Requip-XL Side Effects

Please note - some side effects for Requip-XL may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

Requip-XL Side Effects - for the Professional

Requip-XL

The following adverse reactions are described in more detail in the Warnings and Precautions section of the label:

• Falling asleep during activities of daily living (5.1)
• Syncope (5.2)
• Symptomatic hypotension, hypotension, postural/orthostatic hypotension (5.3)
• Elevation of blood pressure and changes in heart rate (5.4)
• Hallucination (5.5)
• Dyskinesia (5.6)
• Major psychotic disorders (5.7)
• Events with dopaminergic therapy (5.8)
• Retinal pathology (5.9)

Clinical Trial Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug (or of another development program of a different formulation of the same drug) and may not reflect the rates observed in practice.

During the premarketing development of REQUIP XL, patients with advanced Parkinson’s disease received REQUIP XL or placebo as adjunctive therapy in 1 clinical trial. In a second trial, patients with early Parkinson’s disease were treated with REQUIP XL or the immediate-release formulation of REQUIP without L-dopa.

Advanced Parkinson’s Disease (With L-dopa): The most commonly observed adverse reactions (≥5% and numerically greater than placebo) in the 24-week, double-blind, placebo-controlled trial for the treatment of advanced Parkinson’s disease during treatment with REQUIP XL were, in order of decreasing incidence: dyskinesia, nausea, dizziness, hallucination, somnolence, abdominal pain/discomfort, and orthostatic hypotension.

Approximately 6% of 202 patients treated with REQUIP XL discontinued treatment due to adverse event(s) compared with 5% of 191 patients who received placebo. The adverse event most commonly causing discontinuation of treatment with REQUIP XL was hallucination (2%).

Table 2 lists adverse reactions that occurred with a frequency of at least 2% (and were numerically greater than placebo) in patients with advanced Parkinson’s disease treated with REQUIP XL who participated in the 26-week, double-blind, placebo-controlled study. In this study, either REQUIP XL or placebo was used as an adjunct to L -dopa. Adverse reactions were generally mild or moderate in intensity.

*Dose-related.

Although this study was not designed for optimally characterizing dose-related adverse reactions, there was a suggestion (based upon comparison of incidence of adverse reactions across dose ranges for REQUIP XL and placebo) that the incidence for dyskinesia, hypertension, and fall was dose-related to REQUIP XL.

The incidence for many adverse reactions with REQUIP XL treatment was increased relative to placebo (i.e., REQUIP XL % - Placebo % = treatment difference ≥2%) in either the titration or maintenance phases of the study. During the titration phase, an increased incidence (shown in descending order of % treatment difference) was observed for dyskinesia, nausea, abdominal pain/discomfort, orthostatic hypotension, dizziness, vertigo, hypertension, peripheral edema, and dry mouth. During the maintenance phase, an increased incidence was observed for dyskinesia, nausea, dizziness, hallucination, somnolence, fall, hypertension, abnormal dreams, constipation, chest pain, bronchitis, and nasopharyngitis. Some adverse reactions developing in the titration phase persisted (≥7 days) into the maintenance phase. These “persistent” adverse reactions included dyskinesia, hallucination, orthostatic hypotension, and dry mouth.

The incidence of adverse reactions was not clearly different between women and men.

Early Parkinson’s Disease (Without L-dopa): The most commonly observed adverse reactions (≥5%) in the 36-week early Parkinson’s disease trial during treatment with REQUIP XL were, in order of decreasing incidence: nausea (19%), somnolence (11%), abdominal pain/discomfort (7%), dizziness (6%), headache (6%), and constipation (5%). The type of adverse reactions and the frequency (i.e. incidence) with which they occurred were generally similar over the whole treatment period in this study of early Parkinson’s disease patients who were initially treated with REQUIP XL or the immediate-release formulation of REQUIP and subsequently crossed over to treatment with the other formulation.

During the titration phase, an increased incidence with REQUIP XL compared with the immediate-release formulation of REQUIP (i.e., REQUIP XL % - REQUIP IR % = treatment difference ≥2%), shown in descending order of % treatment difference, was observed for: constipation, hallucination, vertigo, abdominal pain/discomfort, nausea, vomiting, fall, headache, diarrhea, pyrexia, and flatulence. During the maintenance phase, an increased incidence was observed for fall, myalgia, and sleep disorder. Several adverse reactions developing in the titration phase persisted (≥7 days) into the maintenance phase. These “persistent” adverse reactions included: constipation, hallucination, muscle spasms, flatulence, insomnia, sleep disorder, abdominal pain/discomfort, cough, and nasopharyngitis.

Adverse Reactions Observed During the Clinical Development of the Immediate-Release Formulation of REQUIP for Parkinson’s Disease (Advanced and Early)

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug (or of another development program of a different formulation of the same drug) and may not reflect the rates observed in practice.

In patients with advanced Parkinson’s disease who were treated with the immediate-release formulation of REQUIP, the most common adverse reactions (≥5% treatment difference from placebo; presented in order of decreasing treatment difference frequency) were dyskinesia (21%), somnolence (12%), nausea (12%), dizziness (10%), confusion (7%), hallucinations (6%), headache (5%), and increased sweating (5%). In patients with early Parkinson’s disease who were treated with the immediate-release formulation of REQUIP, the most common adverse reactions (≥5% treatment difference from placebo; presented in order of decreasing treatment difference frequency) were nausea (38%), somnolence (34%), dizziness (18%), syncope (11%), viral infection (8%), fatigue (7%), leg edema (6%), asthenia (5%), and dyspepsia (5%).

Side Effects by Body System - for Healthcare Professionals

Gastrointestinal

Gastrointestinal side effects have included nausea (12% to 60%), vomiting (12%), abdominal pain (6% to 7%), constipation (5% to 6%), dyspepsia (4% to 5%), diarrhea (5%), anorexia (4%), and flatulence (3%). These side effects may be decreased by taking the drug with food. Gastroesophageal reflux disease, stomach discomfort, abdominal adhesions, abdominal discomfort, abdominal distension, abdominal pain lower, duodenal ulcer, dysphagia, eructation, gastric disorder, gastric hemorrhage, gastric polyps, gastric ulcer, gastrointestinal pain, gastrointestinal infection, hemorrhoids, hiatus hernia, intestinal obstruction, irritable bowel syndrome, loose stools, mouth ulceration, pancreatitis acute, peptic ulcer, rectal hemorrhage, and reflux esophagitis have also been reported. Biliary pain, hemorrhagic gastritis, hematemesis, and salivary duct obstruction have been reported rarely.

Nervous system

Nervous system side effects have included dyskinesia (21% to 34%), dizziness (6% to 26%), headache (5% to 17%), falls (10%), paresthesia (5%), hypokinesia (5%), hypesthesia (4%), hyperkinesia (2%) and vertigo (2%). Neuralgia, involuntary muscle contractions, hypertonia, dysphonia, abnormal coordination, extrapyramidal disorder, migraine, choreoathetosis, coma, stupor, aphasia, convulsions, hypotonia, peripheral neuropathy, and paralysis have also been reported. Grand mal convulsions, hemiparesis, and hemiplegia have been reported rarely.

Psychiatric

Sixty cases of sudden onset of sleep have been reported. Two of these cases have been reported to have lead to fatal car accidents. Patients should be advised that sudden sleep has been reported without warning signs. Patients should be warned against driving or performing other activities which may put the patient or others in danger if drowsiness or sudden sleep were to occur. If drowsiness or sudden sleep does occur, patients should be advised that they should immediately contact their physicians.

Psychiatric side effects have included somnolence (11% to 40%), confusion (5% to 9%), hallucination (5% to 6%), amnesia (3%), yawning (3%), and impaired concentration (2%). Hallucinations appear to be dose related. Anxiety, depression, irritability, sleep disorder, abnormal dreams, agitation, bruxism, confusional state, depressed mood, disorientation, early morning awakening, libido decreased, loss of libido, mood swings, nervousness, nightmare, panic attack, manic reaction, somnambulism, aggressive reaction, neurosis, stress symptoms, and tension have also been reported. Suicide attempt has been reported rarely. Impulse control symptoms, pathological (compulsive) gambling, increased libido including hypersexuality have been reported principally in Parkinson's disease patients treated with dopaminergic drugs, especially at higher doses.

Cardiovascular

Cardiovascular effects have included syncope (11% to 12%), orthostatic symptoms (6%), hypertension (5%), hypotension (2%), palpitation (3%), tachycardia (2%), atrial fibrillation (2%), and extrasystoles (2%). Peripheral ischemia, atherosclerosis, acute coronary syndrome, angina pectoris, angina unstable, bradycardia, cardiac failure, cardiovascular disorder, coronary artery disease, myocardial infarction, sick sinus syndrome, circulatory collapse, and thrombosis have also been reported.

Immunologic

Immunologic side effects have included viral infection (8% to 11%).

General

General side effects have included fatigue (7% to 11%), pain (8%), leg edema (6% to 7%), asthenia (5% to 6%), dependent edema (6%), and chest pain (4%). Hematoma, flushing, and varicose vein have also been reported.

Respiratory

Respiratory side effects have included pharyngitis (6%), rhinitis (4%), sinusitis (4%), bronchitis (3%), cough (3%), and dyspnea (3%). Nasal congestion, asthma, epistaxis, laryngitis, pneumonia, respiratory tract infection, tonsillitis, pleurisy, and pulmonary edema have also been reported.

Ocular

Ocular side effects have included abnormal vision (6%), eye abnormality (3%), diplopia (2%), and xerophthalmia (2%). Conjunctivitis, abnormal lacrimation, blepharitis, glaucoma, abnormal accommodation, blepharospasm, eye pain, photophobia, conjunctival hemorrhage, eye irritation, keratoconjunctivitis sicca, vision blurred, visual acuity reduced, and visual disturbance have also been reported. Scotoma has been reported rarely.

Metabolic

Metabolic side effects have included increases in alkaline phosphatase and BUN. Weight decrease/ increase, hypoglycemia, increased LDH, hyperphosphatemia, hyperuricemia, diabetes mellitus, glycosuria, hypokalemia, hypercholesterolemia, hyperkalemia, acidosis, hyponatremia, thirst, increased CPK, and dehydration. Hypochloremia has been reported rarely.

Genitourinary

Genitourinary side effects have included Impotence (3%). Amenorrhea, vaginal hemorrhage, vaginal infection, penile disorder, prostatic disorder, balanoposthitis, epididymitis, perineal pain, dysuria, micturition frequency, albuminuria, nocturia, polyuria, and renal calculus have also been reported. Breast enlargement, mastitis, uterine hemorrhage, ejaculation disorder, Peyronie's disease, pyelonephritis, acute renal failure, and uremia have been reported rarely.

Other

Other side effects have included increased sweating (5%).

When ropinirole was administered concomitantly with L-dopa to patients with advanced Parkinson's disease, dyskinesia (13% to 34%), nausea (11% to 30%), dizziness (8% to 26%), somnolence (7% to 20%), headache (17%), hallucinations (8% to 10%), falls (10%), abdominal pain (6% to 9%), confusion (9%), increased sweating (7%), vomiting (7%), increased drug level (7%), arthralgia (7%), tremor (6%), anxiety (2% to 6%), urinary tract infection (6%), constipation (4% to 6%), dry mouth (2% to 5%), pain (5%), hypokinesia (5%), paresthesia (5%), diarrhea (3% to 5%), amnesia (5%), nervousness (5%), orthostatic hypotension (5%), peripheral edema (4%), vertigo (4%), back pain (3%), hypertension (3%), hypotension (2%), insomnia, injury, aggravated Parkinsonism, viral infection, abnormal dreams, bronchitis, vertigo, pyrexia, flatulence, nasopharyngitis, myalgia, and sleep disorder have been reported.

Musculoskeletal

Musculoskeletal side effects have included arthralgia, myalgia, muscle spasms, neck pain, osteoarthritis, tendonitis, bone pain, bursitis, groin pain, intervertebral disc degeneration, intervertebral disc protrusion, joint stiffness, joint swelling, localized osteoarthritis, muscle contracture, muscle twitching, osteoporosis, rotator cuff syndrome, sacroiliitis, synovitis, polymyalgia rheumatica, skeletal pain, torticollis, and pain in extremity. Dupuytren's contracture requiring surgery has been reported rarely.

Dermatologic

Dermatologic side effects have included hyperhidrosis, night sweats, and rash. Pruritus, dermatitis, eczema, skin ulceration, alopecia, acne, actinic keratosis, skin hypertrophy, skin discoloration, urticaria, fungal dermatitis, furunculosis, hyperkeratosis, photosensitivity reaction, psoriasis, maculopapular rash, psoriasiform rash, and seborrhea have been reported infrequently.

Hematologic

Hematologic side effects have been reported rarely. These have included purpura, thrombocytopenia, hematoma, vitamin B12 deficiency, hypochromic anemia, eosinophilia, leukocytosis, leukopenia, lymphocytosis, lymphopenia, and lymphedema.

Endocrine

Endocrine side effects have infrequently included hypothyroidism, gynecomastia, and hyperthyroidism. Goiter and SIADH have been reported rarely.

Other

Cases of retroperitoneal fibrosis, pulmonary infiltrates, pleural effusion, pleural thickening, pericarditis, and cardiac valvulopathy have been reported in some patients treated with ergot-derived dopaminergic agents. Complete resolution of symptoms did not always occur upon discontinuation of the drug.

Other side effects have included fibrotic complications, including pleural effusions, pleural fibrosis, interstitial lung disease, and cardiac valvulopathy, although causal relationship was not established.

Hepatic

Hepatic side effects have included cholecystitis colitis, cholelithiasis, ischemic hepatitis, and increased hepatic enzymes.

Oncologic

Oncologic side effects have included malignant breast neoplasm, bladder, carcinoma, benign brain neoplasm, esophageal carcinoma, malignant laryngeal neoplasm, lipoma, rectal carcinoma, and uterine neoplasm. Anaplastic thyroid cancer, angiomyolipoma, basal cell carcinoma, gastric cancer, gastrointestinal stromal tumor, malignant melanoma, prostate cancer, skin papilloma, squamous cell carcinoma, and uterine leiomyoma have also been reported.

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