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Lisuride and Other Dopamine Agonists

On first picking up this book the response is likely to be similar to that of the child who was given a present of a book on penguins. When asked how she liked her present she replied "It was very nice but it told me more about penguins than I wanted to know". Who, one must ask, wants a book of 550 pages devoted to lisuride and other dopamine agonists? This book was compiled from the proceedings of a symposium held in West Berlin in December 1981. It suffers therefore from the disadvantages common to such compilations being at times repetitive with essentially similar work being presented by different groups of scientists; and in being somewhat patchy in its scope. There is also the inevitable criticism that much of the work presented in this way has already been superseded. Nevertheless there are some excellent things to be found in this volume. The main sections of the book are devoted to the endocrine pharmacology of dopamine agonists and the neurological pharmacology of these compounds. In the preliminary sections some aspects of receptor pharmacology are reported. The dopamine receptor is proving to be a highly variable and complex structure which responds slightly differently to each of the new dopaminergic ergot compounds. The chapter on oestrogens and dopamine receptor sensitivity provides a fascinating example of hormonal affects on brain neuronal mechanisms. The unusual pharmacokinetics of ergot compounds is explained and in particular their extensive metabolism during their initial passage through the liver. The section devoted to the neuroendocrine effects of dopaminergic agonists provides a comprehensive review of the subject. The place of these compounds in the treatment of prolactinomas, acromegaly, suppression of lactation, infertility and premenstrual tension is considered in detail by many of the leading workers in this field. It is no exaggeration to say that the management of patients with these conditions has been revolutionised by the introduction of compounds such as bromocriptine and lisuride and these chapters will provide an important source of references in the clinical management of patients with these conditions. The use of dopamine agonists other than levodopa in the treatment of Parkinsonism remains highly contentious. The wide variations in dose and response may relate partly to the complex pharmacokinetics already mentioned. Similarly their value appears to be their longer duration of action than levodopa so that in patients with marked fluctuations in response the addition of a dopamine agonist may be beneficial. It is clear, however, from reading these chapters that the aim must be to find more specific and better tolerated dopamine agonists which avoid the disadvantages of levodopa treatment and might therefore replace levodopa for primary treatment for Parkinson's disease. This book can only be recommended as a reference work. It will be used by pharmacologists needing a review of these compounds and their mode of action; and by clinicians looking for guidance in the treatment of their patients with Parkinson's disease and a wide variety of neuroendocrine disorders.