Dopamine-receptor agonists (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Note: Dopamine agonists

  • Impulse control: all dopamine agonists and levodopa can lead to a problem with impulse control which can lead to gambling, hypersexuality, overeating and excessive shopping. If these develop after the initiation of dopamine agonists seek urgent specialist review: patients will often not recognise these as medicine side-effects and so will need to be asked specifically. Provide the patient information leaflet: Dopamine agonist medication used to treat Parkinson's or Restless legs to all patients on initiation with a dopamine agonist and remind them on a dose increase and when adding in other levodopa therapies.
  • Nausea and vomiting can be a particular problem when uptitrating dopamine agonists. Consider co-prescription of domperidone.
  • All dopamine agonists require careful dose titration.
  • All dopamine agonists can cause postural hypotension, neuropsychiatric adverse effects including psychosis, and leg oedema.

For use in the management of restless legs syndrome see guidance.

ROPINIROLE - (First line)

Therapy notes

MHRA advice: Drug-name confusion: reminder to be vigilant for potential errors (January 2018) (www.gov.uk).

Formulation and dosage details

Formulation:

Tablets 250 micrograms, 500 micrograms, 1mg, 2mg, 5mg (s)

Dosage:

Initially 750 micrograms daily in 3 divided doses, increased by increments of 750 micrograms at weekly intervals to 3mg daily; further increased by increments of up to 3mg at weekly intervals according to response; usual range 3 to 9mg daily; maximum 24mg daily.

Formulation and dosage details

Formulation:

Modified release tablets 2mg, 4mg, 8mg (s)

Dosage:

Initially 750 micrograms daily in 3 divided doses, increased by increments of 750 micrograms at weekly intervals to 3mg daily; further increased by increments of up to 3mg at weekly intervals according to response; usual range 3 to 9mg daily; maximum 24mg daily.

PRAMIPEXOLE - (Second line)

Therapy notes

Formulation and dosage details

Formulation:

Tablets 88 micrograms, 180 micrograms, 350 micrograms, 700 micrograms (s)

Dosage:

Initially 88 micrograms 3 times daily, doubled every 7 days if tolerated to 350 micrograms 3 times daily; further increased if necessary by 180 micrograms 3 times daily at weekly intervals; maximum 3·3mg daily in 3 divided doses. Note dosage reduction in renal impairment.

Formulation and dosage details

Formulation:

Modified release tablets 260 micrograms, 520 micrograms, 1·05mg, 2·1mg, 3·15mg (s)

Dosage:

Initially 260 micrograms once daily, doubling the dose every 7 days to 1·05mg once daily; if necessary, increase further by 520 micrograms at weekly intervals; maximum 3·15mg once daily. Note dosage reduction in renal impairment.

ROTIGOTINE

Therapy notes

Formulation and dosage details

Formulation:

Transdermal patches 1mg/24 hours, 2mg/24 hours, 3mg/24 hours, 4mg/24 hours, 6mg/24 hours, 8mg/24 hours (s)

Dosage:

Parkinson’s disease, initially apply 2mg/24 hours patch, increased in steps of 2mg/24 hours at weekly intervals if required; maximum as monotherapy 8mg/24 hours, maximum as adjunctive therapy with levodopa 16mg/24 hours.

Notes:

Note: Rotigotine: If switching patients to transdermal rotigotine from oral levodopa/dopamine agonists, refer to advice in Impaired oral intake advice for patients with Parkinson’s.

APOMORPHINE

Therapy notes


MHRA advice: Apomorphine with domperidone: minimising risk of cardiac side effects (April 2016) (www.gov.uk).

Formulation and dosage details

Formulation:

Solution for injection 20mg/2mL, 50mg/5mL (s)

Dosage:

Under specialist advice only, by subcutaneous injection, usual range (after initial titration) 3 to 30mg daily in divided doses; maximum total daily dose 100mg.

Formulation and dosage details

Formulation:

Solution for injection, pen injector 30mg/3mL (s)

Dosage:

Under specialist advice only, by subcutaneous injection, usual range (after initial titration) 3 to 30mg daily in divided doses; maximum total daily dose 100mg.

Formulation and dosage details

Formulation:

Solution for infusion, pre-filled syringe 50mg/10mL (s)

Dosage:

Can be given by subcutaneous infusion if requiring more than 10 injections daily; maximum total daily dose 100mg.

Editorial Information

Document Id: F090