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Ropinirole

Classification: A

Drug products: ADARTREL, Requip, Requip Depot, Requip®, Ropinirol 2care4, Ropinirol Ebb, Ropinirol Krka, Ropinirol Mylan, Ropinirol Sandoz, Ropinirol Stada, Ropinirole Orifarm, Ropinirole Teva

ATC code: N04BC04

Substances: ropinirole, ropinirole hydrochloride

Summary

Studies of differences between men and women in effect of ropinirole are lacking.

Some studies report an increased risk of impulse control disturbance in men compared with women when treated with anti-Parkinson drugs, while other studies report no sex difference.

Additional information

The reported incidence and prevalence of Parkinson’s disease (PD) is slightly higher in men than in women. It seems that men develop PD earlier in life compared to women. Several possible explanations behind these sex differences have been suggested; the protective role of estrogens in premenopausal women, and different profiles of risk factors (environmental and/or genetic). Sex differences in clinical presentations of PD have also been reported. Since the activities of daily living might differ between men and women with PD, different treatment strategies can be recommended to men and women with PD [1].

Pharmacokinetics and dosing

Oral clearance of ropinirole have shown to be similar in men and women [7]. Ropinirole is indicated for treatment of Parkinson’s disease and for treatment of Restless Legs Syndrome. Therapy with ropinirole is initiated at a low dose and gradually titrated upward according to clinical tolerability to obtain the optimum therapeutic effect. It is not necessary to adjust the initial dose based on patient’s sex, weight or age [7].

Effects

No studies with a clinically relevant sex analysis regarding the effects of ropinirole have been found.

Adverse effects

Ropinirole have shown to have no dose- or exposure-related effect on mean QT intervals in healthy men and women titrated to doses up to 4 mg/day [7].The increased risk of impulse control disorder with use of dopamine agonists is well known [2-6]. One observational study on dopamine agonists (n=642, approx. 2/3 men) reports a higher frequency of impulse control disorder in men compared to women in patients using dopamine agonists [4].However, in a transversal study of patients on a single nonergolinic dopamine agonist (pramipexole, ropinirole, or rotigotine) (145 men, 88 women) no difference in risk between men and women was reported [6].

Reproductive health issues

Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).

Other information

At oral doses as low as 0.2 mg, ropinirol suppressed serum prolactin concentrations in healthy men [7].

Updated: 2020-09-08

Date of litterature search: 2019-11-07

References

  1. Georgiev D, Hamberg K, Hariz M, Forsgren L, Hariz GM. Gender differences in Parkinson's disease: A clinical perspective. Acta Neurol Scand. 2017;136(6):570-584. PubMed
  2. Weintraub D, Siderowf AD, Potenza MN, Goveas J, Morales KH, Duda JE, Moberg PJ, Stern MB. Association of dopamine agonist use with impulse control disorders in Parkinson disease. Arch Neurol. 2006;63(7):969-73. länk
  3. Schreglmann SR, Gantenbein AR, Eisele G, Baumann CR. Transdermal rotigotine causes impulse control disorders in patients with restless legs syndrome. Parkinsonism Relat Disord. 2012;18:207-9. PubMed
  4. Carrière N, Kreisler A, Dujardin K, Destée A, Defebvre L. [Impulse control disorders in Parkinson's disease: A cohort of 35 patients]. Rev Neurol (Paris). 2012;168:143-51. PubMed
  5. Poletti M, Logi C, Lucetti C, Del Dotto P, Baldacci F, Vergallo A, Ulivi M, Del Sarto S, Rossi G, Ceravolo R, Bonuccelli U. A single-center, cross-sectional prevalence study of impulse control disorders in Parkinson disease: association with dopaminergic drugs. J Clin Psychopharmacol. 2013;33(5):691-4. PubMed
  6. Garcia-Ruiz, P J Martinez Castrillo JC, Alonso-Canovas A, Herranz Barcenas A, Vela L, Sanchez Alonso P, Mata M, Olmedilla Gonzalez N, Mahillo Fernandez I. Impulse control disorder in patients with Parkinson's disease under dopamine agonist therapy: a multicentre study. J Neurol Neurosurg Psychiatry. 2014;85(8):840-4. länk
  7. Requip (ropinirole). DailyMed [www]. US National Library of Medicine. [updated 2018-01-19, cited 2019-11-07]. länk
  8. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2019 [cited 2020-03-10.] länk

Authors: Linnéa Karlsson Lind

Reviewed by: Mia von Euler, Diana Rydberg

Approved by: Karin Schenck-Gustafsson