Is Ropinirole Hydrochloride compatible with breastfeeding? Do we have alternatives for Ropinirole Hydrochloride?

Ropinirole Hydrochloride

October 9, 2016 (High Risk)

Non-ergotamine and D2 /D3 Dopamine agonist drug.
Indicated for Parkinson's disease and Restless Legs Syndrome (Evening dose).

At latest update no published data on excretion into breast milk were found.
Pharmacokinetic data do not allow easily predict the possibility of excretion into breastmilk, since a low protein-binding capacity would not prevent it, however, a large distribution volume would make it unlikely.
Its low oral bioavailability which decreases even more when taken with meals, suggests that plasma concentration would reach a very low level in the infant, except during the neonatal period and in case of prematurity in which intestinal absorption may be increased.
Side effects are neither frequent nor severe.

Prolactin levels may be lowered with decreased production of breastmilk during the first weeks after birth.
Gut absorption may be increased with higher plasma levels if taken together with Ciprofloxacin (Kaye 2000).

Whenever it is used while breastfeeding, it would be wise avoiding it during the first 15 to 20 days and assess milk production and onset of nausea, drowsiness or irritability in infants.
By waiting six hours after medication, excretion into breastmilk would possibly be lowered.

Alternatives

We do not have alternatives for Ropinirole Hydrochloride.

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Writings

  • ροπινιρόλη υδροχλωρική (Greek)
  • Ропинирола Гидрохлорид (Cyrillic)
  • ロピニロール塩酸塩 (Japanese)
  • C16H24N2O,HCl (Molecular formula)
  • SKF-101468 (Experimental code/s)

References

  1. GSK. Ropinirole. Drug Summary. 2014 Full text (in our servers)
  2. AEMPS. Ropinirol. Ficha técnica. 2011 Full text (in our servers)
  3. Kulisevsky J, Pagonabarraga J. Tolerability and safety of ropinirole versus other dopamine agonists and levodopa in the treatment of Parkinson's disease: meta-analysis of randomized controlled trials. Drug Saf. 2010Abstract
  4. Kaye CM, Nicholls B. Clinical pharmacokinetics of ropinirole. Clin Pharmacokinet. 2000Abstract
  5. de Mey C, Enterling D, Meineke I, Yeulet S. Interactions between domperidone and ropinirole, a novel dopamine D2-receptor agonist. Br J Clin Pharmacol. 1991Abstract
  6. de Mey C, Enterling D, Meineke I, Brendel E. Effects of the novel D2-dopaminergic agonist ropinirol on supine resting and stimulated circulatory and neuroendocrine variables in healthy volunteers. Arzneimittelforschung. 1990Abstract
  7. Acton G, Broom C. A dose rising study of the safety and effects on serum prolactin of SK&F 101468, a novel dopamine D2-receptor agonist. Br J Clin Pharmacol. 1989Abstract