Ropinirole 24-Hour Extended Release for Parkinson's Disease

Patients with Parkinson's disease (PD) can be treated with a variety of therapies, both medical and surgical. The majority of the former are dopaminergic i.e. they increase dopaminergic function particularly in the nigrostriatum and include levodopa, dopamine agonists and monoamine oxidase B inhibitors. Dopamine agonists have been shown to improve the motor, and some non-motor, symptoms in PD and are also associated with a low risk for motor complications. For many physicians they have become the first choice for initiating therapy in PD. To date, dopamine agonists have for the most part required multiple (tid) dosing during the day, although the ergot agonist cabergoline was effective as a once a day drug. However, the emergence of cardiac valve fibrosis with this compound and also with pergolide has limited their use. Novel formulations of non-ergot dopamine agonists are now becoming available. Once daily ropinirole appears to be as effective and as well tolerated as the standard preparation, with an easy overnight switch possible. There are many potential benefits to the new extended once a day ropinirole: ease of use, better motor control through better compliance, easier and more rapid titration and the potential for improved night-time control. There may even be the hypothetical benefit of a lower dyskinesia rate.