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Ropinirole hydrochloride is used for the symptomatic management of idiopathic parkinsonian syndrome. Dopamine receptor agonists bromocriptine mesylate, pramipexole dihydrochloride, pergolide mesylate, ropinirole hydrochloride are used as adjuncts to levodopa for the symptomatic management of parkinsonian syndrome in patients with advanced disease. Dopamine receptor agonists also are used as monotherapy for the initial symptomatic management of parkinsonian syndrome. Levodopa currently is the most effective drug for relieving the symptoms of parkinsonian syndrome and traditionally has been considered the drug of choice for the initial symptomatic management of idiopathic parkinsonian syndrome. However, long-term administration of levodopa is associated with motor complications. One strategy to reduce the risk of motor complications and to improve long-term outcome is to initiate symptomatic therapy with a dopamine receptor agonist and to add levodopa as supplemental therapy when dopamine receptor agonist monotherapy no longer provides adequate symptom control. However, clinical studies evaluating this strategy are limited both in number and duration, and it remains to be determined whether initiating therapy with a dopamine receptor agonist rather than levodopa results in a more favorable long-term outcome. Factors to consider when choosing an agent for the initial symptomatic management of idiopathic parkinsonian syndrome include patient age, cognitive status, disease severity, and cost. A dopamine receptor agonist may be preferred for initial therapy in patients 70 years of age or younger. Efficacy of ropinirole for the management of parkinsonian syndrome has been established in several placebo-controlled studies of up to 6 months' duration in patients with early approximately 2 years' duration parkinsonian syndrome receiving no concomitant levodopa therapy, and in patients with advanced parkinsonian syndrome who were receiving levodopa therapy concomitantly.
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