DA agonists - Ergot derivaties: Lisuride

Abstract

Lisuride is an alpha-amino-ergoline with D2 receptor agonist properties and has no apparent D1 receptor effects. Similar to most ergotamine derivatives, lisuride also has 5-HT2 activity. In animal models of Parkinson's disease (PD), lisuride antagonizes reserpine-induced akinesia and induces rotation in the unilaterally 6-OHDA-lesioned rat. Lisuride lowers serum prolactin levels, induces nausea, and lowers blood pressure in healthy volunteers. 1 PHARMACOKINETICSAfter oral administration, lisuride is absorbed completely from the gastrointestinal tract. Peak plasma levels are obtained between 60 to 80 minutes, with high individual variation. Terminal half-life for elimination of lisuride from the plasma is around 2 hours, which is shorter than most other dopamine agonists. Similar to other ergotamine derivatives, absolute oral bioavailability of lisuride is low due to first pass metabolism ranging between 10 to 20%. 60 to 70% of lisuride is bound to human plasma proteins. Lisuride is extensively metabolised with more than 15 metabolites identified.Lisuride has solubility properties similar to apomorphine and therefore can be given subcutaneously and intravenously. REVIEW OF CLINICAL STUDIES PREVENTION OF DISEASE PROGRESSIONNo qualified studies were identified. SYMPTOMATIC CONTROL OF PARKINSONISM MONOTHERAPYOnly one randomized (Level-I) study assessing the effect of lisuride in L-dopa-naïve de novo PD patients was identified, according to the inclusion criteria.Rinne (1989) 2 :This was an open-label, parallel-group, L-dopacontrolled study including 90 patients (mean age 62 years) randomized into 3 different arms: lisuride alone, L-dopa alone, and lisuride plus L-dopa as early combination. If the therapeutic response in the lisuride arm was insufficient after 3 months of treatment, L-dopa could be added to form a second early combination group. Efficacy was assessed using the CURS (Columbia University Rating Scale). Patients recorded, in a daily diary, the occurrence and severity of fluctuations in disability, and were followed for 4 years. After 3 months of follow-up, lisuride monotherapy was less effective than L-dopa (daily doses not given) (CURS percent improvement: L-dopa 56% vs. lisuride 32%, p<0.01). After 4 years of treatment, only 17% of the patients were maintained on lisuride monotherapy. In the other patients L-dopa supplementation was required. After 4 years of follow-up, early combination of lisuride (1.1 mg/d) and low-dose of L-dopa (484 mg/d) resulted in an antiparkinsonian response equal to that achieved with higher doses of L-dopa monotherapy (668 mg/d) (% improvement CURS: combination regimen 28% vs. L-dopa 25%). A similar improvement was reported in the group of lisuride-treated patients who received early L-dopa supplementation after 3 months of treatment (lisuride daily dose = 0.8 combined with 630 mg/d of Ldopa, % improvement CURS: 29%). For both groups that received combination therapy, there were significantly fewer end-of-dose failures and dyskinesias (see "Prevention of Motor Complications"...

Comparative Pharmacological Effects of Lisuride and Lysergic Acid Diethylamide Revisited

“…These include dopamine receptors (D 1 - and D 2 -like), , non-5-HT 2A serotonin receptor subtypes (5-HT 1A , 5-HT 2C , and others), , as well as other sites (adrenergic and histamine receptors) . From a clinical perspective, the dopamine receptor agonist properties of lisuride are thought to mediate its efficacy in treating early symptoms of Parkinson’s disease . Previous experiments in rats showed that lisuride is a more potent agonist at 5-HT 1A than LSD, and this property distinguishes the two drugs. ,, Finally, studies in mice demonstrate that the 5-HT 2A -mediated HTR is suppressed by the 5-HT 1A agonist activity of certain psychedelic compounds, − including the ergoline lysergic acid morpholide (LSM-775) …”