Practical aspects of the use of extended-release ropinirole (requip modutab) in the treatment of Parkinson’s disease
Extended-release ropinirole is a new formulation of the well-known nonergolinic D2/D3 dopamine receptor agonist (DRAs), which has been widely used to treat Parkinson’s disease (PD) in foreign countries for many years. The efficiency of extended-release ropinirole (Requip Modutab) was evaluated in 12 patients with Hoehn-Yahr Stages I-IIPD who had not taken DRAs (n = 6) or had taken, but stopped their use no later than one month before their inclusion into the study (n = 6). The patients’ age was 38 to 72 years (mean 65.3+6.4 years); the disease duration was 1 to 4 years (2.1+1.8years). Six patients received amantadine, 4 had a fixed-dose of rasagi- line. The dose titration of Requip Modutab was 4 to 8 weeks. The starting dose of the drug was 2 mg/day in all the cases. Then it was increased once weekly until the optimal effect was achieved. The effective dose ranged 6 to 16 mg/day (mean 12.1+3.9 mg/day). The most common maintenance dose was 12 mg/day in 6 patients, 16 mg/day in 2, and 8 mg/day in 4. In 3 (25%) patients, the dose had to be decreased because of an adverse reaction. The total follow-up period was 8 months. When ropinirole was used, the average UPDRS (Parts II and II) scores decreased from 22.3+8.9 to 18.1+9.2 and 10.9+4.3 to 9.3+4.6, respectively (p < 0.05). Three (25%), 4 (33%), and 2 (17%) patients showed significant, moderate, and minimal improvement, respectively; 2 (17%) patients had no changes, worsening occurred in 1 (8%) patient. The achieved improvement was steadily maintained throughout the follow-up. Thus, Requip Modutab is an effective and safe agent for the treatment of early-stage PD, which assures an adequate control of motor disorders, on the one hand, and makes it possible to delay the use of levodopa or to be limited to its minimal dose, on the other hand, reducing the risk of fluctuations and dyskinesias. Once-daily use of the drug and a more convenient dose titration scheme create conditions for higher adherence to treatment and its higher efficiency.