英文药名:Requip XL(Ropinirole prolonged-release tablets) 中文药名:罗匹尼罗延长释放片 生产厂家:Glaxo Smith Kline
Dose interruption or discontinuation If treatment is interrupted for one day or more, re-initiation by dose titration on ropinirole immediate release tablets should be considered. If it is necessary to discontinue ropinirole treatment, this should be done gradually by reducing the daily dose over the period of one week. Renal impairment In parkinsonian patients with mild to moderate renal impairment (creatinine clearance between 30 and 50 ml/min) no change in the clearance of ropinirole was observed, indicating that no dosage adjustment is necessary in this population. A study into the use of ropinirole in patients with end stage renal disease (patients on haemodialysis) has shown that a dose adjustment in these patients is required as follows: The recommended initial dose of ReQuip XL is 2 mg once daily. Further dose escalations should be based on tolerability and efficacy. The recommended maximum dose is 18 mg/day in patients receiving regular dialysis. Supplemental doses after dialysis are not required. The use of ropinirole in patients with severe renal impairment (creatinine clearance less than 30 ml/min) without regular haemodialysis has not been studied. Hepatic impairment The use of ropinirole in patients with hepatic impairment has not been studied. Administration of ropinirole to such patients is not recommended. Elderly The clearance of ropinirole is decreased by approximately 15% in patients aged 65 years or above. Although a dose adjustment is not required, ropinirole dose should be individually titrated, with careful monitoring of tolerability, to the optimal clinical response. In patients aged 75 years and above, slower titration during treatment initiation may be considered. Children and adolescents Ropinirole prolonged-release tablets are not recommended for use in children below 18 years of age due to a lack of data on safety and efficacy. 4.3 Contraindications Hypersensitivity to ropinirole or to any of the excipients listed in section 6.1. Severe renal impairment (creatinine clearance <30 ml/min) without regular haemodialysis. Hepatic impairment. 4.4 Special warnings and precautions for use Due to the risk of hypotension, blood pressure monitoring is recommended, particularly at the start of treatment, in patients with severe cardiovascular disease (in particular coronary insufficiency). Patients with a history or presence of major psychotic disorders should only be treated with dopamine agonists if the potential benefits outweigh the risks (see also section 4.5). Impulse control disorders Patients should be regularly monitored for the development of impulse control disorders. Patients and carers should be made aware that behavioural symptoms of impulse control disorders including pathological gambling, increased libido, hypersexuality, compulsive spending or buying, binge eating and compulsive eating can occur in patients treated with dopamine agonists including ReQuip XL. Dose reduction/tapered discontinuation should be considered if such symptoms develop. Impulse control disorders were reported especially at high doses and were generally reversible upon reduction of the dose or treatment discontinuation. Risk factors such as a history of compulsive behaviours were present in some cases (see section 4.8). Ropinirole has been associated with somnolence and episodes of sudden sleep onset, particularly in patients with Parkinson's disease. Sudden onset of sleep during daily activities, in some cases without awareness or warning signs, has been reported uncommonly. Patients must be informed of this and advised to exercise caution while driving or operating machines during treatment with ropinirole. Patients who have experienced somnolence and/or an episode of sudden sleep onset must refrain from driving or operating machines. Furthermore, a reduction of dosage or termination of therapy may be considered. Requip XL tablets are designed to release medication over a 24hr period. If rapid gastrointestinal transit occurs, there may be risk of incomplete release of medication, and of medication residue being passed in the stool. This medicinal product also contains lactose. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine. The 4 mg tablets contain the azo colouring agent sunset yellow (E110), which may cause allergic reactions. 4.5 Interaction with other medicinal products and other forms of interaction There is no pharmacokinetic interaction between ropinirole and L-dopa or domperidone which would necessitate dosage adjustment of these drugs. Neuroleptics and other centrally active dopamine antagonists, such as sulpiride or metoclopramide, may diminish the effectiveness of ropinirole and therefore, concomitant use of these medicinal products should be avoided. Ropinirole is principally metabolised by the cytochrome P450 enzyme CYP1A2. A pharmacokinetic study (with a ropinirole film-coated (immediate-release) tablet dose of 2 mg, three times a day) in Parkinson's disease patients, revealed that ciprofloxacin increased the Cmax and AUC of ropinirole by 60% an 84% respectively, with a potential risk of adverse events. Hence, in patients already receiving ropinirole, the dose of ropinirole may need to be adjusted when medicinal products know to inhibit CYP1A2, e.g. ciprofloxacin, enoxacin, cimetidine or fluvoxamine, are introduced or withdrawn. A pharmacokinetic interaction study in patients with Parkinson's disease between ropinirole (with a ropinirole film-coated (immediate-release) tablet dose of 2 mg, three times a day) and theophylline, a substrate of CYP1A2, revealed no change in the pharmacokinetics of either ropinirole or theophylline. Increased plasma concentrations of ropinirole have been observed in patients treated with high doses of oestrogens. In patients already receiving hormone replacement therapy (HRT), ropinirole treatment may be initiated in the normal manner. However, if HRT is stopped or introduced during treatment with ropinirole, dosage adjustment may be required. Smoking is known to induce CYP1A2 metabolism, therefore if patients stop or start smoking during treatment with ropinirole, adjustment of dose may be required. 4.6 Fertility, pregnancy and lactation Pregnancy There are no adequate data from the use of ropinirole in pregnant women. Studies in animals have shown reproductive toxicity (see section 5.3). As the potential risk for humans is unknown, it is recommended that ropinirole is not used during pregnancy unless the potential benefit to the patient outweighs the potential risk to the foetus. Breast-feeding Ropinirole should not be used in nursing mothers as it may inhibit lactation. No human fertility data are available. 4.7 Effects on ability to drive and use machines Ropinirole may have a major effect on the ability to drive and use machines. Patients being treated with ropinirole and presenting with somnolence and/or sudden sleep episodes must be informed to refrain from driving or engaging in activities where impaired alertness may put themselves or others at risk of serious injury or death (e.g. operating machines) until such recurrent episodes and somnolence have resolved (see also section 4.4). 4.8 Undesirable effects Adverse events are listed below by system organ class and frequency. Frequencies are defined as: very common (>1/10), common (>1/100, <1/10), uncommon (>1/1,000, <1/100), rare (>1/10,000, <1/1,000) very rare (<1/10,000), not known (cannot be estimated from the available data). During clinical trials, the most commonly reported undesirable effects for ropinirole prolonged-release tablets were during monotherapy and dyskinesia during adjunctive therapy with levodopa. The following adverse events were reported during clinical trials with ReQuip XL up to 24 mg/day.
Pathological gambling, increased libido, hypersexuality, compulsive spending or buying, binge eating and compulsive eating can occur in patients treated with dopamine agonists including ReQuip XL. (see section 4.4. 'Special warnings and precautions for use'). Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard. 4.9 Overdose The symptoms of ropinirole overdose are generally related to its dopaminergic activity. These symptoms may be alleviated by appropriate treatment with dopamine antagonists such as neuroleptics or metoclopramide. 5. Pharmacological properties 5.1 Pharmacodynamic properties Pharmacotherapeutic group Dopamine agonist. ATC code: N04BC04 Mechanism of action Parkinson's disease is characterised by a marked dopamine deficiency in the nigral striatal system. Ropinirole is a non-ergoline D2/D3 dopamine agonist that alleviates this deficiency by stimulating striatal dopamine receptors. Ropinirole acts in the hypothalamus and pituitary to inhibit the secretion of prolactin. Clinical efficacy A 36-week, double-blind, three-period crossover study, in monotherapy with a primary end point of change from period baseline in Unified Parkinson's Disease Rating Scale (UPDRS) total motor score was conducted in 161 patients with early phase Parkinson's disease. A subgroup analysis of patients initiated on monotherapy treatment with ropinirole immediate release tablets and switched overnight to the nearest equivalent dose of ropinirole prolonged-release tablets was consistent with similar efficacy from equivalent mg for mg doses. The adjusted mean difference between ropinirole prolonged-release tablets and Requip film-coated (immediate-release) tablets at study-endpoint was 0.7 points (95% CI: [-1.51, 0.10], p=0.0842). Following the overnight switch to a similar dose of the alternative tablet formulation, there was no difference in the adverse event profile and less than 3% of patients required a dose adjustment (all dose adjustments were increases by one dose level. No patients required a dose increase). A 24-week, double-blind, placebo-controlled, parallel group study in patients with Parkinson's disease who were not optimally controlled on levodopa demonstrated that adjunctive therapy of ropinirole prolonged-release tablets results in clinically relevant and statistically significant superiority over placebo in a change from baseline in awake time “off” (adjusted mean treatment difference -1.7 hours (95% CI: [-2.34, -1.09], p<0.0001). This was supported by secondary efficacy parameters of change from baseline in total awake time “on” (+1.7 hours (95% CI [1.06, 2.33], p<0.0001) and total awake time “on” without troublesome dyskinesias (+1.5 hours (95% CI: [0.85, 2.13], p<0.0001). Importantly, there was no indication of an increase from baseline in awake time “on” with troublesome dyskinesias, either from diary card data or from the UPDRS items. Study of the effect of ropinirole on cardiac repolarisation A thorough QT study conducted in male and female healthy volunteers who received doses of 0.5, 1, 2 and 4 mg of ropinirole film-coated (immediate release) tablets once daily showed a maximum increase of the QT interval duration nat the 1 mg dose of 3.46 milliseconds (point estimate) as compared to placebo. The upper bound of the one sided 95% confidence interval for the largest mean effect was less than 7.5 milliseconds. The effect of ropinirole at higher doses has not been systematically evaluated. The available clinical data from a thorough QT study do not indicate a risk of QT prolongation at doses of ropinirole up to 4 mg/day. A risk of QT prolongation cannot be excluded as a thorough QT study at doses up to 24 mg/day has not been conducted. 5.2 Pharmacokinetic properties Absorption Bioavailability of ropinirole is approximately 50% (36–57%). Following oral administration of ropinirole prolonged-release tablets, plasma concentrations of ropinirole increase slowly, with a median time to Cmax of between six and ten hours. In a steady-state study in Parkinson's disease patients receiving 12 mg of Requip XL once daily, a high fat meal increased the systemic exposure to ropinirole as shown by an average 20% increase in AUC (90% CI [1.12, 1.28]) and an average 44% increase in Cmax (90% CI[1.34, 1.56]). Tmax was delayed by 3.0 hours. However, in the studies that established the safety and efficacy of Requip XL, patients were instructed to take study medication without regard to food intake. The systemic exposure to ropinirole is comparable for ropinirole prolonged-release tablets and ropinirole film-coated (immediate-release) tablets based on the same daily dose. Distribution Plasma protein binding of the drug is low (10–40%). Consistent with its high lipophilicity, ropinirole exhibits a large volume of distribution (approximately 7 l/kg). Biotransformation Ropinirole is primarily cleared by CYP1A2 metabolism and its metabolites are mainly excreted in the urine. The major metabolite is at least 100-times less potent than ropinirole in animal models of dopaminergic function. Elimination Ropinirole is cleared from the systemic circulation with an average elimination half-life of about six hours. The increase in systemic exposure (Cmax and AUC) to ropinirole is approximately proportional over the therapeutic dose range. No change in the oral clearance of ropinirole is observed following single and repeated oral administration. Wide inter-individual variability in the pharmacokinetic parameters has been observed. Following steady-state administration of ropinirole prolonged-release tablets, the inter-individual variability of Cmax was between 30% and 55% and for AUC was between 40% and 70%. Special Patient Populations Renal impairment: There was no change observed in the pharmacokinetics of ropinirole in Parkinson's disease patients with mild to moderate renal impairment. In patients with end stage renal disease receiving regular dialysis, oral clearance of ropinirole is reduced by approximately 30%. Oral clearance of the metabolites SKF-104557 and SKF-89124 were also reduced by approximately 80% and 60%, respectively. Therefore, the recommended maximum dose is limited to 18 mg/day in these patients with Parkinson's disease. 5.3 Preclinical safety data Reproductive toxicity Administration of ropinirole to pregnant rats at maternally toxic doses resulted in decreased foetal body weight at 60 mg/kg/day (approximately twice the AUC at the maximum dose in humans), increased foetal death at 90 mg/kg/day (approximately 3 times the AUC at the maximum dose in humans) and digit malformations at 150 mg/kg/day (approximately 5 times the AUC at the maximum dose in humans). There were no teratogenic effects in the rat at 120 mg/kg/day (approximately 4 times the AUC at the maximum dose in humans) and no indication of an effect on development in the rabbit. General toxicology The toxicology profile is principally determined by the pharmacological activity of the drug (behavioural changes, hypoprolactinaemia, decrease in blood pressure and heart rate, ptosis and salivation). In the albino rat only, retinal degeneration was observed in a long term study at the highest dose (50 mg/kg/day), and was probably associated with an increased exposure to light. Genotoxicity Genotoxicity was not observed in a battery of in vitro and in vivo tests. Carcinogenicity Two-year studies have been conducted in the mouse and rat at dosages up to 50 mg/kg. The mouse study did not reveal any carcinogenic effect. In the rat, the only drug-related lesions were Leydig cell hyperplasia/adenoma in the testis resulting from the hypoprolactinaemic effect of ropinirole. These lesions are considered to be a species specific phenomenon and do not constitute a hazard with regard to the clinical use of ropinirole. Safety pharmacology In vitro studies have shown that ropinirole inhibits hERG-mediated currents. The IC50 is 5-fold higher than the expected maximum plasma concentration in patients treated at the highest recommended dose (24 mg/day), see section 5.1. 6. Pharmaceutical particulars 6.1 List of excipients Tablet core Hypromellose 2208, hydrogenated castor oil, carmellose sodium, povidone K29-32, maltodextrin, magnesium stearate, lactose monohydrate, anhydrous colloidal silica, mannitol (E421), ferric oxide yellow (E172) and glycerol dibehenate. Film coat 2 mg: Hypromellose 2910, ferric oxide yellow (E172), titanium dioxide (E171), macrogol 400 and ferric oxide red (E172). 4 mg: Hypromellose 2910, titanium dioxide (E171), macrogol 400, sunset yellow (E110) and indigo carmine (E132). 8 mg: Hypromellose 2910, ferric oxide yellow (E172), titanium dioxide (E171), ferric oxide black (E172), macrogol 400 and ferric oxide red (E172). 6.2 Incompatibilities Not applicable. 6.3 Shelf life ReQuip XL 2mg prolonged-release tablets 2 years. ReQuip XL 4mg prolonged-release tablets 3 years. ReQuip XL 8mg prolonged-release tablets 3 years. 6.4 Special precautions for storage Do not store above 25°C. Store in the original package. 6.5 Nature and contents of container PVC/PCTFE/Aluminium or PVC/PCTFE/PVC/Aluminium blister packs. Packs of 28 or 84 prolonged-release tablets. Not all pack sizes may be marketed 6.6 Special precautions for disposal and other handling No special requirements for disposal. 7. Marketing authorisation holder SmithKline Beecham Limited Great West Road, Brentford, Middlesex TW8 9GS Trading as: GlaxoSmithKline UK Stockley Park West, Uxbridge, Middlesex UB11 1BT 8. Marketing authorisation number(s) Requip XL 2 mg prolonged-release tablets PL 10592/0293 Requip XL 4 mg prolonged-release tablets PL 10592/0295 Requip XL 8 mg prolonged-release tablets PL 10592/0296 9. Date of first authorisation/renewal of the authorisation 07th May 2008 10. Date of revision of the text 13 March 2014 |
Requip XL(Ropinirole prolonged-release tablets)简介:
英文药名:Requip XL(Ropinirole prolonged-release tablets)
中文药名:罗匹尼罗延长释放片
生产厂家:Glaxo Smith Kline药品简介葛兰素史克公司(GSK)近日宣布,罗匹尼罗缓释片(ropinirole,Requ ... 责任编辑:admin |
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