at 0:48:01
Do the ergot agonists include Hydergine?
This is the end of the thread.
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