In the past three or four years, some people with PD have reported
excessive hair thinning (alopecia), and wondered why it was
happening. These reports have largely come from women, possibly
because hair thinning, while not uncommon among men, occurs much less
often in women. What is not widely realized is that some medications,
including certain Parkinson medications can have alopecia as a rare
side effect.

Researchers reported as long ago as 1971 that levodopa appeared to
induce hair loss; while the agonists bromocriptine and pergolide were
later found to have the same effect in a few cases.1,2,3,4 More
recently, the agonists cabergoline, pramipexole (Mirapex®), and
ropinerole (Requip®) have also been found to cause hair loss in a few
people.5,6

Cabergoline
In one case, a woman experienced hair thinning after she began using
cabergoline. Later, when the dose of cabergoline was reduced, the
hair grew back, suggesting that cabergoline may have been the cause
of the alopecia.

Pramipexole and ropinerole
Another report describes hair loss in two women with Parkinson's
disease (PD) who used the agonists pramipexole and ropinerole. One
woman, age 66, had been taking amantadine, and later added
pramipexole. Two months after beginning the pramipexole regimen, she
began to experience hair loss. After tests for thyroid function,
nutrient deficiencies, and other possible causes turned out negative,
the pramipexole was discontinued and ropinerole was substituted. The
hair thinning stopped, and new hair growth began in about four weeks.

The second woman, age 68, had been using selegiline and amantadine
successfully, and later pramipexole was added. Twelve months after
beginning use of pramipexole, which had recently been increased to
3.5 mg per day, she began to notice hair loss. She also switched from
pramipexole to ropinerole, but in her case the hair loss continued.
She then discontinued ropinerole, switching to carbidopa/levodopa.
The hair thinning stopped, and gradually her hair began to regrow,
but did not completely grow back.

The study notes that both women were being treated with amantadine as
well as the agonists, and speculates that the combination of
amantadine and agonists could be the cause of the hair loss.

Causes of alopecia
Before we immediately assume that hair thinning must be due to
medications, however, there are other factors to be considered. Hair
loss can occur for a wide variety of reasons, and it would be very
unwise to change PD medications without first carefully considering
all other possibilities. Here are some of the many possible causes of
hair loss:

Nutrient deficiencies: extreme deficiencies of biotin, pantothenic
acid, iron, and/or zinc can result in hair loss. Malnutrition, and
lack of protein can also be causes. Because those with PD sometimes
change the kind or amount of foods eaten, nutrient deficiencies can
and do occur.
Too much vitamin A or vitamin E can lead to hair loss.
Medications (the following is a partial list of medications that,
rarely, can lead to alopecia):
Parkinson medications
Levodopa (Sinemet®, Madopar®, Dopar®, Larodopa®, Syndopa®, etc.)
Agonists (pergolide, pramipexole, ropinerole, bromocriptine)
Amantadine ? possibly
Cholesterol-lowering drugs — clofibrate, gemfibrozil
Ulcer drugs — cimetidine, ranitidine, famotidine
Anticoagulents — warfarin, heparin
Antigout medications — allopurinol
Antiarthritics — auranofin, indomethacin, naproxen, sulindac,
methotrexate
Antihypertensive — lisinopril; Beta blocker drugs — atenolol,
metoprolol, nadolol, propranolol, timolol
Drugs derived from vitamin-A — isotretinoin, etretinate
Anticonvulsants — trimethadione
Antidepressants — tricyclics, amphetamines; bupropion, selegeline
Antithyroid agents — carbimazole, Iodine, thiocyanate, thiouracil
Also — blood thinners, male hormones (anabolic steroids)
Stress
Hormonal changes
Thyroid disease, both underactive and overactive
Heredity
Pressure on the scalp from hats, caps, wigs or tightly-pulled
hairstyles
A fever of 103 degrees Fahrenheit or more may result in hair loss
weeks later.
Cancer treatments.
Seborrheic dermatitis (sometimes occurs among people with PD)
If you, or someone you know, has noticed hair thinning, consider the
above possibilities. Having more than one of the conditions, or using
more than one of the above medications, increases the likelihood of
hair loss; for example, thyroid disease, stress, low serum iron
levels, and use of one or more of the above listed medications makes
it more likely that hair loss could occur.

Can alopecia be treated?
Most cases of hair loss can be reversed. However, treatment for
alopecia will depend on its cause; for this, you should see a
dermatologist, who can determine why the hair thinning has occurred
and can recommend the appropriate treatment, whether dietary, stress,
thyroid, medication, or other condition is the cause.

If the cause is seborrheic dermatitis, a dermatologist may suggest a
special shampoo or other cleanser. If the cause appears to be
Parkinson medications, however, then you must also discuss this with
your neurologist. Your doctor may be able to recommend a different
medication or combination of medications, particularly if you are
using amantadine along with an agonist. The important thing is to get
a correct diagnosis of the cause of the hair loss, and seek the
treatment that will best address this cause.

By Kathrynne Holden, MS, RD