Objective: To determine the frequency and risk factors of peripheral edema (PE) development and whether discontinuation of the drug is enough for treatment.

To determine frequency and risk factors for peripheral edema (PE) among Parkinson’s disease patients using ropinirole or pramipexole therapy.

Background: Ropinirole and pramipexole are proven to be effective dopamine agonist drugs widely used in Parkinson’s disease treatment. However, these drugs may induce bothersome peripheral edema as a side effect. This edema can be observed as a wide variety of symptoms: from limited ankle/foot edema to whole leg edema disturbing walking.

Method: Medical data of PD patients under DA treatment in our clinic between 2000-2019 were evaluated retrospectively from patient records. The data were analyzed by IBM SPSS Statistics Data Editor.

Results: Data of 370 patients were evaluated. Prevalence of PE was found to be %19 (73 patients). Female predominance was observed, of 73 patients, 45 were women (%61,6). The female gender was found as an independent risk factor for PE (p=0,01), which is consistent with the literature (1). The mean age was 65,6±10,3 years. The mean disease duration was 9,23±5,0 years. Dopamine agonist equivalent dose (DAED) was 321,0±194,6. Age, disease duration and DAED were not associated with PE (p=0,13 ;p=0,82 and p=0,7 respectively). Peripheral edema developed after a mean time of 4,0±3,3 years under DA treatment. The majority of patients (%72,6) were taking DAs for more than two years, but a cut-off value of 2 years DA usage for PE risk was statistically insignificant (p=0,06). Discontinuation of DA treatment resulted in the resolution of PE in a mean time of 3,2 months. Only two patients’ (%2,7) PE persisted.

Conclusion: The cause of dopamine agonist-induced peripheral edema is unknown. This edema may be a more common side effect of DA treatment than previously thought and may be overlooked. Prolonged usage of DAs (especially more than two years) may be a risk factor. PE development is not dose-dependent, and females have a higher risk. This idiosyncratic reaction almost always resolves after cessation of DAs.
To our knowledge, our study has the highest number of cases with PE in literature, making our results valuable for understanding leg edema as a side effect of DA treatment.

References: 1. Kleiner-Fisman G, Fisman DN. Risk Factors for the Development of Pedal Edema in Patients Using Pramipexole. Arch Neurol. 2007;64(6):820–824. 2. Biglan K. M, Holloway R.G, McDermott M.P, Richard I.H(2007). Risk factors for somnolence, edema and hallucinations in early Parkinson disease.Neurology,69(2),187–195.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/frequency-and-risk-factors-of-dopamine-agonist-induced-peripheral-edema-in-patients-with-parkinsons-disease/