Indications: Initial treatment in adults of Parkinson’s disease as monotherapy to delay the introduction of levodopa or in combination with levodopa, over the course of the disease, when levodopa effect wears off or becomes inconsistent and fluctuations in therapeutic effect occur. Available strengths: Repinex XL (ropinirole) 2, 4, and 8mg x 28 tablets. Dosage and method of use: Tablets to be taken once daily, at similar time each day, with or without food, and swallowed whole. Starting dose is 2mg once daily for first week, then increased to 4mg once daily from the second week of treatment. If symptomatic control not achieved, daily dose may be increased by 2mg at weekly or longer intervals up to 8mg once daily; if symptomatic control still not achieved, daily dose may be increased by 2-4mg at 2 weekly or longer intervals. Maximum daily dose is 24mg. Patients should be maintained on the lowest dose that achieves symptomatic control. When given as adjunct to levodopa, may be able to gradually reduce levodopa dose, depending on response. In advanced Parkinson’s Disease patients taking Repinex XL tablets in combination with levodopa, dyskinesias can occur during initial titration of Repinex XL tablets. In clinical trials, a reduction in levodopa dose was shown to potentially ameliorate dyskinesia. If treatment interrupted for one day or more, consider re-initiation by dose titration on ropinirole immediate-release tablets. Discontinue ropinirole treatment gradually over one week. In end stage renal disease where on haemodialysis, recommended initial dose 2mg once daily. Escalate dose according to tolerability and efficacy. Recommended maximum dose 18mg/day. Consider slower titration in patients aged 75 years or older. Contraindications: Hypersensitivity to active substance or excipients; severe renal impairment (creatinine clearance <30 ml/min) without regular haemodialysis; hepatic impairment. Special warnings and precautions for use: Inform patients that ropinirole is associated with somnolence and episodes of sudden sleep onset during daily activities, particularly in Parkinson’s disease. Advise caution while driving or operating machines.  If have experienced somnolence and/or an episode of sudden sleep onset, must refrain from driving or operating machines and consider dose reduction or termination. Due to risk of hypotension, blood pressure monitoring recommended, especially at start of treatment, in patients with severe cardiovascular disease (especially coronary insufficiency). If history of major psychotic disorders, only treat with dopamine agonists if benefits outweigh risks. Regularly monitor for development of impulse control disorders, including pathological gambling, increased libido, hypersexuality, compulsive spending/buying, binge or compulsive eating and if symptoms develop, consider dose reduction/tapered discontinuation. If rapid gastrointestinal transit, risk of incomplete release of active substance and residue being passed in the stool. Symptoms suggestive of neuroleptic malignant syndrome have been reported with abrupt withdrawal of dopaminergic therapy – therefore recommend tapering treatment. Dopamine agonist withdrawal syndrome: Inform patients that non-motor adverse effects may occur when tapering or discontinuing dopamine agonists including ropinirole. Symptoms include apathy, anxiety, depression, fatigue, sweating and pain which may be severe – monitor regularly. If persistent symptoms, consider increasing the ropinirole dose temporarily. Inform patients that hallucinations can occur. Repinex XL 2mg contains lactose – not to be used in patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption.