Ropinirole Hydrochloride

A to Z Drug Facts

 Action Stimulates dopamine receptors in the corpus striatum, relieving parkinsonian symptoms.

 Indications Treatment of the signs and symptoms of idiopathic Parkinson's disease. May be used in conjunction with L-dopa.

 Contraindications Standard considerations.

 Route/Dosage

Individualize by careful titration.

ADULTS: PO 0.25 mg tid initially. Then dosage may be increased weekly by 0.75 mg/day until taking 3 mg/day, then by 1.5 mg/day until taking 9 mg/day, then by 3 mg/day to total dose of 24 mg/day.

 Interactions

Estrogen: May reduce clearance of ropinirole. Ropinirole dosage adjustments may be needed if estrogen therapy is started or stopped during treatment with ropinirole. CYP1A2 inhibitors (eg, cimetidine, ciprofloxacin, diltiazem, enoxacin, erythromycin, fluvoxamine, mexiletine, norfloxacin, tacrine): May decrease metabolic clearance of ropinirole. Ropinirole dosage adjustment may be needed if CYP1A2 inhibitor is started or stopped during treatment with ropinirole. CYP1A2 inducers (eg, smoking, omeprazole): May increase metabolic clearance of ropinirole. Dopamine antagonists (eg, butyrophenones, metoclopramide, phenothiazines, thioxanthenes): May reduce effectiveness of ropinirole.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Syncope; orthostatic hypotension; hypotension; hypertension; tachycardia; palpitations; arrhythmias; peripheral ischemia. CNS: Dizziness; somnolence; headache; confusion; hallucinations; abnormal dreams; tremor; anxiety; insomnia; aggravated Parkinson's disease; hyperkinesia; hypokinesia; dyskinesia; paresthesia; vertigo; amnesia; impaired concentration. DERM: Sweating; flushing. EENT: Abnormal vision; xerophthalmia; rhinitis; pharyngitis. GI: Nausea; vomiting; dyspepsia; constipation; abdominal pain; dry mouth; anorexia; diarrhea; flatulence; dysphagia; increased salivation. GU: Urinary tract infection; urinary frequency; urinary incontinence; impotence. HEMA: Anemia. RESP: Bronchitis; dyspnea; pneumonia. OTHER: Fatigue; viral infection; pain; asthenia; edema; chest pain; malaise; yawning; arthralgia; falls; injury.

 Precautions

Pregnancy: Category C. Lactation: Inhibits prolactin secretion. Do not give to nursing mothers. Children: Safety and efficacy not established. Elderly: Incidence of hallucinations appears to be increased with age. Hepatic and renal function impairment: Use with caution in presence of severe hepatic or renal function impairment. Hypotension: Postural hypotension may occur, especially during dose escalation. Syncope: Syncope, sometimes associated with bradycardia, may occur. Most events occur more than 4 wks after starting therapy and are usually associated with a recent increase in dose. Hallucinations: Can occur during ropinirole therapy. Frequency is greater when used in conjunction with L-dopa. Dyskinesia: Ropinirole may potentiate dopaminergic effects of L-dopa and may cause or exacerbate pre-existing dyskinesias. Abrupt withdrawal: Rapid withdrawal or dose reduction of antiparkinsonism drugs may produce symptoms resembling the neuroleptic malignant syndrome. Retinal pathology: Pathological changes were observed in the retinas of albino rats receiving dopaminergic receptor agonists. The importance of this effect in humans has not been established but cannot be disregarded. CNS effects: Use concomitant CNS depressants with caution because of additive sedative effects. Concurrent L-dopa use: When ropinirole is administered as adjunct therapy to levodopa, the dose of levodopa may be decreased as tolerated.

 Administration/Storage

• Administer tid without regard to meals or food.
• If nausea occurs administer each dose with food.
• Store at controlled room temperature protected from light.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Note hepatic or renal function impairment.
• Complete baseline assessment of parkinsonian symptoms before instituting therapy.
• Assess for therapeutic effects, adverse reactions and drug interactions throughout course of therapy.
• Assess for orthostatic hypotension, dizziness and mental status changes during initial phase of therapy or following dose escalation.
• Assist patient with position changes and ambulation during initial therapy to prevent falling.
• Monitor blood pressure and pulse routinely during therapy.
• Do not administer if significant changes in BP, pulse or mental status occur. Notify physician.

 Patient/Family Education

• Instruct patient to take exactly as prescribed. Advise patient that dose may be taken without regard to meals but to take with food if nausea occurs.
• Inform patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
• Instruct patient to avoid sudden position changes to prevent orthostatic hypotension.
• Instruct patient to report these symptoms to physician: uncontrollable movements, dizziness, mood or mental changes, irregular heartbeat, severe or persistent nausea or vomiting, headache.
• Inform patient that hallucinations can occur and that elderly are more susceptible.
• Advise patient to use caution when taking other drugs with CNS depressant effects (eg, alcohol, sedatives, etc).
• Advise patient not to take any other medications (including otc) without consulting physician.
• Advise patient to notify physician if they become pregnant, plan on becoming pregnant or are breastfeeding while taking this medication.

Books@Ovid
Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts