Reactions 813 - 5 Aug 2000

SPramipexole/ropinirole

Sudden onset of sleep: 2 case reportsTwo patients experienced episodes of sudden onset of sleep

during treatment with pramipexole and/or ropinirole forParkinson’s disease.

The first patient, a 66-year-old woman, had her maintenancedosage of pergolide replaced with pramipexole [dosage andduration of treatment not stated]. Her pramipexole dosage wasthen slowly increased to 1mg 4 times daily and, within 2weeks, she reported falling asleep easily during the day. Sheattributed these daytime sleep episodes to not getting enoughsleep at night. She was also taking selegiline, benzatropine,indapamide and atenolol. Three months later, she experiencedfalling asleep several times while driving. Modafinil was addedto her treatment regimen. One month later, she experiencedanother episode of sudden onset of sleep while cooking, and,one month after that, another episode while walking.

The woman started treatment with ropinirole 0.5mg 3 timesdaily [duration of treatment not stated] with the dosagesubsequently increased to 1mg 3 times daily. One month later,she experienced another sleep attack. Her ropinirole dosagewas decreased to 0.75mg 3 times daily, but she continued toexperience sleep attacks. She discontinued treatment withropinirole, and was treated with levodopa-carbidopa. She didnot experience any further sleep attacks during follow-up.

The second patient, a 55-year-old man, had been treatedwith pramipexole, but this was replaced with ropinirole 2mg 3times daily due to worsening symptoms of Parkinson’sdisease. His other medications included selegiline, levodopa-carbidopa and tolcapone. His dosage of ropinirole wassubsequently increased over a 2-week period to 4mg 3 timesdaily.

Approximately 1 month after starting ropinirole, the man fellasleep while driving his car. Buspirone was added to hisregimen for the treatment of anxiety. One month later, heexperienced another episode of sudden onset of sleep whiledriving. Approximately 6 weeks after starting treatment withropinirole, the dosage of ropinirole was increased over a3-week period to 6mg 3 times daily. Tolcapone wassubsequently withdrawn from his treatment regimen, and thedosage of ropinirole was increased to 8mg 3 times daily. Threemonths later, he experienced another sleep attack whiledriving. Ropinirole was subsequently tapered anddiscontinued, and replaced with pergolide. The man continuedto take levodopa-carbidopa, buspirone and entacapone. Hedid not experience any further sleep attacks during follow-up.

Author comment: Numerous cases of sudden onset of sleepin patients taking pramipexole or ropinirole have previouslybeen reported. ‘It is important for health care professionals tobe aware of the potential for sleep attacks and discuss availableoptions with patients.’Ryan M, et al. Non-ergot dopamine agonist-induced sleep attacks.Pharmacotherapy 20: 724-726, Jun 2000 - USA 800831727

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Reactions 5 Aug 2000 No. 8130114-9954/10/0813-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved