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Ciprofloxacin tablet formulation guideline

Contraindications

Known hypersensitivity/allergic reaction (including urticaria, angioedema, rash, pruritus) to ropinirole or to any of the excipients

Cautions

Risk of somnolence associated with use for restless legs syndrome, as well as (rare) risk of syncope, hypotension, and hallucinations

May cause psychotic-like behavior; abnormal thinking and behavior can consist of one or more of a variety of manifestations including paranoid ideation, delusions, hallucinations, confusion, disorientation, aggressive behavior, agitation, and delirium; risk may be increased in the elderly

Risk of orthostatic hypotension with extended-release formulation

Possible risk of erratic behavior associated with dopamine agonists, compulsive behavior including urge to gamble and increased sexual urges

Potential for elevation in blood pressure and changes in heart rate should be considered when treating patients with cardiovascular disease with extended release formulation

Dyskinesia seen with concurrent use of levodopa

Increased risk of melanoma development and pleural retroperitoneal fibrosis reported, but causation not established; monitoring warranted 

Use caution in patients with history of hepatic/renal impairment, psychotic disorders, dyskinesias, restless leg syndrome

In patients with advanced Parkinson’s disease dyskinesia may occur

Abrupt withdrawal or significant dosage reduction associated with syndrome resembling neuroleptic malignant syndrome (characterized by elevated temperature, muscular rigidity, altered consciousness, and autonomic instability); see Administration section for how to gradually discontinue drug

Before initiating treatment, patients should be advised of potential to develop drowsiness and specifically asked about factors that may increase risk such as concomitantly taking sedating medications or alcohol; the presence of sleep disorders (other than RLS), and concomitant medications that increase ropinirole plasma levels (e.g., ciprofloxacin); if patient develops significant daytime sleepiness or episodes of falling ciprofloxacin tablet formulation guideline asleep during activities that require active participation (e.g., driving a motor vehicle, conversations, eating); therapy should be discontinued; if decision is made to continue therapy patients should be advised to not drive and avoid other potentially dangerous activities; there is insufficient information to establish whether dose reduction will eliminate episodes of falling asleep while engaged in activities of daily living

Patients with Parkinson’s disease may have impaired ability to respond normally to a fall in blood pressure after standing from lying down or seated position; patients receiving therapy should be monitored for signs and symptoms of orthostatic hypotension, especially during dose escalation, and should be informed of risk for syncope and hypotension

Augmentation and rebound in restless leg syndrome

  • Augmentation is a phenomenon in which dopaminergic medication causes a worsening of symptom severity above and beyond the level at the time the medication was started
  • Augmentation symptoms may include earlier onset of symptoms in the evening (or even the afternoon), increase in symptoms, and spread of symptoms to involve other extremities
  • Rebound refers to new onset of symptoms in the early morning hr
  • Therapy should be reviewed and dosage adjustment or discontinuation of treatment considered with augmentation and early-morning rebound in restless syndrome; when discontinuing therapy in patients with restless leg syndrome, gradual reduction of the daily dose is recommended whenever possible

Source: http://reference.medscape.com/drug/requip-xl-ropinirole-343051


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