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Dopamine agonists are used in patients with Parkinson disease. Dopamine agonists, such as ropinirole, are the first-line treatment for restless legs syndrome, while bromocriptine is given for neuroleptic malignant syndrome. Dopamine agonists are also prescribed to counteract dopamine antagonist-induced hyperprolactinemia. Objectives: Identify the mechanism of action of dopamine agonists. Describe the potential adverse effects of dopamine agonists. Review the toxicity of dopamine agonists. Summarize interprofessional team strategies for improving care coordination and communication to advance pharmacotherapy with dopamine agonists and improve outcomes. Access free multiple choice questions on this topic.

Overdose on dopamine agonists is rare. In cases of mild toxicity, symptomatic, and the patient should receive supportive care (such as hydration, electrolyte replacement, and rest). In severe cases of toxicity, symptoms such as dyskinesia, dystonia, hypotension, and dysrhythmias may occur. In these cases, the clinician should decrease the drug dosage should and supportive care provided. Other medications, such as benzodiazepines and antispasmodic agents, can be given to treat dystonia. Hypotension should have treatment with IV fluids and dysrhythmias treated with antiarrhythmic agents.

Providers should monitor patients on dopamine agonists for any signs and symptoms of CNS depression, orthostatic hypotension, or electrolyte imbalance. Patients should be closely monitored by clinicians and the collaboration of all interprofessional healthcare team members, especially during the titration period. Baseline complete blood count with differential, liver function test, BUN/Cr should be obtained before starting the medication, and cardiovascular evaluations are necessary. Patients treated with dopamine agonists might not be aware of the symptoms of orthostatic hypotension. The clinician should consult with a pharmacist on the appropriateness of the agent selected correct dosing and have the pharmacist check for drug interactions on the patient's medication profile. Because falls in the elderly can cause injuries, serious complications, and even death, patient education is necessary for the healthcare team. Nursing staff can be a crucial resource for answering medication dosing and administration questions, alerting patients to possible adverse effects, and serving as an access point to the prescriber. Abnormal obsessive behaviors such as gambling and hypersexuality may occur in patients who did not exhibit these behavioral problems before initiating dopamine agonist therapy. Patients may not report these changes in behaviors due to embarrassment. A psychological evaluation by the healthcare team is the recommendation for patients under dopamine agonist therapy. These examples demonstrate the necessity for interprofessional teamwork when prescribing dopamine agonist medications. [Level 5]