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An exploratory retrospective evaluation of ropinirole-associated psychotic symptoms in an outpatient population treated for restless legs syndrome or Parkinson's disease.
Ann Pharmacother. 2009 Sep; 43(9):1426-32.AP

Abstract

BACKGROUND

Traditional treatment approaches for the management of restless legs syndrome (RLS) and Parkinson's disease (PD) include the use of medications that either directly or indirectly increase dopamine levels. In turn, a potential adverse event that could be expected is the development or exacerbation of psychiatric-related symptoms.

OBJECTIVE

To evaluate and describe the incidence of psychosis and associated behavioral features in patients taking ropinirole for RLS or PD.

METHODS

Patients were identified from a computerized database search of outpatients being treated with ropinirole for 1 of 2 medical conditions: PD or RLS. Data were collected in a retrospective manner from 95 patients who were tracked over the course of their therapy to determine whether psychosis or associated behavioral symptoms developed as a result and whether an intervention was needed to adjust ropinirole dosing or if additional medications had to be added to control features associated with psychosis.

RESULTS

A total of 284 patients being treated for RLS or PD were identified; of this group, 95 patients were identified as being treated for PD or RLS with ropinirole. Of the 95 patients being treated with ropinirole, 13 developed psychotic features that required therapeutic intervention with either the use of an antipsychotic or dose adjustment of ropinirole. PD patients included in this study were numerically more likely to develop psychotic features compared with RLS patients; however, the difference was not statistically significant (p = 0.122). The results do suggest that this risk is increased when ropinirole is used as part of a dual therapy approach with dopamine agonists in the treatment of either PD or RLS (p = 0.003).

DISCUSSION

Dopamine agonists have long been used as preferred treatment in the management of PD and RLS. When treating either PD or RLS in the psychiatric population, the concern arises that increased activity at dopamine receptors may induce or exacerbate psychiatric features. A potential clinical concern with the use of ropinirole is the potential for patients to develop psychiatric features, although there are few data available to demonstrate whether stimulation of targeted individual dopamine receptors is linked to the development or exacerbation of psychotic features. It is also undetermined whether concurrent antipsychotic treatment provides any protective benefit against psychosis, especially in patients already being treated for psychotic symptoms.

CONCLUSIONS

Our findings suggest that ropinirole may play a role in inducing or exacerbating psychosis and its associated features, although a number of confounding variables prevent the determination of a clear association and suggest that further investigation is warranted in controlled clinical trials.

Authors+Show Affiliations

Division of Pharmacy Practice and Administration, School of Pharmacy and Northwest Missouri Psychiatric Rehabilitation Center, University of Missouri at Kansas City, MO 64108, USA. stoners@umkc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19690226

Citation

Stoner, Steven C., et al. "An Exploratory Retrospective Evaluation of Ropinirole-associated Psychotic Symptoms in an Outpatient Population Treated for Restless Legs Syndrome or Parkinson's Disease." The Annals of Pharmacotherapy, vol. 43, no. 9, 2009, pp. 1426-32.
Stoner SC, Dahmen MM, Makos M, et al. An exploratory retrospective evaluation of ropinirole-associated psychotic symptoms in an outpatient population treated for restless legs syndrome or Parkinson's disease. Ann Pharmacother. 2009;43(9):1426-32.
Stoner, S. C., Dahmen, M. M., Makos, M., Lea, J. W., Carver, L. J., & Rasu, R. S. (2009). An exploratory retrospective evaluation of ropinirole-associated psychotic symptoms in an outpatient population treated for restless legs syndrome or Parkinson's disease. The Annals of Pharmacotherapy, 43(9), 1426-32. https://doi.org/10.1345/aph.1M183
Stoner SC, et al. An Exploratory Retrospective Evaluation of Ropinirole-associated Psychotic Symptoms in an Outpatient Population Treated for Restless Legs Syndrome or Parkinson's Disease. Ann Pharmacother. 2009;43(9):1426-32. PubMed PMID: 19690226.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An exploratory retrospective evaluation of ropinirole-associated psychotic symptoms in an outpatient population treated for restless legs syndrome or Parkinson's disease. AU - Stoner,Steven C, AU - Dahmen,Megan M, AU - Makos,Mignon, AU - Lea,Jessica W, AU - Carver,Lora J, AU - Rasu,Rafia S, Y1 - 2009/08/18/ PY - 2009/8/20/entrez PY - 2009/8/20/pubmed PY - 2009/11/3/medline SP - 1426 EP - 32 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 43 IS - 9 N2 - BACKGROUND: Traditional treatment approaches for the management of restless legs syndrome (RLS) and Parkinson's disease (PD) include the use of medications that either directly or indirectly increase dopamine levels. In turn, a potential adverse event that could be expected is the development or exacerbation of psychiatric-related symptoms. OBJECTIVE: To evaluate and describe the incidence of psychosis and associated behavioral features in patients taking ropinirole for RLS or PD. METHODS: Patients were identified from a computerized database search of outpatients being treated with ropinirole for 1 of 2 medical conditions: PD or RLS. Data were collected in a retrospective manner from 95 patients who were tracked over the course of their therapy to determine whether psychosis or associated behavioral symptoms developed as a result and whether an intervention was needed to adjust ropinirole dosing or if additional medications had to be added to control features associated with psychosis. RESULTS: A total of 284 patients being treated for RLS or PD were identified; of this group, 95 patients were identified as being treated for PD or RLS with ropinirole. Of the 95 patients being treated with ropinirole, 13 developed psychotic features that required therapeutic intervention with either the use of an antipsychotic or dose adjustment of ropinirole. PD patients included in this study were numerically more likely to develop psychotic features compared with RLS patients; however, the difference was not statistically significant (p = 0.122). The results do suggest that this risk is increased when ropinirole is used as part of a dual therapy approach with dopamine agonists in the treatment of either PD or RLS (p = 0.003). DISCUSSION: Dopamine agonists have long been used as preferred treatment in the management of PD and RLS. When treating either PD or RLS in the psychiatric population, the concern arises that increased activity at dopamine receptors may induce or exacerbate psychiatric features. A potential clinical concern with the use of ropinirole is the potential for patients to develop psychiatric features, although there are few data available to demonstrate whether stimulation of targeted individual dopamine receptors is linked to the development or exacerbation of psychotic features. It is also undetermined whether concurrent antipsychotic treatment provides any protective benefit against psychosis, especially in patients already being treated for psychotic symptoms. CONCLUSIONS: Our findings suggest that ropinirole may play a role in inducing or exacerbating psychosis and its associated features, although a number of confounding variables prevent the determination of a clear association and suggest that further investigation is warranted in controlled clinical trials. SN - 1542-6270 UR - https://www.unboundmedicine.com/medline/citation/19690226/An_exploratory_retrospective_evaluation_of_ropinirole_associated_psychotic_symptoms_in_an_outpatient_population_treated_for_restless_legs_syndrome_or_Parkinson's_disease_ L2 - https://journals.sagepub.com/doi/10.1345/aph.1M183?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -