How safe is ropinirole compared to other dopamine agonists for the treatment of Parkinson’s disease?

This study evaluated the tolerability and safety of ropinirole (Requip XL) versus other dopamine agonists taken alone or together with levodopa to treat Parkinson’s disease (PD). This study concluded that ropinirole was associated with similar side effects to other dopamine agonists.

For many years, dopamine agonists (DA) have been used for both early and advanced stages of PD. This type of treatment mimics dopamine in the brain, and can help boost the brain’s low dopamine supply. There are two main types of this drug: ergot and non-ergot agonists. Ropinirole is a non-ergot agonist. Whether ropinirole is safer than other dopamine therapies for the treatment of PD remains under investigation.

This study analyzed the results of 40 studies (8795 patients) comparing ropinirole to other dopamine agonists taken alone or with levodopa, and to placebo (substance with no active effect). Therapies included ropinirole, bromocriptine (Parlodel), cabergoline (Dostinex), pramipexole (Mirapex), rotigotine (Neupro), and pergolide (Permax). The average study length was 23 weeks.

Overall, 59.72% of patients reported side effects. The most common side effects included nausea (21.1%), involuntary movements (dyskinesia; 17.7%), dizziness (15.1%), and drowsiness (14.1%). Insomnia (9.7%) and hallucinations (6.7%) were also reported. Patients taking ropinirole experienced more of these side effects compared to levodopa, placebo, or any other dopamine agonist except for pramipexole.

Compared to placebo, ropinirole significantly increased the risks of nausea (2.25-fold), dyskinesia (2.71-fold), dizziness (1.87-fold), drowsiness (2.45-fold), and hallucinations (2.84-fold). No significant difference was found between ropinirole and other dopamine therapies, except for levodopa. Ropinirole decreased risk of dyskinesia by 75% compared to levodopa. 

This study concluded that ropinirole was associated with similar side effects to other dopamine agonists.

In 2007, the FDA removed pergolide from the U.S. market due to links to heart valve disease. Cabergoline is not FDA-approved for PD, but remains on the market for other uses.