Wednesday December 5, 2007 News

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Permax Reported To Cause Dangerous Heart Valve Problems
By Stuart A.

"Due to some recent reports in the medical literature, we would life to take you off of Permax and replace it with Requip." What an unusual letter to receive from your neurologist. To what is he referring? According to Heartlnfo.org, in an article written by Steven Reinberg on April 28, 2004 in Health Day News, the answer is very clear. Permax (pergolide) can damage heart valves. Dr. Richard B. Dewey, Jr., an associate professor at the University of Texas Southwestern Medical Center believes Permax is so dangerous that it should be taken off the market according to Mr. Reinberg's article.

Permax has been widely used for two decades. Today there are an estimated 500,000 people using this drug. Permax is a dopamine agonist that stimulates the production of dopamine. Dopamine is the drug that allows the brain to send signals across the synapse, which separates each nerve, to the muscles that it is time to move in a certain manner. Parkinson's Disease begins to occur when the brain cells that produces the chemical start to die. According to Dr. G. Webster Ross, with the Honolulu Department of Veterans Affairs, the loss of nerve cells begins about 1 3 years before diagnosis. Talking about 13 being an unlucky number! Ross and his associates studied the brains of twelve deceased men who had PD and compared them to the brains of 174 deceased normal men. In doing so, they counted the number of neurons in the substantia nigra brain section. They found forty percent fewer neurons in the men who died after suffering PD than in the non-PD subjects. This finding enabled them to determine when the loss of brain cells began. It has been known for a long time that there are approximately 800,000 dopamine cells when one is born, and that when the cells die down to some number under 200,000 dopamine cells that PD symptoms begin to show.

Dr. Dewey believes that the heart valve damage problems probably only occur in Permax which is similar to the banned diet drug " fen-phen". Further tests are required to determine whether another similar drug called Parlodel, (bromcriptine mesylate) is a risky drug. "The newer dopamine agonists ropinirol (Requip) and pramipexole (Mirapex) are totally different and probably do not cause this problem," Dr. Dewey said. He cautioned that it is not known yet whether they pose any dangers. However, he believes the risk of heart valve damage from Permax is so great that the "drug should be taken off the market."
Dewey bases this position on two research studies in which each patient had an echocardiogram and ultrasound of the heart. When the results were "compared to the forty-six normal adults" on average, there was about a threefold increased risk of heart valve damage in the PWP compared to the normal patients." He continued," if you look at the damage to the tricuspid valve, the risk was even higher-- at about fourteen fold greater risk. The more Permax you take and the longer you take it increase the risk of heart damage.

Moussa A. Youdi, a professor of medicine at the Technion R&D Foundation at the Israel Institute of Technology in Haifa said, "Pergolide has a peripheral toxicity that affects heart valves. It may have to be removed from the list of Parkinson drugs, or the patients should be informed of the risk."

According to Mr. Reinberg's article, Valeant Pharmaceuticals of Costa Mesa, California, maker of Permax, failed to return repeated phone calls.

Dr. Dewey recommends patients taking Permax should see their doctor and get an echocardiogram to see if there is a problem. They should discuss with their doctor whether they should continue taking Permax or switch to another drug. Do not stop taking Permax cold turkey. You must gradually titrate off the drug under medical supervision over a minimum of four weeks.

Hi Tena,
Good article thanks.
Horrible drug Permax. I thought it'd been taken off the market some time ago. If it hasn't it should be.
I too had an echocardiogram 3 yrs ago to check for valvulopathy due to taking Permax for mmm around 8 yrs previously.
I also have a congenital systolic heart murmur so was quite concerned when the news about Permax and associated heart valve problems became known publicly. Luckily all appeared to be well but its obviously a concern to the parkinson community who have a previous history of taking this drug.
Regards,
Lee