Dosing of Ropinirole Prolonged Release in Parkinson's Disease
Ropinirole is a non-ergot D2/D3 agonist for the management of Parkinson's disease (PD). Ropinirole, when given in the immediate-release (IR) form, has to be taken three times a day. It is hypothesized that pulsatile stimulation of dopamine receptors in PD may induce motor fluctuation. Theoretically, motor fluctuation can be avoided by continuous stimulation of the dopamine receptors. Based on this hypothesis, a prolonged-release (PR) formulation was developed.
Ropinirole PR (RPR) is a once daily formulation of ropinirole that is not inferior to the immediate-release formulation. In advanced PD patients, once-daily RPR shows significantly greater improvement in parkinsonian symptoms than IR from. Once daily dosing provides better medication compliance and smoother plasma levels than ropinirole IR (RIR). Therefore, this formulation is regarded as valuable addition to available antiparkinsonian medications.
However, we have met patients unsatisfied with once daily RPR who had asked for multiple daily dosing in clinics occasionally. As seen in the time window of the ropinirole level from Tompson et al., the nocturnal concentration may be lower in the once-daily RPR than the three times daily RIR. The "off" symptoms between dusk and dawn might be more severe in the once daily RPR dosing than in the multiple daily RIR dosing. In addition, the early morning off duration may be longer in the RPR than in the RIR, since the increasing slope of the plasma concentration is gentler in the RPR. Thus multiple dosing with RPR may provide even better control in some patients.
Herein, we compared the preference of patients for once-daily versus twice-daily combination of RPR.
Background
Ropinirole is a non-ergot D2/D3 agonist for the management of Parkinson's disease (PD). Ropinirole, when given in the immediate-release (IR) form, has to be taken three times a day. It is hypothesized that pulsatile stimulation of dopamine receptors in PD may induce motor fluctuation. Theoretically, motor fluctuation can be avoided by continuous stimulation of the dopamine receptors. Based on this hypothesis, a prolonged-release (PR) formulation was developed.
Ropinirole PR (RPR) is a once daily formulation of ropinirole that is not inferior to the immediate-release formulation. In advanced PD patients, once-daily RPR shows significantly greater improvement in parkinsonian symptoms than IR from. Once daily dosing provides better medication compliance and smoother plasma levels than ropinirole IR (RIR). Therefore, this formulation is regarded as valuable addition to available antiparkinsonian medications.
However, we have met patients unsatisfied with once daily RPR who had asked for multiple daily dosing in clinics occasionally. As seen in the time window of the ropinirole level from Tompson et al., the nocturnal concentration may be lower in the once-daily RPR than the three times daily RIR. The "off" symptoms between dusk and dawn might be more severe in the once daily RPR dosing than in the multiple daily RIR dosing. In addition, the early morning off duration may be longer in the RPR than in the RIR, since the increasing slope of the plasma concentration is gentler in the RPR. Thus multiple dosing with RPR may provide even better control in some patients.
Herein, we compared the preference of patients for once-daily versus twice-daily combination of RPR.
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