Reactions 1275 - 24 Oct 2009

★Ropinirole

Panic attack-like episodes (first report) in anelderly patient: case report

A 73-year-old woman with a history of a mixed anxiety-depression disorder developed panic attack-like episodeswhile receiving ropinirole for Parkinson’s disease (PD).

The woman experienced progressive PD despitetreatment with levodopa/carbidopa and started receivingropinirole 0.25 mg/day with weekly dosage increases up to1mg three times per day. At this dose, she beganexperiencing sudden panic attack-like episodes after intakeof each 1mg dose [duration of treatment to reaction onsetnot stated]; symptoms lasted for 1.5–2 hours and consistedof anguish, crying, dizziness, feelings of imminent death,chest and perineal pain, tachypnoea, dyspnoea and highblood pressure.

Ropinirole was withdrawn and the woman’s symptomsceased.

Ropinirole was restarted at a dosage of 0.125 mg/day,and again increased to 1mg three times daily in weeklyincrements. The woman’s symptoms recurred at this dose,and she began receiving rotigotine with good tolerance.Panic attack-like symptoms had not recurred after3 months of follow-up.

Author comment: The patient reported here had adiagnosis of PD and developed a panic attack-like episodeaccording to the [DSM-IV] criteria, which was temporallyrelated to oral ropinirole administration for PD. . . Applicationof a well-known scale for estimating the probability ofadverse drug reactions identified ropinirole as possiblyassociated with the development of panic attack-likeepisodes."Alonso-Navarro H, et al. Panic attack-like episodes possibly associated withropinirole. Clinical Neuropharmacology 32: 237-238, No. 4, Jul-Aug 2009 -Spain 801154249

» Editorial comment: A search of AdisBase, Medline andEmbase did not reveal any previous case reports of panicattacks associated with ropinirole. The WHO ADR databasecontained nine reports of panic attack associated withropinirole.

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Reactions 24 Oct 2009 No. 12750114-9954/10/1275-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved