Ropinirole

DEA Class;  Rx

Common Brand Names; Requip, Requip XL

• Nausea (40-60%)
• Dizziness (6-40%)
• Somnolence (11-40%)
• Syncope (1-12%)
• Vomiting (12%)
• Fatigue (8-11%)
• Viral infection (11%)
• Dyspepsia (10%)
• Falls (10%)
• Hypertension (5%)
• Flushing (3%)
• Orthostasis (1-6%)
• Chest pain (4%)
• Palpitation (3%)
• Extrasystoles (2%)
• Tachycardia (2%)
• Hyperhidrosis (3%)
• Abnormal pain (3-7%)
• Anorexia (4%)
• Flatulence (3%)
• Malaise (3%)
• Hypoesthesia (4%)
• Urinary tract infection (5%)
• Impotence (3%)
• Alkaline phosphatase (3%)
• Abnormal vision (6%)
• Xerophthalmia (2%)
• Increased diaphoresis (3-6%)

Risk of somnolence associated with use for restless legs syndrome, as well as (rare) risk of syncope, hypotension, and hallucinations

May cause psychotic-like behavior; abnormal thinking and behavior can consist of one or more of a variety of manifestations including paranoid ideation, delusions, hallucinations, confusion, disorientation, aggressive behavior, agitation, and delirium; risk may be increased in the elderly; consider dose reduction or stopping the medication if a patient develops psychiatric symptoms while taking the medication

Risk of orthostatic hypotension with extended-release formulation

Possible risk of erratic behavior associated with dopamine agonists, compulsive behavior including urge to gamble and increased sexual urges

Potential for elevation in blood pressure and changes in heart rate should be considered when treating patients with cardiovascular disease with extended release formulation

Dyskinesia seen with concurrent use of levodopa

Increased risk of melanoma development and pleural retroperitoneal fibrosis reported, but causation not established; monitoring warranted

Use caution in patients with history of hepatic/renal impairment, psychotic disorders, dyskinesias, restless leg syndrome

In patients with advanced Parkinson’s disease dyskinesia may occur

Pregnancy

There are no adequate data on developmental risk associated with use in pregnant women; in animal studies, ropinirole had adverse effects on development when administered to pregnant rats at doses similar to (neurobehavioral impairment) or greater than (teratogenicity and embryolethality at >36 times) maximum recommended human dose (MRHD) for Parkinson’s disease

Lactation

There are no data on presence of ropinirole in human milk, the effects of ropinirole on breastfed infant, or effects of ropinirole on milk production; however, inhibition of lactation is expected because ropinirole inhibits secretion of prolactin in humans; ropinirole or metabolites, or both, are present in rat milk