Monotherapy in idiopathic Parkinson's disease; adjunctive treatment w/ levodopa to control "on-off" fluctuations which might permit a reduction in total daily levodopa dose.
Individualized dosage. Adult Initially 2 mg once daily for 1 wk. Dose titration for the 1st 4 wk of treatment: Wk 1: 2 mg daily, wk 2: 4 mg daily, wk 3: 6 mg daily, wk 4: 8 mg daily. If sufficient symptomatic control is not achieved or maintained after initial titration period, the daily dose may be increased up to 4 mg once every 1-2 wk. Max: 24 mg once daily. Patient w/ ESRD (patient on haemodialysis) Initially 2 mg once daily. Max: 18 mg daily in patients receiving regular dialysis.
Severe CV disease, history or presence of major psychotic disorders & compulsive behaviours or concurrent dopaminergic treatment. Not to be taken by patients w/ rare hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. Risk of incomplete release of medication & of medication residue in the stool if rapid GI transit occurs. Avoid abrupt discontinuation. May cause allergic-type reactions due to sunset yellow FCF contained in 4-mg tab. May impair ability to drive or operate machinery. Severe renal impairment (CrCl <30 mL/min) w/o regular dialysis. Not recommended in patients w/ hepatic impairment. Not to be used during pregnancy & lactation. Not recommended in childn & adolescents <18 yr. Elderly ≥65 yr.
Diminished effectiveness w/ neuroleptics & other centrally-active dopamine antagonists eg, sulpiride or metoclopramide. Caution when used w/ other dopamine agonists, alcohol. Increased Cmax & AUC w/ CYP1A2 inhibitors eg, ciprofloxacin, enoxacin, or fluvoxamine. Increased plasma conc w/ high doses of oestrogens. Dose adjustment may be necessary if patients stop or start smoking.
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