Objective: Report a patient with PD treated with irregular doses of pramipexole and extensive chronic edema in lower extremities after 8 years of treatment, taking elevated doses (toxic levels). These doses have never been reported before.

Background: Distal edema is a complication of dopamine agonist (DA) treatment, and described previously but extensive chronic peripheral edema starting after many years has not been described before. The usual is develop this complication shortly. The edema in patients with PD using pramipexole, occurs with a frequency of 5.6% to 50%. Several etiologies have been proposed for chronic edema but it remains unclear and complex. Probably it is a deficient lymphatic system and is not a toxicity effect.

Methods: A 67 year patient with PD initially took pergolide with noticeable benefit. A few years later, he changed to ropinirole. In this transition his PD worsened and he was almost bedridden. Around that time he started Sinemet and pramipexole (instead of ropinirole), entacapone and amantadine. In our initial visit (August 2015) he was on Sinemet (total of 7 tab per day), entacapone (600 mg day), and pramipexole (total of 7 mg per day). He developed edema in both legs around 18 months before the visit (2014). He took diuretics with partial benefit. After the visit he decreased pramipexole to 0.75 TID but his symptoms worsened and he had to return back to the previous dose. He is stable and the edema has been improved helping with a lymphatic drainage.

Conclusions: The recommendation is discontinue the treatment. This patient was unable to stop the treatment and the edema was resolved progressively with lymphatic drainage. The mechanism responsible for edema remains obscure and could be related to a idiosyncratic reaction. The highlight of the current report, to our knowledge, is the first report of severe chronic edema in a patient with PD, secondary to pramipexole after many years of treatment and with high doses not reported before. This abstract is accompanied by pictures showing the different phases in this process. 1. Zavala, J.; Munhoz, R.; Teive H., Pramipexole related chronic lower limb oedema in a patient with Parkinson’s disease. Case Reports / Journal of Clinical Neuroscience 19 (2012) 1298–1299. 2. Tan, E.; Ondo, W. Clinical Characteristics od Pramipexole Induced Peripheral Edema Arch Neurol. 2000; 57: 729-732.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-characterization-of-pramipexole-induced-edema-in-parkinsons-disease-pd-is-it-always-the-best-option-discontinue-the-treatment/