pergolide pergolide pergolide, sold under the brand name permax and prascend (veterinary) among others, is an ergoline-based dopamine receptor agonist used in some countries for the treatment of parkinson's disease. parkinson's disease is associated with reduced dopamine activity in the substantia nigra of the brain. pergolide acts on many of the same receptors as dopamine to increase receptor activity. pergolideclinical datatrade namespermax, prascend (veterinary), othersother names8β--6-propylergolineahfs/drugs.commonographpregnancycategory b routes ofadministrationoralatc coden04bc02 (who) legal statuslegal status us: veterinary use only, withdrawn for human use pharmacokinetic dataprotein binding90%metabolismextensively hepaticelimination half-life27 hoursidentifiers iupac name (6ar,9r,10ar)-9-(methylthiomethyl)-7-propyl-4,6,6a,7,8,9,10,10a-octahydroindoloquinoline cas number66104-22-1 ypubchem cid47811iuphar/bps48drugbankdb01186 ychemspider43503 yunii24mj822nz9keggd08339 ychebichebi:63617 nchemblchembl531 ycomptox dashboard (epa)dtxsid2023438 echa infocard100.241.322 chemical and physical dataformulac19h26n2smolar mass314.49 g·mol−13d model (jsmol)interactive image smiles 12c(csc)cn(ccc)1()cc3cc4cccc2c34 inchi inchi=1s/c19h26n2s/c1-3-7-21-11-13(12-22-2)8-16-15-5-4-6-17-19(15)14(10-20-17)9-18(16)21/h4-6,10,13,16,18,20h,3,7-9,11-12h2,1-2h3/t13-,16-,18-/m1/s1 ykey:yehcicaeulnigd-mzmpzrchsa-n y ny (what is this?) (verify) it was patented in 1978 and approved for medical use in 1989. in 2007, pergolide was withdrawn from the u.s. market for human use after several published studies revealed a link between the drug and increased rates of valvular heart disease. however, a veterinary form of pergolide, marketed under the trade name prascend, is permitted for the treatment of pituitary pars intermedia dysfunction (ppid) also known as equine cushing's syndrome (ecs) in horses. medical uses pergolide is not available for use by humans in the united states, however, it is still used in various other countries, where it is used to treat various conditions including parkinson's disease, hyperprolactinemia, and restless leg syndrome. pergolide is available for veterinary use. under the trade name prascend, manufactured by boehringer ingelheim, it is commonly used for the treatment of pituitary hyperplasia at the pars intermedia or equine cushing's syndrome (ecs) in horses. pharmacology pharmacodynamics pergolide acts as an agonist of dopamine d2 and d1 and serotonin 5-ht1a, 5-ht1b, 5-ht2a, 5-ht2b, and 5-ht2c receptors. it may possess agonist activity at other dopamine receptor subtypes as well, similar to cabergoline. although pergolide is more potent as an agonist of the d2 receptor, it has high d1 receptor affinity and is one of the most potent d1 receptor agonists of the dopamine receptor agonists that are clinically available. the agonist activity of pergolide at the d1 receptor somewhat alters its clinical and side effect profile in the treatment of parkinson's disease. pergolide is said to be hallucinogenic due to activation of 5-ht2a receptors. it has been associated with cardiac valvulopathy due to activation of 5-ht2b receptors. activities of pergolide at various sites site affinity (ki ) efficacy (emax ) action d1 339 ? ? d2s 32 112 full agonist d2l 26 52 partial agonist d3 5.5 71 partial agonist d4 59 56 partial agonist d5 33 ? ? 5-ht1a 1.9 63 partial agonist 5-ht1b 282 90 partial agonist 5-ht1d 13 86 partial agonist 5-ht2a 8.3 103 full agonist 5-ht2b 7.1 113 full agonist 5-ht2c 295 87 partial agonist 5-ht6 30 ? ? 5-ht7 1.0–18 ? ? α1a 1,047 ? ? α1b 692 ? ? α1d 295 ? ? α2a 50 31 partial agonist α2b 32 70 partial agonist α2c 68 16 partial agonist α2d 692 ? ? β1 >10,000 – – β2 >10,000 – – h1 1,698 ? ? m1 >10,000 – – σ1 >10,000 – – σ2 923 ? ? notes: all receptors are human except α2d-adrenergic, which is rat (no human counterpart), and 5-ht6, 5-ht7, σ1, and σ2, which are all rodent (rat or guinea pig). side effects the drug is in decreasing use, as it was reported in 2003 to be associated with a form of heart disease called cardiac fibrosis. in 2007, the united states food and drug administration announced a voluntary withdrawal of the drug by manufacturers due to the possibility of heart valve damage. pergolide is not currently available in the united states for human use. this problem is thought to be due to pergolide's action at the 5-ht2b serotonin receptors of cardiac myocytes, causing proliferative valve disease by the same mechanism as ergotamine, methysergide, fenfluramine, and other serotonin 5-ht2b agonists, including serotonin itself when elevated in the blood in carcinoid syndrome. pergolide can rarely cause raynaud's phenomenon. among similar antiparkinsonian drugs, cabergoline but not lisuride exhibit this same type of serotonin receptor binding. in january, 2007, cabergoline (dostinex) was reported also to be associated with valvular proliferation heart damage. in march 2007, pergolide was withdrawn from the u.s. market for human use, due to serious valvular damage that was shown in two independent studies. pergolide has also been shown to impair associative learning. addictive behaviors at least one british pergolide user has attracted some media attention with claims that it has caused him to develop a gambling addiction. in june 2010, it was reported that more than 100 australian users of the drug are suing the manufacturer over both gambling and sex addiction problems they claim are the result of the drug's side effects. society and culture brand names brand names of pergolide include permax and prascend (veterinary), among others.