2. Apomorphine, pramipexole, ropinirole, and rotigotine:

These are nonergot dopamine agonists that have been approved for the treatment of Parkinson disease. Pramipexole and ropinirole are agonists at dopamine receptors. Apomorphine and rotigotine are newer dopamine agonists available in injectable and transdermal delivery systems, respectively. Apomorphine is meant to be used for the acute management of the hypomobility “off” phenomenon. These agents alleviate the motor deficits in both levodopa-naïve patients (patients who have never been treated with levodopa) and patients with advanced Parkinson disease who are taking levodopa. Dopamine agonists may delay the need to use levodopa therapy in early Parkinson disease and may decrease the dose of levodopa in advanced Parkinson disease.