Reactions 815 - 19 Aug 2000

Ropinirole

Sleep attacks: case reportA 63-year-old man with Parkinson’s disease experienced

sleep attacks while taking ropinirole.The man had been treated with low-dose levodopa, but

discontinued treatment due to gastrointestinal adverse effectsand mild sedation. He subsequently started treatment withropinirole up to a daily dosage of 6mg. During treatment heexperienced mild daytime sleepiness. His symptoms ofParkinson’s disease improved and his motor score on theUnified Parkinson’s Disease Rating Scale reduced from 11 to 1when the dosage of ropinirole was increased to 9 mg/day.

During the following months the man developed excessivedaytime sleepiness and fell asleep during conversations, whilereading, and while watching television. He experiencedapproximately 5 episodes of unplanned sleep each day.Ropinirole was replaced with pergolide at an equivalentdosage and, the following day, his excessive daytimesleepiness resolved. He experienced a reduction on theEpworth sleepiness scale from 17 to 4 units.

The man’s motor symptoms remained well controlled andhe was free from relevant sedation during the following fewmonths.

Author comment: ‘Excessive daytime sleepiness in thepatient described here appeared at the lowest possible dose ofropinirole needed to control his motor symptoms. An overnightswitch to pergolide in a dose that has been shown to beequivalent to ropinirole led to a reversal of sedation withoutdeterioration of parkinsonism . . . switching to anotherdopamine agonist could be a therapeutic option in patientsexperiencing sedation with low doses of dopamine agonists andshould be further studied.’Pirker W, et al. Sleep attacks in Parkinson’s disease. Lancet 356: 597-598, 12 Aug2000 - Austria 800839139

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Reactions 19 Aug 2000 No. 8150114-9954/10/0815-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved