Ropinirole adverse effects

Dopamine receptor agonists. Deficient dopaminergic transmission in the striatum can be compensated by ergot derivatives (bromocriptine p. 114], lisu-ride, cabergoline, and pergolide) and nonergot compounds (ropinirole, prami-pexole). These agonists stimulate dopamine receptors (D2, D3, and D sub-types), have lower clinical efficacy than levodopa, and share its main adverse effects. 

Because of these adverse effects, the drugs are generally first administered at low doses and then the dose is gradually increased over weeks or months as tolerance to the adverse effects develops. These symptoms are generally less frequent and less severe with pramipexole and ropinirole, which allows for a more rapid achievement of therapeutic response. Also, because pramipexole and ropinirole are better tolerated, they are increasingly used as monotherapy. 

PRAMIPEXOLE, ROPINIROLE H2-RECEPTOR BLOCKER-CIMETIDINE T efficacy and adverse effects of pramipexole 1 renal excretion of pramipexole by inhibition of cation transport system. Inhibition of CYP1A2-mediated metabolism of ropinirole Monitor closely i dose of pramipexole may be required. Adjust dose of ropinirole as necessaiy or use alternative acid suppression, e.g. H2 antagonist proton pump inhibitor (not omeprazole or lansoprazole)... 

In a systematic review of randomized controlled trials of pramipexole and ropinirole, dizziness, nausea, hypotension, hallucinations, and somnolence were common adverse effects (1). In 306 patients adverse events secondary to pramipexole that occurred in over 10% included... 

Ciprofloxacin, an inhibitor of CYP1A2, the major enzyme whereby ropinirole is metabolized, increased the risk of ropinirole-induced adverse effects (nausea, somnolence, dizziness) (8). 

Pramipexole is initiated at a dose of 0.125 mg three times a day and increased every 5 to 7 days as tolerated. In a fixed-dose study, daily doses of 3, 4.5, and 6 mg were not more effective than 1.5 mg/day, and the higher doses were associated with a higher frequency of adverse effects. When switching from bromocriptine or pergolide to pramipexole, a 10 1 and 1 1 dosage substitution is recommended, respectively. Ropinirole is initiated at 0.25 mg three times a day and increased by 0.25 mg three times a day on a weekly basis to a maximum of 24 mg/day. The dose of dopaminergic agonists is best determined by slow titration to enhance tolerance and to find the least dose that provides optimal benefit. 

Population pharmacokinetic analysis of clinical study data showed that estrogens (mainly ethinylestradiol ) used in HRT reduced ropinirole clearance by one-third.In another analysis it was found that women taking HRT received a slightly lower daily dose of ropinirole than those not on HRT, with no difference in adverse effects. Therefore, in women already receiving HRT, ropinirole treatment may be started using the usual dose titration.However, it is suggested that a reduction in the ropinirole dosage may be needed if HRT is started, and an increase if it is withdrawn. 

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