Dopamine agonists (pramipexole, ropinirole)
This information explains dopamine agonists including how they work, the benefits and side effects and the different types.
Dopamine agonists is the name used to describe a type (class) of Parkinson’s drugs.
How do dopamine agonists work?
Dopamine agonist drugs trick your brain into thinking they are dopamine. This means they can mimic the way dopamine works, which can reduce your symptoms.
When are dopamine agonists used?
Dopamine agonists are generally prescribed in the earlier stages of Parkinson’s. As everyone is different your specialist may prescribe them at any time if it is right for you.
Treatment with dopamine agonists has to be started carefully. The dose is gradually increased until you and your specialist are happy that your symptoms are under control.
Benefits of dopamine agonists
Not needing to take as much levodopa
If you are taking dopamine agonists, this may mean you can take lower doses of levodopa as your condition progresses. This can reduce the risk of involuntary movements (dyskinesia) and how much they affect you.
Helping levodopa work better
Dopamine agonists can be taken with levodopa medication to help when levodopa wears off or doesn’t work as well. This is because dopamine agonists work for longer in the body and can reduce the ‘on/off’ effect you may have with levodopa.
Fewer tablets to take
Some come in a form that only needs to be taken once a day, which could mean you have to take fewer tablets. But this is only suitable for some people.
Treating restless legs
Dopamine agonist medications can be used for people who have restless legs syndrome, also called Willis-Ekbom disease. Your specialist will decide which particular drug to prescribe if you have this.
Restless legs syndrome can be connected to Parkinson’s or it can be a separate condition. You may experience tingling in your legs and you may have an urge to move them.
Check with your healthcare professional for advice on when to take dopamine agonist medication you are prescribed for restless legs syndrome.
Read our information on restless legs syndrome.
Risks and side effects of dopamine agonists
Sleepiness and fainting
Dopamine agonist drugs can make you sleepy, faint or dizzy. This is most likely to happen when you start taking them. Once you get to a stable dose, this effect often wears off.
Some people have fallen asleep suddenly, without any warning. This can happen when the amount of medication you are taking is increased, but should settle down. If this happens, it’s important that you tell your specialist or Parkinson’s nurse.
Your healthcare team will usually advise you not to drive while they increase your dose of this medication.
Impulsive and compulsive behaviours and hallucinations and delusions
These side effects can happen with any Parkinson’s drugs but are more common with dopamine agonists.
Other side effects
The patient information leaflet that comes with your medication will tell you about all of the side effects that you may experience.
Some possible side effects include:
- feeling sick (nausea)
- constipation
- low blood pressure (hypotension)
- headaches
- anxiety and depression
- movement problems.
Types of dopamine agonists
Below are the types of dopamine agonist drugs. Each drug has a generic (unbranded) name and a branded name.
Pramipexole
Pramipexole is a type of generic dopamine agonist medication.
There are a number of brand names for pramipexole. These are:
- Mirapexin (tablets)
- Mirapexin (modified release tablets)
- Pipexus (modified release tablets)
Taking pramipexole
Below we have included the different forms of pramipexole medication and information on how to take them.
The most up-to-date information on the drug you are taking will be on your patient information leaflet. You will find it with your medication packet. Always read it carefully before you start your treatment.
Follow the advice of your specialist or Parkinson’s nurse about how to take pramipexole so that it works well for your Parkinson’s.
Pramipexole drugs are also used to help your symptoms when your levodopa medication causes you to experience wearing off and dyskinesia. This could be motor fluctuations, or wearing off before your next dose of levodopa is due.
Swallow the tablets with a drink of water. You can take your doses before or after meals.
Your specialist or Parkinson’s nurse will advise you on the best dose. Usually they will give you a low dose of these tablets at first. They will increase the dose roughly every 5 to 7 days until it is right for you and your symptoms.
You will usually take Mirapexin 3 times a day but your specialist or Parkinson’s nurse will advise you on this.
You should take the tablets with a drink of water. Don’t break, crush or chew them. This is because they have been made to release the medicine slowly over the course of the day. You can take them with or without food.
Your healthcare professional will be able to advise you on the best dose. Usually you will be given these tablets on a low dose at first. This will be increased roughly every 5 to 7 days until it is right for you and your symptoms.
You will be prescribed Pipexus or Mirapexin (modified release tablets) once a day. This can make it easier for you to remember your dose.
Ropinirole
Ropinirole is a type of generic dopamine agonist medication.
There are a number of brand names for ropinirole. These include:
- Adartrel (tablets)
- ReQuip (tablets)
- Ipinnia XL (modified release tablets)
- Ralnea XL (modified release tablets)
- Raponer XL (modified release tablets)
- Repinex XL (modified release tablets)
- ReQuip XL (modified release tablets)
- Ropiqual XL (modified release tablets)
Ropinirole medication can be used as a substitute for dopamine because it can have an effect on the same nerve cells where dopamine works. Ropinirole can be used alone or with other medications to treat Parkinson’s.
Taking ropinirole
Below are the different forms of ropinirole medication and information on how to take them.
The most up-to-date information on the drug you are taking will be on your patient information leaflet. You will find it with your medication packet. Always read it carefully before you start your treatment.
Follow the advice of your specialist or Parkinson’s nurse about how to take ropinirole so that it works well for your Parkinson’s.
You usually take Adartrel or ReQuip tablets 3 times a day, before bedtime (or around 3 hours before you go to bed). Your specialist can then increase your dose during the rest of the first week if you don’t experience side effects.
Your specialist or Parkinson’s nurse can advise you on when to take ropinirole so that it works well for your Parkinson’s. They can increase your daily dose over time until it is right for you and your symptoms.
Taking ropinirole with your meals will help to reduce any stomach issues that you may have.
Modified release tablets release your medication slowly throughout the day. This can give you more control of your symptoms. You can take these tablets with or without food. It is important that you take these tablets whole. Don’t chew, crush or divide them into pieces.
At first, your specialist will prescribe you a low dose of Ipinnia XL, Ralnea XL, Raponer XL, Repinex XL, ReQuip XL, or Ropiqual XL. This will usually be once a day for the first week. Your healthcare professional can then increase your daily dose until it is right for you and your symptoms.
In some cases, eating a high fat meal can increase the time ropinirole takes to be absorbed in the body. Speak to your specialist if you think that food is causing problems when you take your medication.
Tell your doctor if you experience side effects from any of these modified release tablets. Other forms of ropinirole medication may be more suitable for you.
Rotigotine
The brand name of rotigotine is Neupro. It is a skin patch which is applied to different areas of the skin and releases the drug slowly.
How does the skin patch work?
Neupro is placed on your skin once at the same time every day. You should hold the patch in place for 30 seconds to allow the drug to start working. It can stay in place for 24 hours before you put on a new one.
If you forget to apply the patch at your usual time or if it falls off, put on a new one for the rest of the day.
How can a skin patch help?
It may be useful if you:
- have trouble swallowing tablets
- experience ‘wearing off’ of your levodopa medication
- experience fluctuations in the way your levodopa medication works
- have restless legs syndrome (an uncontrollable urge to move your legs).
Apomorphine
Apomorphine is a dopamine agonist. Apomorphine can come in a pen, cartridge, vial (small bottle) or an ampoule (small container).
It is injected or goes through an infusion pump. The brand names for apomorphine are APO-go and Dacepton.
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