ropinirole hydrochloride

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ropinirole hydrochloride

Pharmacologic class: Dopamine agonist

Therapeutic class: Antidyskinetic

Pregnancy risk category C

Action

Unknown. Thought to stimulate dopamine receptors in brain.

Availability

Tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg

Tablets (extended-release): 2 mg, 4 mg, 6 mg, 8 mg

Indications and dosages

Idiopathic Parkinson's disease

Adults: For conventional tablets, initially, 0.25 mg P.O. t.i.d. for 1 week, followed by 0.5 mg P.O. t.i.d. for 1 week, then 0.75 mg t.i.d. for 1 week, and then 1 mg t.i.d. for 1 week. After week 4, may increase by 1.5 mg/day q week, up to 9 mg/day; then may increase further by up to 3 mg/day q week, up to 24 mg/day. For extended-release tablets, initially 2 mg P.O. once daily for 1 to 2 weeks, followed by increases of 2 mg/day at 1-week or longer intervals as appropriate, depending on therapeutic response and tolerability, up to a recommended maximum dosage of 24 mg/day.

Moderate to severe primary restless leg syndrome

Adults: Initially, 0.25 mg P.O. once daily, 1 to 3 hours before bedtime. After 2 days, may increase dosage to 0.5 mg once daily and to 1 mg once daily during week 2. For weeks 3 through 6, may increase dosage by 0.5 mg/week, to a dosage of 3 mg; at week 7, dosage may be increased to 4 mg (immediate-release tablets only).

Contraindications

• Hypersensitivity to drug or its components

Precautions

Use cautiously in:
• severe hepatic impairment or cardiovascular disease, bradycardia
• elderly patients
• pregnant patients
• breastfeeding patients (use not recommended).

Administration

• Give with food if drug causes nausea.
• Assess patient for therapeutic response and tolerability at 1-week intervals (minimum) or longer after each dosage increment.
• Know that drug withdrawal should occur over 7 days, with frequency reduced to twice-daily dosing for first 4 days and then to once-daily dosing for next 3 days.

Adverse reactions

CNS: headache, dizziness, confusion, drowsiness, fatigue, neuralgia, amnesia, hyperesthesia, yawning, dystonia, increased dyskinesia, hyperkinesia, akathisia, hallucinations, abnormal thinking, poor concentration, syncope, vertigo, myoclonus, asthenia, malaise, sleep attacks

CV: orthostatic hypotension, hypertension, palpitations, extrasystole, peripheral edema, peripheral ischemia, chest pain, tachycardia, atrial fibrillation

EENT: abnormal vision, rhinitis, sinusitis, pharyngitis

GI: nausea, vomiting, flatulence, abdominal pain, dyspepsia, dry mouth, anorexia

GU: urinary tract infection, decreased libido, erectile dysfunction

Respiratory: bronchitis, dyspnea

Skin: diaphoresis, flushing

Other: viral infection, pain, edema

Interactions

Drug-drug.Butyrophenones (such as haloperidol), metoclopramide, phenothiazines, thioxanthenes: decreased ropinirole effects

Ciprofloxacin, estrogens: increased ropinirole effects

Drugs that alter activity of CYP450-1A2 enzyme system: altered ropinirole clearance

Levodopa: increased levodopa effects

Drug-diagnostic tests.Alkaline phosphatase, blood urea nitrogen: increased levels

Drug-herbs.Kava: decreased ropinirole efficacy

Patient monitoring

• Monitor vital signs, especially for orthostatic hypotension. Assess for peripheral edema.
• Assess neurologic status carefully. Report severe adverse reactions.
• Monitor nutritional and hydration status.

Patient teaching

• Encourage patient to take drug with food if it causes nausea.
• Instruct patient to swallow extended-release tablets whole and not to chew, crush, or divide them.
• Inform patient that hallucinations may occur during ropinirole therapy.
• Advise patient that he may experience the urge to gamble, increased sexual urges, or other intense urges and the inability to control these urges.
• Inform patient (and caregiver, as appropriate) that drug can cause serious CNS reactions; tell him which ones to report. Recommend appropriate safety measures.
• Instruct patient to move slowly when sitting up or standing, to avoid dizziness from sudden blood pressure decrease.

Caution patient not to stop drug abruptly. Dosage must be tapered.
• Advise patient to report swelling of hands or feet.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, vision, and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.