Emerging drugs for autonomic dysfunction in Parkinson's disease

• Published in: Expert opinion on emerging drugs Vol. 18; no. 1; p. 39
• Main Authors: Perez-Lloret, Santiago, Rey, María Verónica, Pavy-Le Traon, Anne, Rascol, Olivier
• Format: Journal Article
• Language: English
• Published: England 01.03.2013
• Subjects: Animals; Antiparkinson Agents - adverse effects; Antiparkinson Agents - therapeutic use; Autonomic Agents - adverse effects; Autonomic Agents - therapeutic use; Autonomic Nervous System Diseases - etiology; Autonomic Nervous System Diseases - prevention & control; Clinical Trials as Topic; Constipation - etiology; Constipation - prevention & control; Drugs, Investigational - adverse effects; Drugs, Investigational - therapeutic use; Humans; Hypotension, Orthostatic - etiology; Hypotension, Orthostatic - prevention & control; Parkinson Disease - drug therapy; Parkinson Disease - physiopathology; Sialorrhea - etiology; Sialorrhea - prevention & control; Urinary Incontinence - etiology; Urinary Incontinence - prevention & control
• ISSN: 1744-7623
• DOI: 10.1517/14728214.2013.766168

Autonomic dysfunction, including orthostatic hypotension (OH), sialorrhea, sexual dysfunction, urinary dysfunction and constipation is a common feature of Parkinson's disease (PD). Even though its treatment has been recognized as a major unmet need in PD, there is a paucity of clinical trials to assess their treatment. Evidence about the efficacy and safety of available treatments for autonomic dysfunction is summarized. Potential targets for upcoming therapies are then discussed in light of what is currently known about the physiopathology of each disorder in PD. Proof-of-concept trials and circumstantial evidence about treatments for autonomic dysfunction as well as upcoming clinical trials are discussed. Finally, critical aspects of clinical trials design are considered. Botulinum toxin (BTX) or glycopyrrolate might be used for sialorrhea whereas macrogol could be useful in constipation. There is preliminary evidence suggesting that fludrocortisone, domperidone, droxidopa or fipamezole may be effective for the treatment of OH. Tropicamide, clonidine or radiotherapy are under development for sialorrhea. Sildenafil may be effective for the treatment of erectile dysfunction; BTX or behavioral therapy for urinary incontinence and lubiprostone and probiotics for constipation. Sound clinical trials are needed in order to allow firm evidence-based recommendations about these treatments.