";s:4:"text";s:4540:" If you log out, you will be required to enter your username and password the next time you visit. Parkinson Disease Immediate release. and formulary information changes.
Diseases & Conditions
2002
Immediate release: 0.25 mg/day PO 1-3 hr before bedtime; after day 2, may be increased to 0.5 mg/day PO; at end of week 1, increased to 1 mg/day, then increased weekly by 0.5 mg/day up to 4 mg/day See Administration for discontinuation instructionsKnown hypersensitivity/allergic reaction (including urticaria, angioedema, rash, pruritus) to ropinirole or to any of the excipientsRisk of somnolence associated with use for restless legs syndrome, as well as (rare) risk of syncope, hypotension, and hallucinationsMay 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 medicationRisk of orthostatic hypotension with extended-release formulationPossible risk of erratic behavior associated with dopamine agonists, compulsive behavior including urge to gamble and increased sexual urgesPotential for elevation in blood pressure and changes in heart rate should be considered when treating patients with cardiovascular disease with extended release formulationIncreased 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 syndromeIn patients with advanced Parkinson’s disease dyskinesia may occurAbrupt withdrawal or significant dosage reduction associated with syndrome resembling neuroleptic malignant syndrome (characterized by elevated temperature, muscular rigidity, altered consciousness, and autonomic instability); see Administration section for how to gradually discontinue drugBefore initiating treatment, patients should be advised of potential to develop drowsiness and specifically asked about factors that may increase risk such as concomitantly taking sedating medications or alcohol; the presence of sleep disorders (other than RLS), and concomitant medications that increase ropinirole plasma levels (e.g., ciprofloxacin); if patient develops significant daytime sleepiness or episodes of falling asleep during activities that require active participation (e.g., driving a motor vehicle, conversations, eating); therapy should be discontinued; if decision is made to continue therapy patients should be advised to not drive and avoid other potentially dangerous activities; there is insufficient information to establish whether dose reduction will eliminate episodes of falling asleep while engaged in activities of daily livingPatients with Parkinson’s disease may have impaired ability to respond normally to a fall in blood pressure after standing from lying down or seated position; patients receiving therapy should be monitored for signs and symptoms of orthostatic hypotension, especially during dose escalation, and should be informed of risk for syncope and hypotensionThere 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 diseaseThere 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 milkDevelopmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant from ropinirole or from the underlying maternal conditionA: Generally acceptable.
2002
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