| Background:Pamipexole,the represents of D2/D3 receptors partial agonists,are routine therapeutics for Parkinson’s disease.The main mechanism of pramiexole is t 和stimulation of postsynaptic D2 and D3 receptors in nigra-striatum pathways to supply the DA deficiency caused by Parkinson’s disease.Some studies have found that pramipexole may be beneficial on the treatment of EPS,psychiatric symptoms and mood disorders of schizophrenia,but its’ efficacy and safety condition on the Chinese populations still need to be verified.Objective: To explore the efficacy and tolerance of low-dose D2/D3 receptor partial agonists pramipexole in the treatment of EPS and psychiatric symptoms and mood symptoms of schizophrenia.Method: 10 subjects with EPS(including drug induced parkinsonism and akathisia)are recruited in a stage-1 、open-label 、pilot study.All of the subjects are treated with low dose of pramipexole.The evaluation are preformed in baseline 、day 3、week 1 、week 2 、week 4 、week 6、week 8.The ratings of SAS、 BARS、 PANSS、 CDSS 、CGI-S and adverse effect are recorded in every visit.The stage 2 study was a randomized,single-blind,Antan-controlled clinical trial.subjects with Extrapyramidal symptoms(except TD)were enrolled and randomly divided into the Antan group and the pramipexole group to observe the efficacy and safety of pramipexole and Antan for different types of EPS.The dosage range of pramipexole group was 0.375 mg-0.75 mg/d,and the dose of antan was 2-4 mg/d.Clinicians could adjust the dosage according to the changes of patients’ condition.Results : Low-dose of pramipexole could significantly reduce SAS total score in patients with drug-induced Parkinsonism(F(6,7)=9.46,P < 0.001),pramipexole are safe and well tolerated among patients with DIP.Only mild to moderate adverse reactions(nausea,sedation,etc.)were found in the study.In the stage-2 study,low-dose pramipexole did not show efficacy on akathisia,and the deterioration of psychiatric symptoms and mood symptoms were more common among patients with akathisia.Study didn’t find paramipexole significantly improved the psychiatric symptoms and mood symptoms of schizophrenic patients.Considering the low dosage of experimental drugs,the efficacy of pramipexole on psychiatric symptoms and emotional symptoms of schizophrenic patients still needs to be explored.The stage-2 study found that the anticholinergics represented by Antan could also significantly improve symptoms of DIP(F = 8.71,P = 0.003).Long-term use of anticholinergic drugs had no significant Efficacy on symptoms of DIP,and long-term use of anticholinergic drugs had more side effects correlated with it’s anticholinergic effect.Conclusion: Low dose of pramipexole may improve antipsychotic-induced parkinsonism,but it is not effective and well-tolerated for akathisia,and more patients with akathisia experienced more deterioration of psychiatric symptoms and mood symptoms.Study has shown pramipexole were not fit for treating antipsychotic induced akathisia.Improvements of psychiatric symptoms and mood symptoms of schizophrenia were not detected with the treatment of low dose of pramipexole,and whether pramipexole have efficacy on sychiatric symptoms and mood symptoms of schizophrenia need to be further confirmed.Anticholinergic drugs can improve the drug induced Parkinsonism,but the long-term use of them has no obvious benefit for patients in this study.Anticholinergics side effects of anticholinergics were harmful for the drug treatment and prognosis of the patient.Shortterm use of anticholinergic drugs and instant withdrawal when EPS are relieved is a reasonable way to use anticholinergic drugs clinically. |
PDF Full Text Request