Ropinirole Disease Interactions

Neuroleptic malignant syndrome (NMS) has not occurred during administration of ropinirole, however, the syndrome has rarely been precipitated by rapid dosage reduction, abrupt discontinuation, or changes in other dopamine agonist therapy.

Dopamine agonists may impair the systemic regulation of blood pressure, with resultant orthostatic hypotension at any time, but especially during dose escalation. Additionally, patients with Parkinson's disease may have an impaired capacity to respond to an orthostatic challenge. For these reasons, patients with Parkinson's disease (or restless legs syndrome) who are being treated with dopaminergic agonists typically require careful monitoring for signs/symptoms of orthostatic hypotension, especially during dose escalation, and should be advised of this risk.

Ordinarily, patients with major psychotic disorder should not be treated with dopaminergic antiparkinsonian agents, because of the risk of exacerbating psychosis. Hallucinations and psychotic-like behavior have been reported with dopaminergic medications. In addition, certain medications used to treat psychosis may exacerbate the symptoms of Parkinson's disease and may decrease the effectiveness of these drugs. The use of bromocriptine in patients with severe psychotic disorders is not recommended.

The trials of ropinirole excluded patients with significant cardiovascular disease, hence patients with cardiovascular conditions should be treated with caution.

The pharmacokinetic disposition of ropinirole has not been studied in patients with hepatic impairment, however, the serum concentration of ropinirole may be increased and the elimination half-life prolonged in these patients. Therapy with ropinirole should be administered cautiously in patients with hepatic impairment, and dosages titrated according to patient parameters and clinical tolerability.

Ropinirole is primarily eliminated by the kidney. Less than 10% of ropinirole is excreted unchanged in the urine. No dose adjustment is necessary in patients with moderate renal impairment (CrCl 30 to 50 mL/min). For patients with end-stage renal disease on hemodialysis, a reduced maximum dose is recommended.