Piribedil (Trivastal)

Class

Dopamine D2/D3 receptor agonist

Mechanism

Stimulates D2/D3 receptors, enhancing dopaminergic transmission in the mesocortical and nigrostriatal pathways

FDA-Approved Use

None in the United States (used in Europe for Parkinson’s disease)

Off-Label Use

Apathy in Parkinson’s disease (PD), cognitive impairment in neurodegenerative diseases

Formulation

Oral tablets

Titration

50 mg p.o. daily, titrated slowly

Dose Range

50–150 mg/day

Kinetics

Hepatic metabolism; half-life ~12 hours

Common AEs

Nausea, hypotension, dizziness, somnolence

Serious/Rare AEs

Impulse-control disorders, hallucinations

Monitoring

Monitor blood pressure, psychiatric status, and impulse-control symptoms

Black Box Warning

None

Considerations

Caution in dementia or psychosis due to risk of hallucinations; monitor for impulse-control issues in Parkinson’s disease.