Ropinirole Disease Interactions

Dopamine agonists may impair the systemic regulation of blood pressure, with resultant orthostatic hypotension, especially during dose escalation. Therapy with dopamine agonists should be monitored carefully in patients with Parkinson's disease since they may have an impaired ability to respond to an orthostatic challenge, and also in patients receiving antihypertensive drugs.

Ordinarily, patients with major psychotic disorder should not be treated with dopaminergic antiparkinson 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.

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.

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.