ropinirole

ROUTE		ONSET		PEAK		DURATION
PO		unknown		unknown		8 hr

Contraindicated in:

Hypersensitivity;
Major psychotic disorder;
Impulsive control/compulsive behaviors.

Use Cautiously in:

Hepatic impairment (slower titration may be required);
Severe cardiovascular disease;
OB: Safety not established in pregnancy;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Safety and effectiveness not established in children;
Geri: ↑risk of hallucinations in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

CV: orthostatic hypotension, hypertension, peripheral edema, syncope

Derm: sweating

EENT: abnormal vision

GI: constipation, dry mouth, dyspepsia, nausea, vomiting

Neuro: dizziness, syncope, aggression, agitation, confusion, delirium, delusions, disorientation, drowsiness, dyskinesia, fatigue, hallucinations, headache, impulse control disorders (gambling, sexual, uncontrolled spending, binge/compulsive eating), insomnia, paranoid ideation, psychosis, SLEEP ATTACKS, somnolence, weakness

Interactions ⬆ ⬇

Drug-drug:

CYP1A2 inhibitors, including ciprofloxacin, may ↑ levels and risk of toxicity.
CYP1A2 inducers, including cigarette smoke, may ↓ levels and effectiveness.
Estrogens may ↑ levels and risk of toxicity.
Phenothiazines, butyrophenones, thioxanthenes, or metoclopramide may ↓ effectiveness.
May ↑ effects of levodopa; consider ↓ dose of levodopa.

Route/Dosage ⬆ ⬇

Parkinson Disease

PO (Adults ): Immediate release: 0.25 mg 3 times daily for 1 wk, then 0.5 mg 3 times daily for 1 wk, then 0.75 mg 3 times daily for 1 wk, then 1 mg 3 times daily for 1 wk; then may ↑ by 1.5 mg/day every wk up to 9 mg/day; then may ↑ by up to 3 mg/day every wk up to 24 mg/day; Extended release: 2 mg once daily for 1–2 wk; may ↑ by 2 mg/day; do not exceed 8 mg/day in patients with advanced Parkinson disease or 12 mg/day in patients with early Parkinson disease.

Renal Impairment

PO (Adults ): Hemodialysis: Immediate release: 0.25 mg 3 times daily; may ↑ dose as needed based on response and tolerability (not to exceed 18 mg/day).

Restless Leg Syndrome

PO (Adults ): Immediate release: 0.25 mg once daily initially, 1–3 hr before bedtime. After 2 days, ↑ to 0.5 mg once daily and then to 1 mg once daily by the end of first wk of dosing; then ↑ by 0.5 mg weekly, up to 4 mg/day as needed/tolerated.

Renal Impairment

PO (Adults ): Hemodialysis: Immediate release 0.25 mg once daily; may ↑ dose as needed based on response and tolerability (not to exceed 3 mg/day).

Availability ⬆ ⬇

(Generic available)

Immediate-release tablets: 0.25 mg; 0.5 mg; 1 mg; 2 mg; 3 mg; 4 mg; 5 mg
Extended-release tablets: 2 mg; 4 mg; 6 mg; 8 mg; 12 mg

Assessment ⬆ ⬇

Assess BP and HR periodically during therapy.
Assess for drowsiness, sleep disorders, and concurrent use of sedating medications or alcohol. If significant daytime sleepiness or falling asleep during activities that require active participation occurs, ropinirole may be discontinued.
Assess for signs/symptoms of psychosis (confusion, paranoid ideation, delusions, hallucinations, disorientation, aggression, agitation, delirium) and ask specifically about impulsive and compulsive behaviors (gambling, binges, ↑ sexual urges). If psychosis or inability to control urges occurs, consider ↓ dose or discontinue ropinirole.
Parkinson Disease: Assess for signs/symptoms of Parkinson disease (tremor, muscle weakness and rigidity, ataxic gait) prior to and during therapy.
Restless Leg Syndrome: Assess sleep patterns and frequency of restless leg events.
Monitor for augmentation (earlier onset of symptoms in the evening or afternoon), ↑ in symptoms, spread of symptoms to other extremities, and rebound (new onset of symptoms in the early-morning hours). If signs/symptoms occur, consider dose adjustment or discontinuation of therapy.

Lab Test Considerations:

May ↑ BUN.

Implementation ⬆ ⬇

Do not confuse ropinirole with Risperdal or risperidone.
PO: May be administered without regard to food. Administration with food may ↓ nausea. DNC: Swallow extended-release tablets whole; do not break, crush, or chew.
Taper or discontinuation may cause withdrawal symptoms (apathy, anxiety, depression, fatigue, insomnia, sweating, pain); symptoms do not respond to levodopa. Trial readministration of ropinirole at lowest dose may be considered.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Instruct patient to take missed doses as soon as possible; omit if almost time for next dose. Do not double doses or stop abruptly; may cause hyperpyrexia and confusion.
Caution patient to change positions slowly to minimize symptoms of orthostatic hypotension and to notify health care provider if syncope related to bradycardia occurs. Older patients are at ↑ risk.
Inform patient that ropinirole may cause falling asleep while engaged in activities of daily living, including the operation of motor vehicles, conversations, and eating. Notify health care provider if periods of daytime sleepiness occur.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications, including alcohol and other CNS depressants.
Advise patient that fluids, sugarless gum or candy, ice, or saliva substitutes may help minimize dry mouth. Consult health care provider if dry mouth continues for >2 wk.
Advise patient to have periodic skin exams to check for lesions that may be melanoma.
Advise patient to notify health care provider if new or ↑ gambling, sexual, or other impulse control disorders or psychotic-like behaviors occur.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding. Advise patients that ropinirole could inhibit lactation.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇