Efficacy and tolerability of high doses of ropinirole in Parkinson's disease

E. Moro, A. Albanese, N. Van Blercom, P. Pollak

Research output: Contribution to journalArticlepeer-review

Abstract

Ropinirole is a nonergoline D2-dopamine agonist drug with potent dosedependent antiparkinsonian activity and good tolerability. It is effective at low doses (6 mg/day) as monotherapy at the beginning of Parkinson's disease (PD). But in advanced PD, high doses of ropinirole (up to 24 mg/day, the recommended highest daily dose) are not sufficient to control parkinsonian signs without levodopa. We report two cases of PD patients who underwent very high doses of ropinirole either as monotherapy or with other antiparkinsonian drugs. Case 1. A 32-year-old patient, with tremor dominant PD, came to our attention to perform right Vim stimulation. He exhibited severe resting tremor, moderate rigidity and bradykinesia of his left hemibody, gradually worsening over 8 years. He had taken various antiparkinsonian drugs without a satisfactory tremor reduction. He could not tolerate pergolide and bromocriptine, in spite of high doses of domperidone. So he was implanted in his left Vim, with a complete tremor control of his arm tremor, but only partial benefit on his leg. Afterwards, we started ropinirole up to 24 mg/day. with good but incomplete results for tremor, bradykinesia and rigidity. For this reason, the patient himself augmented ropinirole up to 50 mg/day, with a complete parkinsonian signs control. We decided to stop Vim stimulation. Case 2. A 62-year-old woman with 15 years of PD duration was admitted in our hospital to perform STN stimulation. After ten years of stable clinical conditions, she developed severe motor fluctuations with frequent falls from freezing. To avoid levodopa dose increase, she had taken 57 mg/day of ropinirole for about a year, with clinical improvement and good tolerability. She decreased the dose when tolcapone was started. Afterwards, she developed hallucinations, and suspended tolcapone and ropinirole. We conclude that ropinirole is effective in improving all parkinsonian signs in a dose-dependent fashion. Its tolerability permits to achieve high daily doses which can be very powerful as monotherapy in earlyonset PD and in advanced PD with lower levodopa intake.

Original languageEnglish
Pages (from-to)268
Number of pages1
JournalItalian Journal of Neurological Sciences
Volume20
Issue number4
Publication statusPublished - 1999

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

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