Introduction: Pergolide is a widely used antiparkinsonian dopamine agonist. Following occasional case reports, two studies recently suggested potentially frequent and severe valvular disease associated with pergolide intake.
State of art: Although there is now strong evidence to consider that pergolide may induce valvulopathy, incidence, severity, and risk factors for this adverse effect remain to be clarified. Valvular disease associated with pergolide consists in fibrosis and resembles conditions described in carcinoid carcinoma and in patients taking fenfluramine therapy. The mechanisms leading to valvular fibrosis are unknown but involvement of 5-HT(2B) receptors, especially expressed in valvular fibroblasts, is suspected.
Perspectives and conclusions: Following the recommendations of the Agence Française de Sécurité Sanitaire des Produits de Santé, we describe a clinical practice attitude for pergolide therapy in Parkinson's disease.