How much ropinirole is safe to take for Parkinson’s disease and Restless Legs Syndrome. What are the recommended dosages and titration schedules for ropinirole. How should ropinirole doses be adjusted for patients with renal or hepatic impairment.

Understanding Ropinirole: A Comprehensive Guide to Dosage and Administration

Ropinirole is a medication primarily used to treat Parkinson’s disease and Restless Legs Syndrome (RLS). As with any medication, proper dosing is crucial for achieving optimal therapeutic effects while minimizing potential side effects. This comprehensive guide will explore the recommended dosages, titration schedules, and important considerations for safe and effective use of ropinirole.

Ropinirole Dosage for Parkinson’s Disease

For patients with Parkinson’s disease, ropinirole is available in both immediate-release and extended-release formulations. The dosing regimens for each are as follows:

Immediate-Release Tablets

• Initial dose: 0.25 mg orally three times daily
• Titration: Increase dose weekly based on efficacy and tolerability
• Maximum dose: 8 mg orally three times a day (24 mg total daily dose)

Is there a recommended titration schedule for immediate-release ropinirole in Parkinson’s disease? Yes, the following schedule is typically followed:

1. Week 1: 0.25 mg three times daily
2. Week 2: 0.5 mg three times daily
3. Week 3: 0.75 mg three times daily
4. Week 4: 1 mg three times daily
5. After week 4: Increase by 1.5 mg/day weekly up to 9 mg/day, then by 3 mg/day weekly up to the maximum dose

Extended-Release Tablets

• Initial dose: 2 mg orally once daily for 1 to 2 weeks
• Titration: Increase by 2 mg/day at weekly or longer intervals
• Maximum dose: 24 mg orally once a day

Can patients switch from immediate-release to extended-release ropinirole? Yes, when switching, the initial dose of the extended-release tablet should closely match the total daily dose of the immediate-release formulation. Subsequent adjustments should be made based on therapeutic response and tolerability.

Ropinirole Dosage for Restless Legs Syndrome

For patients with Restless Legs Syndrome, ropinirole is prescribed in immediate-release form. The dosing regimen is as follows:

• Initial dose: 0.25 mg orally once a day on Days 1 and 2
• Titration: Gradually increase dose based on individual response
• Maximum dose: 4 mg orally once a day

What is the recommended titration schedule for RLS patients? The following schedule is typically used:

1. Days 3-7: 0.5 mg once daily
2. Week 2: 1 mg once daily
3. Week 3: 1.5 mg once daily
4. Week 4: 2 mg once daily
5. Week 5: 2.5 mg once daily
6. Week 6: 3 mg once daily
7. Week 7: 4 mg once daily

When should ropinirole be taken for RLS? It is recommended to take ropinirole 1 to 3 hours before bedtime for optimal management of RLS symptoms.

Dosage Adjustments for Special Populations

Certain patient populations may require dosage adjustments to ensure safe and effective use of ropinirole. These include patients with renal or hepatic impairment, as well as those undergoing dialysis.

Renal Impairment

For patients with moderate renal impairment (CrCl 30 to 50 mL/min), no dosage adjustment is necessary for either Parkinson’s disease or RLS. However, there is limited data available for patients with severe renal impairment who are not on regular dialysis.

Hepatic Impairment

While specific guidelines for hepatic impairment are not available, caution is recommended when administering ropinirole to patients with liver disease. Dose adjustments may be required based on individual patient response and tolerability.

Dialysis Patients

For patients with end-stage renal disease (ESRD) on hemodialysis, the following dosing recommendations apply:

Parkinson’s Disease

• Immediate-release: Initial dose of 0.25 mg orally three times a day, with a maximum dose of 6 mg three times a day
• Extended-release: Initial dose of 2 mg orally once a day, with a maximum dose of 18 mg once a day

Restless Legs Syndrome

• Initial dose: 0.25 mg orally once a day
• Maximum dose: 3 mg orally once a day

Are supplemental doses required after dialysis? No, supplemental doses of ropinirole are not necessary following dialysis sessions.

Important Considerations for Ropinirole Administration

To ensure optimal therapeutic outcomes and minimize potential adverse effects, several key factors should be considered when administering ropinirole:

• Ropinirole can be taken with or without food
• For patients with Parkinson’s disease, if a significant interruption in therapy occurs, retitration may be necessary
• When discontinuing ropinirole for Parkinson’s disease, a gradual tapering is recommended:
  • Immediate-release: Reduce frequency from three times daily to twice daily for 4 days, then once daily for 3 days before stopping
  • Extended-release: Gradually discontinue over a 7-day period
• For RLS patients, tapering was not used in clinical trials prior to discontinuation
• If ropinirole is used as adjunct therapy to levodopa in Parkinson’s disease, the levodopa dose may be gradually decreased as tolerated

How does ropinirole interact with levodopa in Parkinson’s disease treatment? When ropinirole is added to levodopa therapy, it may allow for a reduction in the levodopa dose. On average, patients have been able to reduce their levodopa dose by 31% with immediate-release ropinirole and 34% with extended-release ropinirole.

Potential Side Effects and Precautions

While ropinirole can be an effective treatment for Parkinson’s disease and RLS, it’s important to be aware of potential side effects and necessary precautions:

• Common side effects may include nausea, dizziness, somnolence, and orthostatic hypotension
• Patients should be cautioned about the potential for sudden onset of sleep during daily activities
• Impulse control disorders, including pathological gambling and hypersexuality, have been reported
• Hallucinations may occur, particularly in elderly patients with Parkinson’s disease
• Dyskinesia may be exacerbated in Parkinson’s disease patients

What should patients be aware of regarding the potential for sudden onset of sleep? Patients should be informed that ropinirole can cause sudden onset of sleep during daily activities, including driving. They should be advised not to drive or engage in other potentially dangerous activities until they have gained sufficient experience with the medication to gauge its effects.

Monitoring and Follow-up

Regular monitoring and follow-up are essential for patients taking ropinirole to ensure optimal therapeutic outcomes and minimize potential risks:

• Assess efficacy and tolerability at each follow-up visit
• Monitor for signs of impulse control disorders
• Evaluate for the development or worsening of dyskinesia in Parkinson’s disease patients
• Regularly assess blood pressure, particularly in patients at risk for orthostatic hypotension
• Consider periodic skin examinations for melanoma, as Parkinson’s disease patients may have an increased risk

How often should patients on ropinirole be monitored? The frequency of monitoring should be individualized based on the patient’s condition, dose, and response to treatment. However, more frequent follow-ups are typically recommended during the initial titration period and when making dose adjustments.

Special Populations and Considerations

Certain patient groups require special attention when prescribing and administering ropinirole:

Elderly Patients

Older adults may be more sensitive to the effects of ropinirole and may require lower initial doses and more gradual titration. They are also at increased risk for certain side effects, such as hallucinations and orthostatic hypotension.

Pregnant and Breastfeeding Women

The safety of ropinirole during pregnancy and breastfeeding has not been established. The potential risks and benefits should be carefully weighed for women who are pregnant or planning to become pregnant.

Pediatric Patients

Safety and efficacy of ropinirole have not been established in patients younger than 18 years old. Its use in this population is not recommended.

Are there any known drug interactions with ropinirole that patients should be aware of? Yes, several important drug interactions exist:

• CYP1A2 inhibitors (e.g., ciprofloxacin, fluvoxamine) may increase ropinirole levels
• Estrogens may decrease ropinirole clearance
• Dopamine antagonists (e.g., neuroleptics, metoclopramide) may diminish the effectiveness of ropinirole
• Alcohol may potentiate the sedative effects of ropinirole

Patients should always inform their healthcare provider about all medications, supplements, and herbal products they are taking to avoid potential interactions.

In conclusion, ropinirole can be an effective treatment option for both Parkinson’s disease and Restless Legs Syndrome when used appropriately. Proper dosing, careful titration, and regular monitoring are key to maximizing its benefits while minimizing potential risks. As with any medication, individualized treatment plans and close communication between patients and healthcare providers are essential for optimal outcomes.

Ropinirole Dosage Guide + Max Dose, Adjustments

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Medically reviewed by Drugs.com. Last updated on Mar 17, 2023.

Applies to the following strengths: 12 mg; 6 mg; 2 mg; 4 mg; 8 mg; 0.25 mg; 0.5 mg; 1 mg; 5 mg; 3 mg; 0.25 mg-0.5 mg-1 mg

Usual Adult Dose for:

• Parkinson’s Disease
• Restless Legs Syndrome

Additional dosage information:

• Renal Dose Adjustments
• Liver Dose Adjustments
• Dose Adjustments
• Precautions
• Dialysis
• Other Comments

Usual Adult Dose for Parkinson’s Disease

Immediate-release tablets:
Initial: 0.25 mg orally three times daily

After 1 week, the dose may be titrated up in weekly increments based on individual efficacy and tolerability:
Week 2: give 0.5 mg orally 3 times daily
Week 3: give 0.75 mg orally 3 times daily
Week 4: give 1 mg orally 3 times daily
After week 4, increase by 1.5 mg/day on a weekly basis up to a dose of 9 mg/day, then increase by 3 mg/day on a weekly basis up to a maximum daily dose of 24 mg
Maximum Dose: 8 mg orally three times a day

Extended-release tablets:
Initial: 2 mg orally once daily for 1 to 2 weeks, followed by increases of 2 mg/day at 1-week or longer intervals, depending on therapeutic response and tolerability
Maximum dose: 24 mg orally once a day

Patients may switch from immediate-release to extended-release: The initial dose of extended-release tablet should most closely match the total daily dose of immediate-release formulation. Following conversion, adjust dose depending on response and tolerability.

Comments:

• If significant interruption in therapy occurs, retitration may be necessary; upon discontinuation, this drug should be gradually tapered over a 7-day period.
• The extended-release tablet is designed to release medication over a 24-hour period, if rapid gastrointestinal transit occurs, and tablet residue is observed in the stool, there is a risk of incomplete release of medication,

Use: For the treatment of Parkinson’s disease.

Usual Adult Dose for Restless Legs Syndrome

Immediate-release tablets:
Initial: 0.25 mg orally once a day on Day 1 and Day 2
Dose titration: May titrate as follows based on individual efficacy and tolerability:
Days 3 to 7: give 0.5 mg orally once a day

• Week 2: give 1 mg orally once a day
• Week 3: give 1.5 mg orally once a day
• Week 4: give 2 mg orally once a day
• Week 5: give 2. 5 mg orally once a day
• Week 6: give 3 mg orally once a day
• Week 7: give 4 mg orally once a day

Maximum Dose: 4 mg orally once a day

Comments:

• Take 1 to 3 hours before bedtime.
• In clinical trials, this drug was not tapered prior to discontinuation.

Use: For the treatment of moderate to severe Restless Legs Syndrome.

Renal Dose Adjustments

Parkinson’s disease:
Moderate renal impairment (CrCl 30 to 50 mL/mi): No dosage adjustment is necessary
Severe renal impairment without regular dialysis: No data available

Restless Leg Syndrome:
Moderate renal impairment (CrCl 30 to 50 mL/min): No dosage adjustment is necessary
Severe renal impairment without regular dialysis: No data available

Liver Dose Adjustments

Dose adjustments may be required; however, no specific guidelines have been suggested. Caution is recommended.

Dose Adjustments

Doses are individually titrated based on efficacy and tolerability.

Parkinson’s disease:

• If this drug is administered as adjunct therapy to levodopa, the concurrent dose of levodopa may be decreased gradually as tolerated; the average dose reduction of levodopa was 31% and 34% with immediate-release and extended-release tablets, respectively.

Drug interruption:

• If significant interruption in therapy occurs, this drug may need to be retitrated.

Drug discontinuation:

• Immediate-release tablets: Reduce the frequency of administration from 3 times a day to 2 times a day for 4 days, then once a day for 3 days, prior to discontinuation.
• Extended-release tablets: Gradually discontinue over a 7-day period

Precautions

Safety and efficacy of ropinirole have not been established in patients younger than 18 years.

Safety and efficacy of the extended-release product have not been established in patients with Restless Legs Syndrome (RLS).

Consult WARNINGS section for additional precautions.

Dialysis

Peritoneal dialysis: Data not available

End stage renal disease (ESRD) on hemodialysis:
Parkinson’s disease, Immediate-release:

• Initial dose: 0.25 mg orally 3 times a day
• Dose titration should be based on tolerability and need for efficacy
• Maximum dose: 6 mg orally 3 times a day

Parkinson’s disease, Extended-release:

• Initial dose: 2 mg orally once a day
• Dose titration should be based on tolerability and need for efficacy
• Maximum dose: 18 mg orally once a day

Restless Leg Syndrome:

• Initial dose: 0.25 mg orally once a day
• Dose titration should be based on tolerability and need for efficacy
• Maximum dose: 3 mg orally once a day

Comments: Supplemental doses after dialysis are not required.

Other Comments

Administration advice:

• May take with or without food
• If a dose is missed, take your next dose as scheduled; do not double your next dose
• Extended-release products should be taken once a day at a similar time each day; they should not be chewed, crushed, or split
• Restless Leg Syndrome: Take once a day 1 to 3 hours before bedtime

General:

• If significant interruption to therapy occurs, this drug should be retitrated.
• Parkinson’s Disease: This product should be tapered before discontinuation.
• Restless Legs Syndrome: This drug was not tapered to discontinuation during clinical trials.

Monitoring:

• Cardiovascular: Monitor for signs and symptoms of orthostatic hypotension, particularly during dose escalation; consider blood pressure monitoring at the start of treatment, especially in patients with significant cardiovascular disease.
• Nervous System: Monitor for somnolence and drowsiness
• Dermatologic: Monitor for melanomas; consider periodic skin examinations by dermatologists.
• Psychiatric: Question patients about new or increased gambling urges, sexual urges, uncontrolled spending, binge or compulsive eating, or other urges.

Patient advice:

• This drug frequently causes drowsiness; patients should not drive a car or operate machinery or other potentially dangerous activities until it is determined how this drug affects their mental and/or motor performance.
• Patients should be instructed to report episodes of sudden onset of sleep, new or worsening dyskinesia, new or worsening compulsive behaviors and/or unusual urges.
• Patients should be instructed to report changes in the size, shape, or color of moles on their skin and should have their skin checked on a regular basis for melanomas.
• Patients should be aware that this drug may cause orthostatic blood pressure changes including fainting and dizziness and patients should be advised to avoid standing rapidly after sitting or lying down.
• Patients should speak to their physician or health care provider if they become pregnant, intend to become pregnant, or are breastfeeding.

More about ropinirole

• Check interactions
• Compare alternatives
• Pricing & coupons
• Reviews (320)
• Drug images
• Side effects
• Patient tips
• During pregnancy
• Support group
• Drug class: dopaminergic antiparkinsonism agents
• Breastfeeding
• En español

Patient resources

• Drug Information
• Ropinirole Extended-Release Tablets
• Ropinirole Tablets

Other brands

Requip, Requip XL

Professional resources

• Prescribing Information

Related treatment guides

• Restless Legs Syndrome
• Parkinson’s Disease
• Periodic Limb Movement Disorder
• Tardive Dyskinesia

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Ropinirole: treats the symptoms of Parkinson’s disease

1. About ropinirole

Ropinirole is a medicine used for conditions that affect the way you move. It is used to treat the symptoms of Parkinson’s disease and restless legs syndrome.

If you have Parkinson’s disease, ropinirole can improve symptoms like shaking (tremors), slowness and stiffness. If you have restless legs syndrome, it helps control your leg muscles.

Ropinirole is only available on prescription and comes as tablets, including slow-release tablets.

2. Key facts

• If you’re taking ropinirole for restless legs syndrome, take it just before you go to bed.
• You’ll usually start on a low dose. This will be increased gradually to help reduce side effects, like feeling sick.
• Some people find that ropinirole makes them fall asleep suddenly. This is more likely to happen while your dose is being increased. Do not drive, ride a bike, or use tools and machinery until you know how this medicine affects you.
• Other possible side effects include twitching or twisting movements (dyskinesias). Your doctor may try changing your dose if this happens.
• Do not stop taking this medicine suddenly. If you need to stop taking it, your doctor or specialist nurse will reduce your dose gradually.

3. Who can and cannot take ropinirole

Most adults (aged 18 and above) can take ropinirole. However, it’s not suitable for everyone.

To make sure it’s OK for you, tell your doctor if you:

• have ever had an allergic reaction to ropinirole or any other medicine
• have kidney disease or liver disease
• have a serious heart condition or problems with your blood pressure
• have a serious mental health condition such as psychosis
• are pregnant, trying to get pregnant, or breastfeeding

4.

How and when to take ropinirole

Ropinirole comes as

• standard tablets (immediate release)
• slow-release tablets (also called prolonged release) that release the medicine into your body gradually

Try to take your ropinirole at the same time, or times, every day.

You can take ropinirole with or without food. However, you’re less likely to feel sick if you have it with food.

Swallow the tablets whole with a drink of water. Do not crush or chew the slow-release tablets. This is because they have a coating that lets the medicine into your body gradually.

If you have problems swallowing tablets, speak to a pharmacist or doctor.

Dosage and strength

Standard tablets come as 0.25mg, 0.5mg, 1mg, 2mg and 5mg strength tablets.

Slow-release tablets come as as 2mg, 3mg, 4mg, 6mg and 8mg strength tablets.

Doses vary from person to person. Always follow the instructions from your doctor or specialist nurse.

You will usually start on a low dose. Your doctor or specialist nurse will increase your dose gradually until your symptoms are under control. It’s best to take the lowest dose to control your symptoms because this helps reduce the chance of side effects.

Dosage for restless legs syndrome

You will usually start on 0.25mg, taken once a day. It’s best to take it just before bed to help with restless legs syndrome. Your dose will be increased gradually after a few days or weeks, up to a maximum dose of 4mg a day.

Dosage for Parkinson’s disease

You will usually start on 0.25mg, taken 3 times a day. Your dose will be increased each week, up to a usual daily dose of 9mg to 16mg.

However, if you take ropinirole with co-beneldopa or co-careldopa (or any other medicine containing levodopa), the maximum dose can go up 24mg a day.

What if I miss a dose?

If you forget to take a dose of ropinirole, skip the missed dose and take your next one at the usual time.

Do not take a double dose to make up for a forgotten one.

If you take ropinirole for Parkinson’s disease and miss your doses for 1 day or more, ask your doctor or specialist nurse for advice on how to start taking it again.

If you take ropinirole for restless legs syndrome and miss your doses for more than 2 days, ask your doctor for advice on how to start taking it again.

Important

Do not stop taking ropinirole suddenly. You can have serious withdrawal symptoms, such as changes in mood, tiredness, sweating and pain. If you need to stop taking it, your doctor or specialist nurse will reduce the dose gradually.

What if I take too much?

Taking 1 extra tablet is unlikely to harm you, but talk to your doctor, specialist nurse or pharmacist if you are concerned.

If you take more than your usual dose, you may get symptoms such as:

• feeling or being sick
• headaches, sweating or feeling dizzy
• feeling confused, or seeing, feeling or hearing things that other people cannot (hallucinations)
• feeling more sleepy or physically weak
• twitching or twisting

Urgent advice: Contact 111 for advice now if:

• you take more than double your total daily dose of ropinirole
• you take more than your usual dose of ropinirole and have any of the symptoms above

Go to 111. nhs.uk or call 111

Immediate action required: Call 999 or go to A&E now if:

You have taken more than your usual dose of ropinirole and:

• you have chest pain
• you have fast or irregular heart beats

If you need to go to hospital, take the medicines packet and any remaining medicine with you. Do not drive yourself. Get someone else to drive you or call for an ambulance.

5. Side effects

Like all medicines, ropinirole can cause side effects. However, many people have no side effects or only minor ones.

Common side effects

These common side effects of ropinirole happen in more than 1 in 100 people.

Keep taking the medicine, but talk to your doctor or pharmacist if these side effects bother you or do not go away:

• dizziness when you get up from sitting or lying down
• feeling tired and weak
• stomach pain
• heartburn
• feeling sick or being sick
• feeling anxious or nervous
• uncontrollable twitching or twisting movements – this is more likely if you’ve been taking ropinirole for a long time or at a high dose.

Serious side effects

It is possible to have serious side effects with ropinirole. Some are rare and happen in less than 1 in 1,000 people, but others can be more common.

Tell your doctor or specialist nurse if:

• you start binge eating, gambling or shopping uncontrollably or having an unusually high sex drive – these are signs of impulse control disorder
• you feel unusually sleepy or suddenly fall asleep during the day
• you see, feel or hear things that are not there (hallucinations) or feel confused – this is more likely to happen in older people
• your legs, feet or hands become swollen
• your restless legs syndrome gets worse

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to ropinirole.

Immediate action required: Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you’re breathing very fast or struggling to breathe (you may become very wheezy or feel like you’re choking or gasping for air)
• your throat feels tight or you’re struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who’s unwell may also have a rash that’s swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of ropinirole. For a full list, see the leaflet inside your medicines packet.

Information:

You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

6. How to cope with the side effects of ropinirole

What to do about:

• dizziness when you get up from sitting or lying down – try getting up very slowly, or stay sitting down until you feel better. If you still feel dizzy, lie down so you do not faint, then sit up for a while until you feel OK again. Do not drive, cycle, or operate machinery if you feel dizzy. Try to avoid alcohol as it may make you feel worse.
• feeling tired and weak – make sure you rest and drink plenty of fluids and try to avoid alcohol. Do not drive, cycle or use tools or machinery if you are feeling tired or weak. Try to take ropinirole at a time when you can sit or lie down until you feel better. If you’re still having problems after a week, speak to your doctor, as they may need to change your medicine.
• stomach pain – it can help to eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on your stomach may also help. If you are in a lot of pain, speak to a doctor or pharmacist. 
• heartburn – it might help to eat smaller and more frequent meals, and to eat and drink slowly. Talk to your doctor if the symptoms get worse.
• feeling or being sick – taking your ropinirole after a meal or a snack can help. If you are being sick, have small, frequent sips of water to avoid dehydration. Sickness should improve with time, but if it becomes a problem your doctor may be able to prescribe an anti-sickness medicine.
• feeling anxious or nervous – this should improve as your body gets used to the medicine. If it does not, or the symptoms get worse, speak to your doctor or specialist nurse.
• uncontrollable twitching or twisting movements – let your doctor or specialist nurse know as soon as possible. They may need to adjust your dose or medicine.

7. Pregnancy and breastfeeding

Pregnancy and ropinirole

Ropinirole is not often used in pregnancy. This is because there is little information about how the medicine may affect your baby. However, your doctor may advise you to take it if they think the benefits of taking the medicine outweigh any risks.

If you become pregnant while taking ropinirole, speak to your doctor as soon as possible.

Breastfeeding and ropinirole

Ropinirole is not often used when breastfeeding.

The medicine can make breastfeeding more difficult as it can reduce the amount of milk your body makes.

Non-urgent advice: Tell your doctor if you’re:

• trying to get pregnant
• pregnant
• breastfeeding

8. Cautions with other medicines

There are some medicines that do not mix well with ropinirole.

Tell your doctor, specialist nurse or pharmacist if you’re taking any of these medicines before starting ropinirole:

• anti-sickness medicines, such as metoclopramide or prochlorperazine
• antidepressants or antipsychotic medicines, such as fluvoxamine, amisulpride, risperidone or haloperiodol
• hormone replacement therapy (HRT) or contraceptives that contain high levels of oestrogen (ethinylestradiol)
• medicines that can lower your blood pressure – blood pressure medicines, tablets that make you pee more (diuretics), or erectile dysfunction medicines such as sildenafil (Viagra) or tadalafil (Cialis)
• ciprofloxacin, an antibiotic
• warfarin, to prevent blood clots (anticoagulant)

Taking painkillers with ropinirole

It’s usually OK to take mild painkillers, such as paracetamol or ibuprofen, if you need pain relief.

Check with your doctor before taking any stronger prescription painkillers (including opioids) such as codeine, morphine or tramadol).

Mixing ropinirole with herbal remedies and supplements

There’s very little information about taking herbal remedies and supplements with ropinirole. Not enough research has been done to know whether they can affect your medicine.

Important:
Medicine safety

Tell your doctor or pharmacist if you’re taking any other medicines, including herbal medicines, vitamins or supplements.

9. Common questions about ropinirole

How does ropinirole work?

Ropinirole belongs to a group of medicines called dopamine agonists. Dopamine is an important chemical which sends nerve messages from your brain to your muscles.

With Parkinson’s disease, you have less dopamine, so it’s harder for your brain to send these messages. This can give you the shakes, as well as making your muscles stiff and your movements slow.

Ropinirole works by copying natural dopamine in the brain. This helps improve movement symptoms related to low dopamine levels in the body, such as in Parkinson’s and restless legs syndrome.

How long does it take to work?

You may notice an improvement after taking your first dose. However, it can take up to 1 week for ropinirole to have its full effect.

Talk to your specialist if your symptoms do not improve after taking ropinirole for 2 to 3 weeks.

How long will I take it for?

You can keep taking this medicine as long as it’s controlling your symptoms and you’re not having any serious side effects. Many people take ropinirole for several months or even years.

Is it safe to take for a long time?

Many people take ropinirole safely for many months or years.

Ropinirole may be an effective treatment for Parkinson’s disease for several years, taken either on its own or with other Parkinson’s medicines such as co-careldopa or co-beneldopa.

However, it may not work for everyone. Speak to your doctor or specialist nurse if you feel your symptoms are getting worse – you may need to have your dose changed.

What will happen if I stop taking it?

If you stop taking ropinirole, your symptoms will return unless you are taking other medicines for Parkinson’s disease or restless legs syndrome.

Do not stop taking ropinirole suddenly. It can lead to serious withdrawal symptoms, such as changes in mood, tiredness, sweating and pain.

If you need to stop taking this medicine, your doctor or specialist nurse will reduce the dose gradually. This will help prevent withdrawal symptoms.

Can I smoke with ropinirole?

Smoking can affect the way ropinirole works.

If you stop or start smoking, or take it up again, while you’re on ropinirole, your dose may need to be adjusted. Let your doctor know if you are thinking of stopping or starting smoking.

Can I drink alcohol with it?

Drinking alcohol while taking ropinirole may make you feel sleepy or tired. When you first start taking ropinirole it’s best to stop drinking alcohol, until you see how the medicine affects you.

Is there any food or drink I need to avoid?

Apart from being careful about alcohol, you can eat and drink normally while taking ropinirole.

It is best to take ropinirole with food if you can – you’ll be less likely to feel or be sick.

Are there similar medicines to ropinirole?

Ropinirole belongs to a group of medicines called dopamine receptor agonists.

Dopamine receptor agonists fall into 2 types of medicine:

• ergot-derived dopamine agonists such as bromocriptine, cabergoline and pergolide – originally made from a type of fungus called ergot
• non ergot-derived dopamine receptor agonists such as ropinirole, pramipexole and rotigotine

Non ergot-derived dopamine receptor agonists are usually preferred, as they have fewer side effects on the heart.

There are also several other medicines that work differently to ropinirole that can be used to treat Parkinson’s disease or restless legs syndrome. So if ropinirole does not work for you, or you are bothered by side effects, speak to your doctor or specialist nurse. They may be able to discuss other options.

Will it affect my contraception?

Ropinirole does not stop contraception working, including the combined pill and emergency contraception.

However, the oestrogen (ethinylestradiol) in some contraceptives may increase the amount of ropinirole in your body, so your dose of ropinirole may need to be reduced.

Speak to your doctor or pharmacist before taking ropinirole if you are taking a contraceptive that contains oestrogen. This includes the combined pill, contraceptive patch and vaginal ring.

If ropinirole makes you vomit, your contraceptive pills may not protect you from pregnancy. Look at the pill packet to find out what to do.

Find out more about what to do if you’re on the pill and you’re being sick.

Will it affect my fertility?

There’s no evidence to suggest that taking ropinirole reduces fertility.

However, speak to a pharmacist or your doctor before taking it if you’re trying to get pregnant. Ropinirole is not usually recommended during pregnancy.

Can I drive or ride a bike?

Some people find ropinirole can make them feel dizzy or sleepy, or makes them fall asleep suddenly. This is more likely to happen when your dose is being increased. If this happens to you, do not drive, cycle or use tools or machinery.

Speak to your doctor. They will tell you when you can start driving again once these side effects stop.

If you’ve been diagnosed with Parkinson’s disease, you must tell the DVLA and your car insurance company as soon as possible.

What else can help with symptoms of Parkinson’s disease?

There’s currently no cure, but there are treatments for Parkinson’s disease to help relieve the symptoms and maintain your quality of life.

These treatments include:

• supportive therapies, such as physiotherapy or speech therapy
• medicines
• a type of surgery called deep brain stimulation

You may not need any treatment during the early stages of Parkinson’s disease, as symptoms are usually mild. But you may need regular appointments with your specialist so your condition can be monitored.

A care plan will usually be agreed with your healthcare team and you and your family or carers. This will outline the treatments and help you need now and what you’re likely to need in the future. This will need to be reviewed regularly.

Regular exercise is particularly important because it helps relieve muscle stiffness, improves mood and relieves stress. Find out more about living with Parkinson’s disease, including advice on staying active.

What else can help with restless legs syndrome?

The symptoms of restless legs syndrome will usually improve by treating the underlying cause, such as iron deficiency anaemia or cardiovascular disease.

But if the cause is unknown, the symptoms can get worse with time and severely affect your life. In this case there are other treatments for restless legs syndrome that can help.

These include:

• relaxation exercises, leg massage, or taking a hot bath in the evening
• lifestyle changes such as stopping smoking, getting more sleep, and exercise. If you want to give up smoking, talk to your doctor about the different ways to stop.

effective methods and rules of application

An article about the treatment of Parkinson’s disease with pills and how to use them correctly. Find out what pills exist and how to choose the most effective ones for Parkinson’s disease.

Parkinson’s disease is a progressive disease of the nervous system, which is manifested by impaired movement and difficulty in maintaining balance. Already today this disease is diagnosed in millions of people in the world, and every year the number of cases is only increasing. Currently, the only way to manage the disease and reduce its manifestations is the treatment with drugs that improve the patient’s quality of life and delay its progression.

Typically, specially formulated drugs in tablet form are used to treat Parkinson’s disease. The effectiveness of the course of treatment directly depends on the correctness of their use. Before you start taking medicines, you must carefully study the instructions for use and consult a professional doctor.

In this article, we will talk about how the pills help to cope with Parkinson’s disease, as well as give recommendations on the correct use of drugs, reduce the risks of possible side effects and what nuances of taking medicines should be taken into account and what indicators should be monitored during the course of treatment.

Parkinson’s disease: treatment with pills and their use

What is Parkinson’s disease

Parkinson’s disease is a neurodegenerative disease that manifests itself in the form of impaired movement and coordination. It occurs due to a decrease in the amount of dopamine in the brain, which is responsible for transmitting signals between neurons.

Positive

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Negative

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Neutral

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Tablet treatment

Tablets are the main treatment for Parkinson’s disease. They can stop or slow the progression of the disease and improve the quality of life of patients.

The drugs are divided into two groups: levodopa and non-levodopa. Levodopa is a dopamine precursor that is converted into it in the brain. Nelevodopa are other drugs that can increase dopamine levels or mimic its effects.

How to use tablets

Drugs are selected individually, depending on the severity of the symptoms and the tolerance of the patient. Non-levodopa drugs are usually prescribed first, followed by levodopa. At the initial stages of the disease, the use of monotherapy is acceptable.

When using tablets, the exact dosage must be observed and possible side effects such as nausea, dizziness, hypotension and dyskinesia should be monitored. It is also important to consider the incompatibility of tablets with certain other drugs, including tranquilizers and antidepressants.

Conclusion

The treatment of Parkinson’s disease with pills is an important and effective method of dealing with the disease. However, this method requires careful selection of drugs and compliance with the individual dosage for each patient.

What is Parkinson’s disease?

Parkinson’s disease is a chronic disease of the central nervous system that results in movement, coordination and balance disorders. It is one of the most common neurological diseases and most often manifests itself in older people.

In Parkinson’s disease, there is a loss of neurons responsible for the production of dopamine, a substance that helps control movement and coordination. This leads to the three main symptoms of the disease: trembling, congestion, and decreased muscle strength. In addition, patients may experience fatigue, muscle and joint pain, sleep problems, and digestive disturbances.

Parkinson’s disease is incurable, but drug therapy can improve patients’ quality of life and slow the progression of symptoms.

Parkinson’s Tablets

Parkinson’s disease is a neurodegenerative disorder that causes movement problems, tremors, loss of balance and coordination, and physical and mental fatigue. Various types of pills are used to treat this disease, which help reduce symptoms and slow the progression of the disease.

Levodopa

Levodopa is one of the most common medicines used to treat Parkinson’s disease. It increases the level of dopamine in the brain, which helps reduce the symptoms of the disease. Levodopa is often used in combination with other medicines, such as carbidopa, which help maintain blood levels of levodopa.

Anticholinergics

Anticholinergics block acetylcholine receptors in the brain, which may help reduce trembling and muscle stiffness in patients with Parkinson’s disease. These tablets may cause side effects such as dry mouth and difficulty urinating.

Dopamine agonists

Dopamine agonists mimic the action of dopamine in the brain to help improve coordination, balance and movement in patients with Parkinson’s disease. Some of these tablets may cause drowsiness, dizziness, and low blood pressure.

Exemplary names of tablets for the treatment of Parkinson’s disease Type of tablets Exemplary names0076

Anticholinergics Artane, Cogentin, Kemadrin Dopamine agonists Mirapex, Requip, Neupro, Apokyn

Benefits of treating Parkinson’s tablets

Parkinsonism is a complex disease that requires long-term treatment. Treating Parkinson’s with pills has many benefits.

• Fast acting: Tablets act quickly and patients notice improvement within a few days.
• Relief of symptoms: Tablets can effectively reduce shaking, slow down movements and reduce muscle tightness. They make the daily life of patients more comfortable and maintain their quality of life.
• Ease of use: Tablets are easy to take and do not require special storage conditions.
• Safety: Tablet treatment is safe and easy to use.

Depending on the severity of the symptoms and the individual patient, the doctor may prescribe different types of pills to treat parkinson’s. Patients should follow the doctor’s recommendations and not exceed the dosage of medications.

Parkinson’s treatment with pills is regarded as one of the most convenient ways to reduce symptoms and improve the quality of life of patients.

How to take the pills for Parkinson’s disease?

Parkinson’s disease is a chronic disease that progresses over time and requires ongoing medical treatment. The main drug to combat this disease is levodopa. But how to take pills for Parkinson’s disease?

It is important to take regularly. Tablets should be taken strictly at the appointed time and do not skip doses, even if the symptoms of the disease do not appear at the moment. Violation of the regimen can lead to an increase in the amount of the drug in the blood, cause side effects, or vice versa, reduce the effectiveness of treatment.

The correct dosage of must be observed. The dose of tablets should be prescribed by the attending physician, taking into account the severity of the disease, the age and weight of the patient. Often a combination of drugs is used to effectively control Parkinson’s symptoms, so you should not change the dosage yourself or stop taking any drug without consulting your doctor.

It is important to keep the interval between taking tablets. If the doctor has prescribed taking the pills at a certain time, it is necessary to observe equal intervals between doses. This regulates the amount of drug in the blood and allows you to achieve a stable level of therapeutic substance in the body.

Tell your doctor about side effects of . If you experience any side effects such as nausea, vomiting, dizziness, drowsiness while taking the medicine, you should contact your doctor. The doctor may adjust the dosage or prescribe a different drug to eliminate unwanted effects.

Side effects of Parkinson’s pills

Parkinson’s pills can be effective in managing the symptoms of the disease, but they can also have some side effects.

One of the most common side effects of these tablets is nausea. Some people may also experience vomiting, which can impair the absorption of drugs and lead to a decrease in the effectiveness of treatment.

Another potential side effect of Parkinson’s pills is difficulty urinating or worsening urinary problems. This can happen due to an increase in the flow of urine into the bladder, causing it to expand and have less control over the exit of urine from the body.

Some patients may experience allergic reactions to Parkinson’s tablets. This can be expressed in the form of a skin rash, itching or swelling. If you have an allergic reaction to the tablets, you should contact your doctor so they can prescribe a different drug.

Some Parkinson’s tablets may cause drowsiness or dizziness, which may impair working ability or increase the risk of falling. In such cases, it is best to refrain from driving or performing other cognitively limiting tasks.

Finally, in some cases, the use of Parkinson’s pills may cause problems with consciousness, such as hallucinations or disorientation. If you notice these symptoms, contact your doctor for corrective treatment.

How long should I take my Parkinson’s tablets?

The duration of taking the Parkinson’s tablets depends on the individual characteristics of each patient. The decision about when to stop taking medications should be made by your doctor.

At the initial manifestations of Parkinson’s disease, treatment may be short-term. Some patients develop symptoms suddenly and are given a course of therapy, which is then stopped. However, if the disease becomes chronic, tablets become a necessary part of the routine treatment.

If medications have been prescribed to control symptoms, continue as long as the effect of the medications persists. It is also important to understand that taking the pills should not be interrupted without the consent of the doctor, as this may lead to a deterioration in the patient’s condition.

In general, taking pills for Parkinson’s disease is a long-term process that requires regular monitoring by the doctor to adjust the dosage and take other medications if necessary.

Drugs for the treatment of Parkinson’s disease in Russia

Parkinson’s disease is a neurodegenerative disease characterized by impaired motor functions and can also lead to mental disorders. In Russia, various drugs are used to treat this disease, which are prescribed by a doctor based on the severity of the symptoms and the patient’s condition.

1. Levodopa is the most effective and widely used drug for the treatment of Parkinson’s disease in Russia. It contains levodopa, a precursor to dopamine, which helps replenish the deficiency of this neurotransmitter in the brain. The drug can be used as monotherapy or combined with other drugs.
2. Dopaminergic agonists are drugs that act on dopamine receptors in the brain. They can be used as monotherapy or in combination with levodopa. This group of drugs includes rotigotine, pramipexole, apomorphine and others.
3. Monoamine oxidase B inhibitors are drugs that reduce the breakdown of dopamine in the brain by increasing its concentration. This group of drugs includes rastegilmine, selegiline, entacapone, and others.
4. Anticholinergic drugs – may help improve shaking and muscle stiffness, but are less effective than other drugs and may cause side effects such as dry mouth or constipation. This group of drugs includes trihexyphenide, biperiden, etc.

It is important to understand that each patient may require an individual approach to treatment, and drugs may be prescribed in various combinations and dosages depending on symptoms and response to therapy.

Parkinson’s drugs in the US and Europe

Levodopa

Levodopa is one of the most popular and effective Parkinson’s drugs in the US and Europe. This drug contains dopamine, the lack of which is one of the main causes of the disease.

Levodopa reduces symptoms such as trembling and muscle stiffness and improves motor function.

Anti-Parkinsonian agonists

Anti-Parkinsonian agonists are medicines that stimulate certain receptors in the brain and thus reduce the symptoms of Parkinson’s disease. These drugs are often used in combination with Levodopa to increase its effectiveness.

Some of the most commonly used anti-Parkinsonian agonists include drugs such as Ropinirole, Pramipexole and Rotigotine.

MAO-B inhibitors

MAO-B inhibitors are drugs that help keep dopamine in the brain, slowing its breakdown. These drugs are often prescribed in the early stages of Parkinson’s disease and are also used in combination with Levodopa to increase its effectiveness.

Some of the most commonly used MAO-B inhibitors in the US and Europe include the drugs Selegiline and Rasagiline.

Alternatives to tablets for the treatment of Parkinson’s disease

Parkinson’s disease is a chronic neurological disease that leads to impaired coordination of movements and reduced motor functions. Usually, this disease is treated with pills aimed at maintaining the level of dopamine in the body.

However, along with medication, there are a number of alternative methods that can help people with Parkinson’s disease.

• Exercise and Rehabilitation – Physical exercise as well as rehabilitation activities such as massage, gymnastics, yoga and dance can help restore movement and improve quality of life.
• Acupuncture – techniques that use massage and stimulation of certain points on the body can help relieve pain and improve mood.
• Proper nutrition – Proper nutrition, balanced in protein, vitamins, fats and carbohydrates, helps maintain a healthy nervous system and general physical condition.

Although these methods are not medicinal, most are considered safe and low-cost ways to improve the quality of life of people with Parkinson’s disease. However, it is important to communicate with specialists such as physicians, physical therapists, and nutritionists for specific recommendations for each method.

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Q&A:

What is Parkinson’s disease?

Parkinson’s disease is a degenerative disease of the nervous system that results in impaired movement, persistent tremors, and other disorders.

What are the symptoms of Parkinson’s disease?

Symptoms of Parkinson’s disease include tremors, slow movements, muscle stiffness, coordination problems, memory and concentration problems, sleep and mood disturbances.

How is Parkinson’s disease treated?

Parkinson’s disease is treated with a combination of pills and exercise to help improve coordination and flexibility. Surgical treatments may also be used in severe cases.

Which tablets are used to treat Parkinson’s disease?

Levodopa, dopaminergic agonists, COMT inhibitors, MAO inhibitors, and others are commonly used to treat Parkinson’s disease. The dosage and combination of drugs depend on the severity of the symptoms and the individual characteristics of the patient.

How to use the tablets for the treatment of Parkinson’s disease?

Parkinson’s tablets should be taken as directed by your doctor. They can be taken with or without food, depending on the specific drug. It is important not to exceed the dosage and take the tablets strictly on schedule.

Can Parkinson’s disease be completely cured?

There is currently no cure for Parkinson’s disease. Treatment is aimed at improving symptoms and slowing the progression of the disease.

Self-medication for Parkinson’s disease: risk or opportunity?

The first and foremost rule in the treatment of Parkinson’s disease is not to try to choose drugs or their dosage on your own. Treatment should be prescribed only by a doctor, taking into account the individual characteristics of the patient and the stage of the disease. Only in this case can we count on a real improvement in the condition and slowing down the progression of the disease.

However, some patients search the Internet for information about the treatment of Parkinson’s disease and try various methods of self-treatment. This can have serious negative consequences, since most drugs have side effects, and improper use can lead to worsening of the condition and the development of complications.

Parkinson’s disease is a chronic disease that requires long-term and constant monitoring by a physician. Self-medication can only worsen the condition and lead to the development of complications. Patients who are already taking medication should not change the dosage on their own or interrupt the course of treatment, even if they feel better.

Of course, patients can educate themselves, learn about the disease, communicate with other patients and attend support groups. This can help them better understand their condition and reduce their anxiety levels. However, any medical advice should only be given by a qualified physician.

An integrated approach to the treatment of Parkinson’s disease

Parkinson’s disease is a chronic disease of the nervous system that leads to impaired coordination of movements and the ultimate poverty of movement. Although the treatment of Parkinson’s disease begins with medication, a comprehensive approach includes not only pharmacological therapy, but also physical and psychological support.

Medication:

Treatment for Parkinson’s disease begins with medications to help control the symptoms of the disease. The main drugs are levodopa and carbidopa, which increase dopamine levels in the brain. It is important to dose the drugs correctly and monitor their side effects.

Physical therapy:

Physical therapy can help improve coordination and muscle flexibility, as well as increase endorphins, natural pain relievers. Treatment may include exercise, massage, or yoga. The doctor may also work with the patient to develop symptom management strategies to help them cope with difficulties in daily life.

Psychological support:

For many patients, Parkinson’s disease can be physically and emotionally difficult, and can lead to reduced social activity. Psychological support can help a patient cope with emotional stress and improve quality of life by recognizing their strengths and developing strategies to maintain independence and social activity

Sample Parkinson’s treatment plan Method of treatment Goal Examples

9 0077 Physical therapy

Drug therapy	Improved symptom control	Levodopa, carbidopa
Improved coordination and flexibility of muscles	Exercise, massage, yoga
Psychological support	Coping with emotional stress and increasing social activity	Psychological counseling, strategy development

Ropinirole – description of the substance, pharmacology, use, contraindications, formula

Contents

• Structural formula

• Russian name

• English name

• Latin name

• chemical name

• Gross formula

• Pharmacological group of the substance Ropinirole

• Nosological classification

• CAS code

• pharmachologic effect

• Characteristic

• Pharmacology

• Application of Ropinirole

• Contraindications

• Application restrictions

• Use during pregnancy and lactation

• side effects of ropinirole

• Interaction

• Overdose

• Dosage and administration

• Precautionary measures

• Information sources

• Trade names with the active substance Ropinirole

Structural formula

Russian name

Ropinirole

English name

Ropinirole

Latin name

98 Ropiniroli)

Chemical name

4-(2-Dipropylaminoethyl)-1,3- Dihydodol-2-OH (in the form of hydrochloride)

gross Formula

C ₁₆ H ₂₄ N ₂ O

Pharmacological group Ropinirol

Dopaminomimetics

Antiparkinsonian drugs

Nosological classification

ICD-10 code list

CAS code

91374-21-9

Pharmacological action

Pharmacological action –

antiparkinsonian .

Characteristics

Antiparkinsonian.

Ropinirole hydrochloride is a white to yellow solid with a melting point of 243 to 250°C and a solubility in water of 133 mg/mL.

Pharmacology

Selective non-ergoline agonist of dopamine D ₂ and D ₃ receptors. A possible mechanism of action in the treatment of Parkinson’s disease is associated with a stimulating effect on postsynaptic D ₂ receptors in the basal nuclei of the brain (caudate nucleus / putamen). Ropinirole has been shown to improve motor function in animal models of Parkinson’s disease. In particular, it weakens the motor deficit caused by damage to the ascending nigrostriatal dopaminergic pathway by the neurotoxin MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine).

By compensating for dopamine deficiency, ropinirole reduces the degree of physical inactivity, rigidity and tremor, which are symptoms of parkinsonism. Ropinirole enhances the effects of levodopa, including controlling the frequency of the “on/off” phenomenon and the “end of dose” effect associated with long-term therapy with levodopa drugs, and allows you to reduce the daily dose of levodopa. Ropinirole also has an effect at the level of the hypothalamus and pituitary gland, inhibiting the secretion of prolactin.

Pharmacokinetics

Absorption. In clinical studies with ropinirole immediate-release tablets, 88% of the radiolabeled substance was found in the urine, with an absolute bioavailability of 45-55% (first-pass effect through the liver). The relative bioavailability of ropinirole in the form of sustained release tablets compared to ropinirole in the form of immediate release tablets is approximately 100%. A single dose study of ropinirole sustained release tablets in healthy volunteers showed an increase in AUC of approximately 30% and C0407 max – by about 44%. In a multiple dose study in patients with Parkinson’s disease, a fat-rich meal increased AUC by approximately 20% and C _max by approximately 44%, T _max by 3 hours. C _ss is achieved within 4 days.

Distribution. Ropinirole is well distributed throughout the tissues of the body, the apparent d “> V _d is 7. 5 l / kg. Plasma protein binding is up to 40%, the blood / plasma ratio is 1: 1.

Metabolism. Ropinirole is extensively metabolized in the liver to inactive metabolites. In vitro studies”> in vitro showed that ropinirole is metabolized mainly by the CYP1A2 isoenzyme of cytochrome P450 (It is known that this isoenzyme is induced by smoking and omeprazole; inhibited by fluvoxamine, mexiletine, such “old” fluoroquinolones as ciprofloxacin, norfloxacin).

Elimination Clearance of ropinirole after oral administration – 47 l / h, T _1/2 – approximately 6 hours Excreted by the kidneys as metabolites, less than 10% – unchanged.

Pharmacokinetics in special clinical situations

Age. Clearance of ropinirole after oral administration is reduced by approximately 15% in patients aged 65 years and older compared with younger patients (dose adjustment is not required).

Pos. Clearance values ​​are similar in women and men.

Race. There were no changes in the pharmacokinetics of ropinirole depending on race.

Impaired kidney function. Population pharmacokinetic analysis showed that the pharmacokinetics of ropinirole does not change in patients with mild to moderate renal impairment. The use of ropinirole in patients with severe renal impairment has not been evaluated.

Impaired liver function. The pharmacokinetics of ropinirole have not been studied in patients with hepatic impairment. These patients may have higher plasma levels and lower clearance of ropinirole than patients with normal hepatic function.

Clinical studies

The efficacy of ropinirole extended release tablets has been demonstrated in two randomized, double-blind, multicentre clinical trials in patients with early and advanced stages of Parkinson’s disease. One study evaluated the efficacy and safety of ropinirole versus placebo as an adjunct to levodopa therapy in patients with advanced disease who were on concomitant levodopa therapy (n=393). The second study included patients with early disease who did not receive levodopa (n=161).

Use of the substance Ropinirole

According to the State Register ¹ , ropinirole in the dosage form of tablets of prolonged action is indicated for the treatment of Parkinson’s disease – monotherapy of the early stages of the disease in patients requiring dopaminergic therapy to delay the prescription of levodopa; as part of combination therapy in patients receiving levodopa preparations, in order to increase the effectiveness of levodopa, including the control of the “on-off” phenomenon and the “end of dose” effect during chronic levodopa therapy, as well as to reduce the daily dose of levodopa.

According to the PDR (2009) ² ropinirole extended release tablet formulation is indicated for the treatment of idiopathic Parkinson’s disease.

Contraindications

Hypersensitivity.

Restrictions on use

Severe cardiovascular insufficiency (see “Precautions”), a history of psychiatric disorders (may be prescribed only if the expected benefit outweighs the potential risk), impaired liver function, severe renal impairment ( Cl creatinine <30 ml / min), pregnancy, breastfeeding, age up to 18 years (safety and efficacy in children have not been determined).

Use in pregnancy and lactation

In pregnancy possible if the expected effect of therapy outweighs the potential risk to the fetus.

FDA fetal category C.

Ropinirole inhibits human prolactin secretion and has the potential to inhibit lactation. Animal studies have shown that ropinirole and/or its metabolites are excreted into the milk of lactating rats. It is not known whether ropinirole is excreted in human breast milk.

Because many drugs are excreted in a woman’s milk and because ropinirole can cause serious adverse effects on the infant, a decision should be made to either stop breastfeeding or stop taking ropinirole (depending on the mother’s need for this drug).

Adverse effects of the substance Ropinirole

Study in patients with advanced Parkinson’s disease who are on concomitant therapy with levodopa.

The most commonly observed adverse events (?5% and greater than placebo) in patients treated with ropinirole extended release tablet formulation during the 24-week study were: dyskinesia, nausea, dizziness, hallucinations, drowsiness, pain/discomfort in abdomen, orthostatic hypotension.

Approximately 6% of 202 patients treated with ropinirole sustained release tablet formulation discontinued treatment due to side effects compared with placebo patients: 5% of 191 patient. The most common side effect leading to discontinuation of ropinirole treatment was hallucinations (2%).

The table shows the side effects observed with a frequency of ?2% in patients receiving ropinirole in the dosage form of tablets of a sustained release, and exceeding the frequency of placebo.

Table

Side effects observed in double-blind, placebo-controlled trials in the treatment of patients with advanced Parkinson’s disease (with concomitant therapy with levodopa)

900 76

9 0077 2

Body systems/Adverse reactions	Ropinirole (n=202), %	Placebo (n=191), %
Ear and labyrinth disorders
Vertigo	4	2
Gastrointestinal disorders
Nausea	11	4
Constipation	4	2
Abdominal pain/discomfort	6	3
Diarrhea	3	2
Dry mouth 2	<1
General reactions
Peripheral edema	4	1
Falls (dose-dependent effect)	2	1
Disorders of the musculoskeletal system and connective tissue e			3	2
From the side of the nervous system
Dyskinesia (dose-dependent effect)	13	3 90 078
Dizziness	8	3
Drowsiness	7	4
Psychic
Hallucinations	8	2
Anxiety	1
CCC
Orthostatic hypotension	5	1
Arterial hypotension	2	0
Hypertension (dose-dependent effect)	3	2

Study in patients with early stage Parkinson’s disease (without concomitant levodopa therapy). Nausea (19%), drowsiness (11%), abdominal pain/discomfort (7%), dizziness (6%), headache (6%), constipation (5%).

It should be borne in mind that data on side effects obtained in placebo-controlled studies cannot be used to predict the occurrence of side effects in ordinary medical practice, because. patients’ condition and other factors may differ from those prevailing in clinical trials. Similarly, the frequency of occurrence of side effects (as a percentage) given in the tables may differ from that obtained by other clinical investigators, because. each drug test may be conducted with a different set of conditions. However, these figures give the physician an idea of ​​the relative contribution of the substance itself and other factors (not related to drugs) to the development of side effects when using drugs in the population.

Interaction

in studies in vitro “> in vitro shows that Ropinirol is metabolized mainly with the participation of the CYP1A2 of the CYTOCHROM P450. Accordingly, inhibiting (for example, drugs such as ciprofloxine, fluvoxamine) or induction) CYP1A2 isoenzyme can change the clearance of ropinirole.In this regard, in the case of termination or initiation of treatment with strong inducers or inhibitors of CYP1A2 during therapy with ropinirole, dose adjustment may be necessary.0003

Ciprofloxacin. Co-administration of ciprofloxacin, a CYP1A2 inhibitor (500 mg twice daily) and ropinirole immediate-release tablets (2 mg 3 times daily) resulted in an increase in max”>C _max and AUC of ropinirole by approximately 60% and 84%, respectively (n=12 patients)

Cigarette smoking appears to increase clearance of ropinirole as smoking is known to stimulate this isoenzyme

Levodopa Co-administration of carbidopa + levodopa (10/100 mg twice per day) with ropinirole (2 mg 3 times a day) did not affect the equilibrium pharmacokinetics of ropinirole (n = 28 patients). Oral administration of ropinirole (2 mg 3 times a day) led to an increase in the equilibrium value0407 max levodopa by 20%, but did not affect AUC (n=23 patients).

Digoxin. Co-administration of ropinirole (2 mg 3 times daily) with digoxin (0.125 mg–0.25 mg 1 time daily) did not affect the steady-state pharmacokinetics of digoxin (n=10 patients).

Theophylline. A pharmacokinetic drug interaction study in 12 patients with Parkinson’s disease showed that the use of theophylline, which is a substrate of the CYP1A2 isoenzyme (300 mg twice a day) and ropinirole (2 mg 3 times a day), did not change the pharmacokinetics of ropinirole at equilibrium. Ropinirole (2 mg 3 times a day) did not affect the pharmacokinetics of theophylline (5 mg/kg IV).

Estrogens. A population pharmacokinetic analysis found that high dose estrogens (usually used in hormone replacement therapy – HRT) reduce the oral clearance of ropinirole by approximately 35% (n=16 patients). In patients who received HRT before the start of treatment with ropinirole, no dose adjustment is required, but the dose of ropinirole should be adjusted if HRT is started or stopped during treatment with ropinirole.

Dopamine antagonists. Since ropinirole is a dopamine agonist, it is possible that dopamine antagonists such as neuroleptics (phenothiazines, butyrophenones, thioxanthenes) or metoclopramide may reduce the effectiveness of ropinirole (simultaneous administration should be avoided).

Population analysis showed that commonly prescribed drugs such as selegiline, amantadine, tricyclic antidepressants, benzodiazepines, ibuprofen, thiazides, antihistamines and anticholinergics do not affect the oral clearance of ropinirole.

Overdose

Symptoms: when taken more than 24 mg/day – mainly due to dopaminergic activity (nausea, dizziness), as well as visual hallucinations, hyperhidrosis, claustrophobia, chorea, palpitations, asthenia, nightmares, vomiting, drowsiness . In addition, when taking less than 24 mg / day (or if the dose is unknown), vomiting, coughing, fatigue, fainting, incl. vasovagal, dyskinesia, agitation, chest pain, orthostatic hypotension, drowsiness, state of confusion.

Treatment: administration of dopamine antagonists such as neuroleptics or metoclopramide, maintenance therapy.

Dosage and administration

Inside . The dosage regimen is selected individually, depending on the effectiveness and tolerability of the drug. A dose reduction is recommended if the patient experiences drowsiness at any stage of dose selection. With the development of other adverse reactions, it is necessary to reduce the dose of the drug, followed by a gradual increase. It should be borne in mind the need to titrate the dose when skipping a dose (one or more). Cancellation should be carried out gradually, reducing the daily dose for at least 1 week.

In elderly patients, as well as in patients with impaired renal function, dose titration is carried out as usual, in patients with impaired liver function – with caution.

Precautions

Drowsiness and sudden sleep attacks. Patients should be warned about the possibility of drowsiness or sudden sleep episodes during therapy with ropinirole, which may lead to injury. In the event of such reactions, it is necessary to provide for the possibility of discontinuing therapy with ropinirole.

Syncope . Syncope, sometimes associated with bradycardia, has been reported during treatment with ropinirole. Thus, in a placebo-controlled study, syncope was recorded in 2 of 202 (1%) patients with an advanced stage of the disease and in none of the patients in the placebo group.

Since patients with severe cardiovascular insufficiency were not included in clinical studies of ropinirole extended release, use with caution in this category of patients (see “Restrictions for use”).

Arterial hypotension. Dopamine agonists interfere with the systemic regulation of blood pressure and may therefore lead to postural hypotension. In patients with Parkinson’s disease taking ropinirole, blood pressure monitoring is recommended. Arterial hypotension, incl. orthostatic, can develop both at the time of dose titration and during maintenance therapy.

Increased blood pressure and changes in heart rate. In a placebo-controlled trial of ropinirole in patients with advanced Parkinson’s disease, there was no significant change in mean blood pressure and heart rate in patients treated with ropinirole compared with placebo. However, a marked increase in SBP (≥40 mmHg) was recorded in the reclining position in 8% of patients in the ropinirole group compared with 5% in the placebo group, in the standing position – in 9and 6% respectively. An increase in heart rate (≥15 bpm) in the reclining position was observed in 23% of patients in the ropinirole group compared with 18% of patients in the placebo group, a decrease in heart rate (≥15 bpm) in 19 and 17% of cases respectively. In the standing position, a marked increase in heart rate (≥30 bpm) was recorded with ropinirole in 2% of cases compared with <1% placebo and a moderate decrease in heart rate (≥15 bpm) - 24 and 19% respectively.

An increase in blood pressure and a change in heart rate were observed both at the time of dose titration and during maintenance therapy.

The possibility of increased blood pressure and changes in heart rate should be considered when treating patients with cardiovascular disease with ropinirole (see “Restrictions on use”).

Hallucinations. The incidence of hallucinations is increased in patients over 65 years of age. Co-administration of entacapone and levodopa with ropinirole may also increase the risk of this adverse effect. In a placebo-controlled clinical trial, 43 patients treated with both entacapone and levodopa did not experience hallucinations; patients treated with sustained release ropinirole concomitantly with levodopa had hallucinations.patients out of 155 (6%) who received entacapone, ropinirole and levodopa at the same time – in 7 patients out of 47 (15%).

Dyskinesia. Extended release ropinirole potentiates the dopaminergic side effect of levodopa and may induce and/or exacerbate pre-existing dyskinesia in levodopa-treated patients with Parkinson’s disease. Reducing the dose of dopaminergic drugs can reduce this adverse effect.