l CONTRA-INDICATIONS Avoid in pre-eclampsia . cardiac
valvulopathy (exclude before treatment). history of
pericardial fibrotic disorders . history of puerperal
psychosis . history of pulmonary fibrotic disorders . history
of retroperitoneal fibrotic disorders
l CAUTIONS Cardiovascular disease . history of peptic ulcer
(particularly in acromegalic patients). history of serious
mental disorders (especially psychotic disorders). Raynaud’s syndrome
▶ Hyperprolactinemic patients In hyperprolactinaemic patients,
the source of the hyperprolactinaemia should be
established (i.e. exclude pituitary tumour before
l INTERACTIONS → Appendix 1: dopamine receptor agonists
dysfunction . sleep disorders . vertigo . vomiting
▶ Uncommon Delusions . erythromelalgia . hepatic function
abnormal . psychotic disorder.rash .respiratory disorders
l ALLERGY AND CROSS-SENSITIVITY Cabergoline should not
be used in patients with hypersensitivity to ergot alkaloids.
l CONCEPTION AND CONTRACEPTION Exclude pregnancy
before starting and perform monthly pregnancy tests
during the amenorrhoeic period. Caution—advise nonhormonal contraception if pregnancy not desired.
Discontinue 1 month before intended conception
(ovulatory cycles persist for 6 months).
l PREGNANCY Discontinue if pregnancy occurs during
treatment (specialist advice needed).
l BREAST FEEDING Suppresses lactation; avoid breastfeeding if lactation prevention fails.
l HEPATIC IMPAIRMENT Manufacturer advises caution in
severe impairment (risk of increased of exposure).
Dose adjustments Manufacturer advises consider dose
reduction in severe impairment.
▶ Monitor for fibrotic disease.
▶ Monitor blood pressure for a few days after starting
treatment and following dosage increase.
l TREATMENT CESSATION Antiparkinsonian drug therapy
should never be stopped abruptly as this carries a small
risk of neuroleptic malignant syndrome.
l PRESCRIBING AND DISPENSING INFORMATION Dispense in
original container (contains desiccant).
Driving and skilled tasks Sudden onset of sleep Excessive
daytime sleepiness and sudden onset of sleep can occur
with dopamine-receptor agonists.
Patients starting treatment with these drugs should be
warned of the risk and of the need to exercise caution
when driving or operating machinery. Those who have
experienced excessive sedation or sudden onset of sleep
should refrain from driving or operating machines until
these effects have stopped occurring.
Management of excessive daytime sleepiness should
focus on the identification of an underlying cause, such as
depression or concomitant medication. Patients should be
counselled on improving sleep behaviour.
Hypotensive reactions Hypotensive reactions can occur in
some patients taking dopamine-receptor agonists; these
can be particularly problematic during the first few days of
treatment and care should be exercised when driving or
BNF 78 Parkinson’s disease 421
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 10, 21
▶ Cabergoline (Non-proprietary)
Cabergoline 500 microgram Cabergoline 500microgram tablets | 8 tablet P £34.99 DT = £34.97
Cabergoline 1 mg Cabergoline 1mg tablets | 20 tablet P £66.00
Cabergoline 2 mg Cabergoline 2mg tablets | 20 tablet P £73.14
Cabergoline 1 mg Cabaser 1mg tablets | 20 tablet P £83.00 DT =
Cabergoline 2 mg Cabaser 2mg tablets | 20 tablet P £83.00 DT
Cabergoline 500 microgram Dostinex 500microgram tablets |
Monotherapy in Parkinson’s disease where dopaminereceptor agonists other than ergot derivative not
▶ Adult: Initially 50 micrograms once daily for day 1,
dose to be taken at bedtime, then 50 micrograms twice
daily for days 2–4, then increased in steps of
100–250 micrograms daily, dose to be increased at
intervals of 3–4 days, increased to 1.5 mg daily in
3 divided doses at day 28, then increased in steps of up
to 250 micrograms every 3–4 days, this increase to be
started after day 30; maintenance 2.1–2.5 mg daily;
Adjunctive therapy with co-beneldopa or co-careldopa in
Parkinson’s disease where dopamine-receptor agonists
other than ergot derivative not appropriate
▶ Adult: Initially 50 micrograms daily for 2 days, then
increased in steps of 100–150 micrograms every 3 days,
dose to be adjusted over next 12 days following initial
dose and usually given in 3 divided doses, then
increased in steps of 250 micrograms every 3 days,
during pergolide titration, levodopa dose may be
reduced cautiously; maximum 3 mg per day
Pergolide has been associated with pulmonary,
retroperitoneal, and pericardial fibrotic reactions.
Exclude cardiac valvulopathy with echocardiography
before starting treatment with pergolide; it may also be
appropriate to measure the erythrocyte sedimentation
rate and serum creatinine and to obtain a chest X-ray.
Patients should be monitored for dyspnoea, persistent
cough, chest pain, cardiac failure, and abdominal pain or
tenderness. If long-term treatment is expected, then
lung-function tests may also be helpful. Patients taking
pergolide should be regularly monitored for cardiac
fibrosis by echocardiography (within 3–6 months of
initiating treatment and subsequently at 6–12 month
Treatment with dopamine-receptor agonists is
associated with impulse control disorders, including
pathological gambling, binge eating, and hypersexuality.
Patients and their carers should be informed about the
risk of impulse control disorders. There is no evidence
that ergot- and non-ergot-derived dopamine-receptor
agonists differ in their propensity to cause impulse
recommended. If the patient develops an impulse
control disorder, the dopamine-receptor agonist or
levodopa should be withdrawn or the dose reduced until
l CONTRA-INDICATIONS Cardiac valvulopathy (exclude
before treatment). history of fibrotic disorders
confusion . psychosis . underlying cardiac disease
l INTERACTIONS → Appendix 1: dopamine receptor agonists
l PREGNANCY Use only if potential benefit outweighs risk.
l BREAST FEEDING May suppress lactation.
l TREATMENT CESSATION Antiparkinsonian drug therapy
should never be stopped abruptly as this carries a small
risk of neuroleptic malignant syndrome.
Driving and skilled tasks Sudden onset of sleep Excessive
daytime sleepiness and sudden onset of sleep can occur
with dopamine-receptor agonists.
Patients starting treatment with these drugs should be
warned of the risk and of the need to exercise caution
when driving or operating machinery. Those who have
experienced excessive sedation or sudden onset of sleep
should refrain from driving or operating machines until
these effects have stopped occurring.
Management of excessive daytime sleepiness should
focus on the identification of an underlying cause, such as
depression or concomitant medication. Patients should be
counselled on improving sleep behaviour.
Hypotensive reactions Hypotensive reactions can occur in
some patients taking dopamine-receptor agonists; these
can be particularly problematic during the first few days of
treatment and care should be exercised when driving or
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 10
Pergolide (as Pergolide mesilate) 250 microgram Pergolide
250microgram tablets | 100 tablet P £36.03
Pergolide (as Pergolide mesilate) 1 mg Pergolide 1mg tablets | 100 tablet P £121.38
Parkinson’s disease, used alone or as an adjunct to cobeneldopa or co-careldopa
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Adult: Initially 88 micrograms 3 times a day, if
tolerated dose to be increased by doubling dose every
5–7 days, increased to 350 micrograms 3 times a day,
then increased in steps of 180 micrograms 3 times a
day if required, dose to be increased at weekly
intervals, during dose titration and maintenance,
levodopa dose may be reduced, maximum daily dose to
be given in 3 divided doses; maximum 3.3 mg per day
▶ BY MOUTH USING MODIFIED-RELEASE MEDICINES
▶ Adult: Initially 260 micrograms once daily, dose to be
increased by doubling dose every 5–7 days, increased
to 1.05 mg once daily, then increased in steps of
520 micrograms every week if required, during dose
titration and maintenance, levodopa dose may be
reduced according to response; maximum 3.15 mg per
Moderate to severe restless legs syndrome
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Adult: Initially 88 micrograms once daily, dose to be
taken 2–3 hours before bedtime, dose to be increased
by doubling dose every 4–7 days if necessary, repeat
dose titration if restarting treatment after an interval
of more than a few days; maximum 540 micrograms per
DOSE EQUIVALENCE AND CONVERSION
▶ Doses and strengths are stated in terms of pramipexole
▶ Equivalent strengths of pramipexole (base) in terms of
pramipexole dihydrochloride monohydrate (salt) for
immediate-release preparations are as follows:
▶ 88 micrograms base : 125 micrograms salt;
▶ 180 micrograms base : 250 micrograms salt;
▶ 350 micrograms base : 500 micrograms salt;
▶ 700 micrograms base : 1 mg salt.
▶ Equivalent strengths of pramipexole (base) in terms of
pramipexole dihydrochloride monohydrate (salt) for
modified-release preparations are as follows:
▶ 260 micrograms base : 375 micrograms salt;
▶ 520 micrograms base : 750 micrograms salt;
▶ 1.57 mg base : 2.25 mg salt;
▶ 2.62 mg base : 3.75 mg salt;
Treatment with dopamine-receptor agonists is
associated with impulse control disorders, including
pathological gambling, binge eating, and hypersexuality.
Patients and their carers should be informed about the
risk of impulse control disorders. There is no evidence
that ergot- and non-ergot-derived dopamine-receptor
agonists differ in their propensity to cause impulse
recommended. If the patient develops an impulse
control disorder, the dopamine-receptor agonist should
be withdrawn or the dose reduced until the symptoms
l CAUTIONS Psychotic disorders .risk of visual disorders
(ophthalmological testing recommended). severe
l INTERACTIONS → Appendix 1: dopamine receptor agonists
▶ Common or very common Appetite abnormal . behaviour
▶ Frequency not known Depression . dopamine agonist
withdrawal syndrome . generalised pain . sweating
l PREGNANCY Use only if potential benefit outweighs risk—
l BREAST FEEDING May suppress lactation; avoid—present
l RENAL IMPAIRMENT For modified-release tablets, avoid if
eGFR less than 30 mL/minute/1.73 m2
Dose adjustments For immediate-release tablets in
Parkinson’s disease, initially 88 micrograms twice daily
(max. 1.57 mg daily in 2 divided doses) if eGFR
; initially 88 micrograms once
daily (max. 1.1 mg once daily) if eGFR less than
. If renal function declines during
treatment, reduce dose by the same percentage as the
For immediate-release tablets in restless legs syndrome,
reduce dose if eGFR less than 20 mL/minute/1.73 m2
For modified-release tablets, initially 260 micrograms on
alternate days if eGFR 30–50 mL/minute/1.73 m2
increased to 260 micrograms once daily after 1 week,
further increased if necessary by 260 micrograms daily at
weekly intervals to max. 1.57 mg daily.
l MONITORING REQUIREMENTS Risk of postural hypotension
(especially on initiation)—monitor blood pressure.
l TREATMENT CESSATION Antiparkinsonian drug therapy
should never be stopped abruptly as this carries a small
risk of neuroleptic malignant syndrome.
Driving and skilled tasks Sudden onset of sleep Excessive
daytime sleepiness and sudden onset of sleep can occur
with dopamine-receptor agonists.
Patients starting treatment with these drugs should be
warned of the risk and of the need to exercise caution
when driving or operating machinery. Those who have
experienced excessive sedation or sudden onset of sleep
should refrain from driving or operating machines until
these effects have stopped occurring.
Management of excessive daytime sleepiness should
focus on the identification of an underlying cause, such as
depression or concomitant medication. Patients should be
counselled on improving sleep behaviour.
Hypotensive reactions Hypotensive reactions can occur in
some patients taking dopamine-receptor agonists; these
can be particularly problematic during the first few days of
treatment and care should be exercised when driving or
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 10, 25
▶ Pramipexole (Non-proprietary)
Pramipexole (as Pramipexole dihydrochloride monohydrate)
260 microgram Pramipexole 260microgram modified-release tablets
| 30 tablet P £8.50–£30.87 DT = £14.77
Pramipexole (as Pramipexole dihydrochloride monohydrate)
520 microgram Pramipexole 520microgram modified-release tablets
| 30 tablet P £20.00–£61.73 DT = £30.74
Pramipexole (as Pramipexole dihydrochloride monohydrate)
1.05 mg Pramipexole 1.05mg modified-release tablets | 30 tablet P £28.00–£123.46 DT = £56.68
Pramipexole (as Pramipexole dihydrochloride monohydrate)
1.57 mg Pramipexole 1.57mg modified-release tablets | 30 tablet P £80.94–£192.24 DT = £126.82
Pramipexole (as Pramipexole dihydrochloride monohydrate)
2.1 mg Pramipexole 2.1mg modified-release tablets | 30 tablet P £50.00–£246.91 DT = £110.97
Pramipexole (as Pramipexole dihydrochloride monohydrate)
2.62 mg Pramipexole 2.62mg modified-release tablets |
30 tablet P £134.95–£320.41 DT = £222.06
BNF 78 Parkinson’s disease 423
Pramipexole (as Pramipexole dihydrochloride monohydrate)
3.15 mg Pramipexole 3.15mg modified-release tablets | 30 tablet P £155.95–£370.38 DT = £210.46
▶ Mirapexin (Boehringer Ingelheim Ltd)
Pramipexole (as Pramipexole dihydrochloride monohydrate)
260 microgram Mirapexin 0.26mg modified-release tablets | 30 tablet P £32.49 DT = £14.77
Pramipexole (as Pramipexole dihydrochloride monohydrate)
520 microgram Mirapexin 0.52mg modified-release tablets |
30 tablet P £64.98 DT = £30.74
Pramipexole (as Pramipexole dihydrochloride monohydrate)
1.05 mg Mirapexin 1.05mg modified-release tablets | 30 tablet P £129.96 DT = £56.68
Pramipexole (as Pramipexole dihydrochloride monohydrate)
1.57 mg Mirapexin 1.57mg modified-release tablets | 30 tablet P £202.36 DT = £126.82
Pramipexole (as Pramipexole dihydrochloride monohydrate)
2.1 mg Mirapexin 2.1mg modified-release tablets | 30 tablet P £259.91 DT = £110.97
Pramipexole (as Pramipexole dihydrochloride monohydrate)
2.62 mg Mirapexin 2.62mg modified-release tablets | 30 tablet P £337.27 DT = £222.06
Pramipexole (as Pramipexole dihydrochloride monohydrate)
3.15 mg Mirapexin 3.15mg modified-release tablets | 30 tablet P £389.87 DT = £210.46
▶ Oprymea (Consilient Health Ltd)
Pramipexole (as Pramipexole dihydrochloride monohydrate)
260 microgram Oprymea 0.26mg modified-release tablets | 30 tablet P £25.56 DT = £14.77
Pramipexole (as Pramipexole dihydrochloride monohydrate)
520 microgram Oprymea 0.52mg modified-release tablets | 30 tablet P £51.14 DT = £30.74
Pramipexole (as Pramipexole dihydrochloride monohydrate)
1.05 mg Oprymea 1.05mg modified-release tablets | 30 tablet P £102.28 DT = £56.68
Pramipexole (as Pramipexole dihydrochloride monohydrate)
1.57 mg Oprymea 1.57mg modified-release tablets | 30 tablet P £159.26 DT = £126.82
Pramipexole (as Pramipexole dihydrochloride monohydrate)
2.1 mg Oprymea 2.1mg modified-release tablets | 30 tablet P £204.56 DT = £110.97
Pramipexole (as Pramipexole dihydrochloride monohydrate)
2.62 mg Oprymea 2.62mg modified-release tablets | 30 tablet P £337.27 DT = £222.06
Pramipexole (as Pramipexole dihydrochloride monohydrate)
3.15 mg Oprymea 3.15mg modified-release tablets | 30 tablet P £389.87 DT = £210.46
Pramipexole (as Pramipexole dihydrochloride monohydrate)
260 microgram Pipexus 0.26mg modified-release tablets |
30 tablet P £16.25 DT = £14.77
Pramipexole (as Pramipexole dihydrochloride monohydrate)
520 microgram Pipexus 0.52mg modified-release tablets | 30 tablet P £32.49 DT = £30.74
Pramipexole (as Pramipexole dihydrochloride monohydrate)
1.05 mg Pipexus 1.05mg modified-release tablets | 30 tablet P £64.98 DT = £56.68
Pramipexole (as Pramipexole dihydrochloride monohydrate)
1.57 mg Pipexus 1.57mg modified-release tablets | 30 tablet P £101.18 DT = £126.82
Pramipexole (as Pramipexole dihydrochloride monohydrate)
2.1 mg Pipexus 2.1mg modified-release tablets | 30 tablet P £129.96 DT = £110.97
Pramipexole (as Pramipexole dihydrochloride monohydrate)
2.62 mg Pipexus 2.62mg modified-release tablets | 30 tablet P £168.64 DT = £222.06
Pramipexole (as Pramipexole dihydrochloride monohydrate)
3.15 mg Pipexus 3.15mg modified-release tablets | 30 tablet P £194.94 DT = £210.46
CAUTIONARY AND ADVISORY LABELS 10
▶ Pramipexole (Non-proprietary)
Pramipexole (as Pramipexole dihydrochloride monohydrate)
88 microgram Pramipexole 88microgram tablets | 30 tablet P £8.60 DT = £4.38
Pramipexole (as Pramipexole dihydrochloride monohydrate)
Pramipexole (as Pramipexole dihydrochloride monohydrate)
Pramipexole (as Pramipexole dihydrochloride monohydrate)
▶ Mirapexin (Boehringer Ingelheim Ltd)
Pramipexole (as Pramipexole dihydrochloride monohydrate)
88 microgram Mirapexin 0.088mg tablets | 30 tablet P £11.24
Pramipexole (as Pramipexole dihydrochloride monohydrate)
180 microgram Mirapexin 0.18mg tablets | 30 tablet P £22.49
DT = £2.06 | 100 tablet P £74.95
Pramipexole (as Pramipexole dihydrochloride monohydrate)
350 microgram Mirapexin 0.35mg tablets | 30 tablet P £44.97
DT = £13.83 | 100 tablet P £149.90
Pramipexole (as Pramipexole dihydrochloride monohydrate)
700 microgram Mirapexin 0.7mg tablets | 30 tablet P £89.94
DT = £2.52 | 100 tablet P £299.82
▶ Oprymea (Consilient Health Ltd)
Pramipexole (as Pramipexole dihydrochloride monohydrate)
88 microgram Oprymea 0.088mg tablets | 30 tablet P £3.23 DT
Pramipexole (as Pramipexole dihydrochloride monohydrate)
180 microgram Oprymea 0.18mg tablets | 30 tablet P £6.09 DT
Pramipexole (as Pramipexole dihydrochloride monohydrate)
350 microgram Oprymea 0.35mg tablets | 30 tablet P £32.47
DT = £13.83 | 100 tablet P £108.23
Pramipexole (as Pramipexole dihydrochloride monohydrate)
700 microgram Oprymea 0.7mg tablets | 30 tablet P £18.26 DT
= £2.52 | 100 tablet P £117.63
Parkinson’s disease, either used alone or as adjunct to cobeneldopa or co-careldopa
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Adult: Initially 750 micrograms daily in 3 divided doses,
then increased in steps of 750 micrograms daily, dose
to be increased at weekly intervals, increased to 3 mg
daily in 3 divided doses, then increased in steps of
1.5–3 mg daily, adjusted according to response, dose to
be increased at weekly intervals; usual dose 9–16 mg
daily in 3 divided doses, higher doses may be required if
used with levodopa, when administered as adjunct to
levodopa, concurrent dose of levodopa may be reduced
by approx. 20%, daily maximum dose to be given in
3 divided doses; maximum 24 mg per day
▶ BY MOUTH USING MODIFIED-RELEASE MEDICINES
▶ Adult: Initially 2 mg once daily for 1 week, then 4 mg
once daily, increased in steps of 2 mg at intervals of at
least 1 week, adjusted according to response, increased
to up to 8 mg once daily, dose to be increased further if
still no response; increased in steps of 2–4 mg at
intervals of at least 2 weeks if required, consider slower
titration in patients over 75 years, when administered
as adjunct to levodopa, concurrent dose of levodopa
may gradually be reduced by approx. 30%; maximum
Parkinson’s disease in patients transferring from
ropinirole immediate-release tablets
▶ BY MOUTH USING MODIFIED-RELEASE MEDICINES
▶ Adult: Initially ropinirole modified-release once daily
substituted for total daily dose equivalent of ropinirole
immediate-release tablets; if control not maintained
after switching, titrate dose as above
Moderate to severe restless legs syndrome
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Adult: Initially 250 micrograms once daily for 2 days,
increased if tolerated to 500 micrograms once daily for
5 days, then increased if tolerated to 1 mg once daily
for 7 days, then increased in steps of 500 micrograms
daily, adjusted according to response, dose to be
increased at weekly intervals; usual dose 2 mg once
daily, doses to be taken at night; maximum 4 mg per
l UNLICENSED USE Doses in the BNF may differ from those
Ropinirole has been confused with risperidone; care
must be taken to ensure the correct drug is prescribed
Treatment with dopamine-receptor agonists is
associated with impulse control disorders, including
pathological gambling, binge eating, and hypersexuality.
Patients and their carers should be informed about the
risk of impulse control disorders. There is no evidence
that ergot- and non-ergot-derived dopamine-receptor
agonists differ in their propensity to cause impulse
recommended. If the patient develops an impulse
control disorder, the dopamine-receptor agonist should
be withdrawn or the dose reduced until the symptoms
l CAUTIONS Elderly . major psychotic disorders . severe
cardiovascular disease (risk of hypotension—monitor
l INTERACTIONS → Appendix 1: dopamine receptor agonists
disorders . nausea . nervousness . peripheral oedema . syncope . vertigo . vomiting
▶ Uncommon Hypotension . sexual dysfunction
▶ Rare or very rare Hepatic reaction
l PREGNANCY Avoid unless potential benefit outweighs
risk—toxicity in animal studies.
l BREAST FEEDING May suppress lactation—avoid.
▶ When used for Parkinson’s disease Manufacturer advises avoid
▶ When used for Restless legs syndrome Manufacturer advises
caution in moderate impairment; avoid in severe
l RENAL IMPAIRMENT Avoid if eGFR less than
l TREATMENT CESSATION Antiparkinsonian drug therapy
should never be stopped abruptly as this carries a small
risk of neuroleptic malignant syndrome.
l PATIENT AND CARER ADVICE Manufacturer advises
patients and their carers should be informed of the risk of
developing dopamine dysregulation syndrome; addictionlike symptoms should be reported.
▶ When used for Parkinson’s disease Manufacturer advises if
treatment is interrupted for one day or more, re-initiation
by dose titration should be considered—consult product
▶ When used for Moderate to severe restless legs
syndrome Manufacturer advises if treatment is
interrupted for more than a few days, re-initiation by dose
Sudden onset of sleep Excessive daytime sleepiness and
sudden onset of sleep can occur with dopamine-receptor
Patients starting treatment with these drugs should be
warned of the risk and of the need to exercise caution
when driving or operating machinery. Those who have
experienced excessive sedation or sudden onset of sleep
should refrain from driving or operating machines until
these effects have stopped occurring.
Management of excessive daytime sleepiness should
focus on the identification of an underlying cause, such as
depression or concomitant medication. Patients should be
counselled on improving sleep behaviour.
Hypotensive reactions Hypotensive reactions can occur in
some patients taking dopamine-receptor agonists; these
can be particularly problematic during the first few days of
treatment and care should be exercised when driving or
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) decisions
The Scottish Medicines Consortium has advised (July 2006)
that ropinirole (Adartrel ®) should be restricted for use in
patients with a baseline score of 24 points or more on the
International Restless Legs Scale.
The Scottish Medicines Consortium has advised
(September 2008) that ropinirole (Requip ® XL) is accepted
for use within NHS Scotland for the treatment of
idiopathic Parkinson’s disease in patients already taking
ropinirole immediate release tablets and in whom
adequate symptomatic control has been established.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension, oral
CAUTIONARY AND ADVISORY LABELS 10, 25
▶ Ropinirole (Non-proprietary)
Ropinirole (as Ropinirole hydrochloride) 2 mg Ropinirole 2mg
modified-release tablets | 28 tablet P £10.66 DT = £12.54
Ropinirole (as Ropinirole hydrochloride) 4 mg Ropinirole 4mg
modified-release tablets | 28 tablet P £21.33 DT = £25.09
Ropinirole (as Ropinirole hydrochloride) 8 mg Ropinirole 8mg
modified-release tablets | 28 tablet P £35.79 DT = £42.11
▶ Ipinnia XL (Ethypharm UK Ltd)
Ropinirole (as Ropinirole hydrochloride) 2 mg Ipinnia XL 2mg
tablets | 28 tablet P £5.64 DT = £12.54
Ropinirole (as Ropinirole hydrochloride) 3 mg Ipinnia XL 3mg
tablets | 28 tablet P £8.46 DT = £8.46
Ropinirole (as Ropinirole hydrochloride) 4 mg Ipinnia XL 4mg
tablets | 28 tablet P £11.29 DT = £25.09
Ropinirole (as Ropinirole hydrochloride) 6 mg Ipinnia XL 6mg
tablets | 28 tablet P £15.32 DT = £15.32
Ropinirole (as Ropinirole hydrochloride) 8 mg Ipinnia XL 8mg
tablets | 28 tablet P £18.95 DT = £42.11
▶ Ralnea XL (Consilient Health Ltd)
Ropinirole (as Ropinirole hydrochloride) 2 mg Ralnea XL 2mg
tablets | 28 tablet P £10.65 DT = £12.54
Ropinirole (as Ropinirole hydrochloride) 4 mg Ralnea XL 4mg
tablets | 28 tablet P £21.32 DT = £25.09
Ropinirole (as Ropinirole hydrochloride) 8 mg Ralnea XL 8mg
tablets | 28 tablet P £35.79 DT = £42.11
Ropinirole (as Ropinirole hydrochloride) 2 mg Raponer XL 2mg
tablets | 28 tablet P £12.54 DT = £12.54
Ropinirole (as Ropinirole hydrochloride) 4 mg Raponer XL 4mg
tablets | 28 tablet P £25.09 DT = £25.09
Ropinirole (as Ropinirole hydrochloride) 8 mg Raponer XL 8mg
tablets | 28 tablet P £42.11 DT = £42.11
BNF 78 Parkinson’s disease 425
▶ ReQuip XL (GlaxoSmithKline UK Ltd)
Ropinirole (as Ropinirole hydrochloride) 2 mg ReQuip XL 2mg
tablets | 28 tablet P £12.54 DT = £12.54
Ropinirole (as Ropinirole hydrochloride) 4 mg ReQuip XL 4mg
tablets | 28 tablet P £25.09 DT = £25.09
Ropinirole (as Ropinirole hydrochloride) 8 mg ReQuip XL 8mg
tablets | 28 tablet P £42.11 DT = £42.11
▶ Repinex XL (Aspire Pharma Ltd)
Ropinirole (as Ropinirole hydrochloride) 2 mg Repinex XL 2mg
tablets | 28 tablet P £6.20 DT = £12.54
Ropinirole (as Ropinirole hydrochloride) 4 mg Repinex XL 4mg
tablets | 28 tablet P £12.50 DT = £25.09
Ropinirole (as Ropinirole hydrochloride) 8 mg Repinex XL 8mg
tablets | 28 tablet P £21.00 DT = £42.11
▶ Ropilynz XL (Lupin Healthcare (UK) Ltd)
Ropinirole (as Ropinirole hydrochloride) 4 mg Ropilynz XL 4mg
tablets | 28 tablet P £21.32 DT = £25.09
Ropinirole (as Ropinirole hydrochloride) 8 mg Ropilynz XL 8mg
tablets | 28 tablet P £35.79 DT = £42.11
Ropinirole (as Ropinirole hydrochloride) 2 mg Ropiqual XL 2mg
tablets | 28 tablet P £12.54 DT = £12.54
Ropinirole (as Ropinirole hydrochloride) 4 mg Ropiqual XL 4mg
tablets | 28 tablet P £25.09 DT = £25.09
Ropinirole (as Ropinirole hydrochloride) 8 mg Ropiqual XL 8mg
tablets | 28 tablet P £42.11 DT = £42.11
Ropinirole (as Ropinirole hydrochloride) 2 mg Spiroco XL 2mg
tablets | 28 tablet P £5.63 DT = £12.54
Ropinirole (as Ropinirole hydrochloride) 4 mg Spiroco XL 4mg
tablets | 28 tablet P £11.28 DT = £25.09
Ropinirole (as Ropinirole hydrochloride) 8 mg Spiroco XL 8mg
tablets | 28 tablet P £18.94 DT = £42.11
CAUTIONARY AND ADVISORY LABELS 10, 21
▶ Ropinirole (Non-proprietary)
Ropinirole (as Ropinirole hydrochloride)
250 microgram Ropinirole 250microgram tablets | 12 tablet P £15.00 DT = £3.02
Ropinirole (as Ropinirole hydrochloride)
500 microgram Ropinirole 500microgram tablets | 28 tablet P £25.00 DT = £7.32
Ropinirole (as Ropinirole hydrochloride) 1 mg Ropinirole 1mg
tablets | 84 tablet P £56.71 DT = £56.71
Ropinirole (as Ropinirole hydrochloride) 2 mg Ropinirole 2mg
tablets | 28 tablet P £21.25–£49.99 DT = £14.56 | 84 tablet P £33.35–£52.50
Ropinirole (as Ropinirole hydrochloride) 5 mg Ropinirole 5mg
tablets | 84 tablet P £185.63 DT = £185.51
▶ Adartrel (GlaxoSmithKline UK Ltd)
Ropinirole (as Ropinirole hydrochloride) 250 microgram Adartrel
250microgram tablets | 12 tablet P £3.94 DT = £3.02
Ropinirole (as Ropinirole hydrochloride) 500 microgram Adartrel
500microgram tablets | 28 tablet P £15.75 DT = £7.32
Ropinirole (as Ropinirole hydrochloride) 2 mg Adartrel 2mg
tablets | 28 tablet P £31.51 DT = £14.56
▶ ReQuip (GlaxoSmithKline UK Ltd)
Ropinirole (as Ropinirole hydrochloride) 250 microgram ReQuip
250microgram tablets | 21 tablet P £5.70
Ropinirole (as Ropinirole hydrochloride) 1 mg ReQuip 1mg tablets
| 84 tablet P £56.71 DT = £56.71
Ropinirole (as Ropinirole hydrochloride) 2 mg ReQuip 2mg tablets
Ropinirole (as Ropinirole hydrochloride) 5 mg ReQuip 5mg tablets
| 84 tablet P £195.92 DT = £185.51
Monotherapy in Parkinson’s disease
▶ BY TRANSDERMAL APPLICATION USING PATCHES
▶ Adult: Initially 2 mg/24 hours, then increased in steps
of 2 mg/24 hours every week if required; maximum
Adjunctive therapy with co-beneldopa or co-careldopa in
▶ BY TRANSDERMAL APPLICATION USING PATCHES
▶ Adult: Initially 4 mg/24 hours, then increased in steps
of 2 mg/24 hours every week if required; maximum
Moderate to severe restless legs syndrome
▶ BY TRANSDERMAL APPLICATION USING PATCHES
▶ Adult: Initially 1 mg/24 hours, then increased in steps
of 1 mg/24 hours every week if required; maximum
Treatment with dopamine-receptor agonists is
associated with impulse control disorders, including
pathological gambling, binge eating, and hypersexuality.
Patients and their carers should be informed about the
risk of impulse control disorders. There is no evidence
that ergot- and non-ergot-derived dopamine-receptor
agonists differ in their propensity to cause impulse
recommended. If the patient develops an impulse
control disorder, the dopamine-receptor agonist should
be withdrawn or the dose reduced until the symptoms
l CAUTIONS Avoid exposure of patch to heat.remove patch
(aluminium-containing) before magnetic resonance
l INTERACTIONS → Appendix 1: dopamine receptor agonists
oedema . psychiatric disorders . skin reactions . sleep
disorders . syncope . vertigo . vomiting . weight changes
▶ Uncommon Agitation . angioedema . arrhythmias . confusion . sexual dysfunction . vision disorders
▶ Rare or very rare Delirium . delusions . irritability . psychotic disorder. seizure
▶ Frequency not known Dopamine dysregulation syndrome
l PREGNANCY Avoid—no information available.
l BREAST FEEDING May suppress lactation; avoid—present
l HEPATIC IMPAIRMENT Manufacturer advises caution in
severe impairment (no information available).
Dose adjustments Manufacturer advises consider dose
reduction in severe impairment.
l MONITORING REQUIREMENTS Ophthalmic testing
l TREATMENT CESSATION Antiparkinsonian drug therapy
should never be stopped abruptly as this carries a small
risk of neuroleptic malignant syndrome.
l DIRECTIONS FOR ADMINISTRATION Manufacturer advises
apply patch to clean, dry, intact, healthy and non-irritated
skin on torso, thigh, hip, shoulder or upper arm by
pressing the patch firmly against the skin for about
30 seconds. Patches should be removed after 24 hours and
the replacement patch applied on a different area (avoid
using the same area for 14 days)—consult product
literature for further information.
l PATIENT AND CARER ADVICE Manufacturer advises
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