Which of the following dopamine agonists is a non-ergot derivative and is preferred as monotherapy in early Parkinson disease?

Explanation

## Dopamine Agonists in Parkinsonism ### Classification | Class | Agents | Key Features | |-------|--------|--------------| | **Ergot derivatives** | Bromocriptine, Pergolide, Cabergoline | Higher risk of fibrosis (cardiac, pulmonary, retroperitoneal); older agents | | **Non-ergot derivatives** | Ropinirole, Pramipexole, Rotigotine | Better safety profile; preferred in modern practice | ### Why Ropinirole? **Key Point:** Ropinirole is a non-ergot D₂/D₃ dopamine agonist with a favourable side-effect profile and no association with cardiac valvulopathy or pulmonary fibrosis. **High-Yield:** Non-ergot dopamine agonists (ropinirole, pramipexole) are now **first-line agents** for early Parkinson disease, especially in younger patients (<70 years), because they: - Reduce motor complications (dyskinesia, motor fluctuations) compared to levodopa monotherapy - Lack the fibrotic complications of ergot derivatives - Delay the need for levodopa **Clinical Pearl:** Ergot derivatives (bromocriptine, pergolide) are now reserved for specific situations due to risk of: - Cardiac valvulopathy (aortic/mitral regurgitation) - Pulmonary fibrosis - Retroperitoneal fibrosis ### Mechanism Ropinirole directly stimulates dopamine receptors (D₂ > D₃ > D₁), bypassing the need for dopamine synthesis and thus independent of nigrostriatal degeneration. [cite:KD Tripathi 8e Ch 12]