pramipexole (containing Dopamine), can it contribute to heart regurgitation?

[Sunny70]

I recently had an echocardiogram after chest x-ray for breathlessness and it was thought to show an enlarged heart , but later found it wasn’t, hence the ecg. It has shown that I have some regurgitation which GP said nothing to worry about but I have read that Dopamine can be a cause of this. Can anyone give advice on this and whether I should ask to change medication? Thanks

[SueJohnson]

This is something you should discuss with your doctor. Does the pramipexole control your RLS?

[Sunny70 in reply to SueJohnson]

yes it does, thanks, just wondered if anyone knew.

[ChrisColumbus]

Pramipexole has been associated with GERD (Gastroesophageal Reflux Disease) most commonly in women over 60 who have been on Prami for less than 6 months. However the sample size on which this study was based was comparatively small

[Sunny70 in reply to ChrisColumbus]

thanks but wasn’t asking about GERD. I should have said regurgitation in my heart.

[ChrisColumbus in reply to Sunny70]

Sorry, read 'regurgitation' thought 'reflux'...

"moderate evidence that treatment with pramipexole and cabergoline is associated with a higher risk of heart failure in patients with Parkinson's".

Study was looking at role of dopamine agonists in cardiac regurgitation and heart failure.

[Sunny70]

It was my fault for not putting ‘heart’. I don’t have Parkinsons and on a low dose of pramipexole so still not sure about it. I’ll need to,discuss with GP probably. Thanks

[Joolsg]

Mild regurgitation is common and doesn't cause breathlessness, just a slight heart murmur. I've had it for over 30 years, well before dopamine agonists. Your recent breathlessness is probably more likely to be linked to your thyroid issues. I noticed they reduced your propranolol recently.Breathlessness can be linked to low iron stores and thyroid and RLS patients benefit from having serum ferritin above 100, preferably 200.

As you're on Pramipexole, keeping ferritin above 100 might also delay augmentation.

Ask for a full panel fasting blood test and check your ferritin numbers.

Another possible cause of breathlessness is a recent Covid infection. That can leave you with continuing respiratory issues.

[Sunny70 in reply to Joolsg]

thank you so much for this comprehensive reply. My ferritin has been low but the last time was just in the normal level. It is hard to suggest all of this to the GP. My thyroid is also at the normal level. I have not seen report from the cardiologist but GP said not to worry but nothing has been explained which is causing me to worry. I’ll have to have a chat I think so I can understand. I do tend to overthink everything especially my mortality at my age. Thanks again for your support.

[Joolsg in reply to Sunny70]

Your GP will tell you ferritin is 'normal' at 15. But thyroid patients and RLS patients need much higher levels. There is a FB group called the Iron Protocol and it's full of stories of patients suffering heart palpitations, anxiety, breathlessness all Because ferritin is below 100. GPs really do not understand the link. I suggest you discuss it fully with your endocrinologist and say you'd like to raise your ferritin levels.In the meantime, as you've been told ferritin is only just in the normal range, you could supplement with ferrous bisglycinate every other night to raise levels and tell your endocrinologist that you're doing it to improve RLS and avoid augmentation on Pramipexole.

[SueJohnson in reply to Sunny70]

Ask your doctor what your ferritin number is as Joolsg pointed out normal in others is not normal for people with RLS. Also ask what your TSAT is. Also, did you take it fasting after midnight? Improving your ferritin to over 100 helps 60% of people with RLS and in some completely eliminates their RLS. As far as taking iron, take with 100 mg of vitamin C or some orange juice at least 1 hour before a meal or coffee and at least 2 hours after a meal or coffee since iron is absorbed better on an empty stomach. If your ferritin is between 75 and 100 or if your transferrin saturation is below 20, you may need an iron infusion since iron isn't absorbed as well above 75. If you take magnesium or calcium take them at least 2 hours apart since they interferes with the absorption of iron. Don't take tumeric as it can interfere with the absorption of iron. Also antacids interfere with its absorption. It takes several months for the iron tablets or iron infusion to slowly raise your ferritin. Ask for a new blood test after 8 weeks if you have an iron infusion or after 3 months if you are taking iron tablets.

[Sunny70 in reply to SueJohnson]

Many thanks for all that information and I will certainly ask my GP what you suggested. Can I ask what is TSAT?

[SueJohnson]

Transferrin Saturation Percentage

[Sunny70 in reply to SueJohnson]

Thank you, take care.