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  药店国别: 美国药房
产地国家: 美国
所属类别: 神经系统药物->帕金森症
处方药:处方药
包装规格: 0.25毫克/片 30片/盒
计价单位:
  点击放大  
该药品相关信息网址1:
http://www.requip.com/
该药品相关信息网址2:
http://www.drugs.com/requip.html
原产地英文商品名:
ROPINIROLE HCL(REQUIP GENERIC) 0.25mg/tablet 30tablets/box
原产地英文药品名:
ROPINIROLE HYDROCHLORIDE
中文参考商品译名:
盐酸罗匹尼罗(REQUIP仿制药) 0.25毫克/片 30片/盒
中文参考药品译名:
盐酸罗匹尼罗
原产地国家批准上市年份:
0000/00/00
英文适应病症1:
RLS
英文适应病症2:
Parkinsonism
临床试验期:
完成
中文适应病症参考翻译1:
不宁腿综合症
中文适应病症参考翻译2:
帕金森氏症
药品信息:

---------------------------------------------------------------
 详细处方信息以本药内容附件PDF文件(2009111121412313.pdf)的“原文Priscribing Information”为准
---------------------------------------------------------------
部分中文罗匹尼罗处方资料(仅供参考)

FDA批准帕金森病药Requip用于多动腿综合征的治疗
    5月5日,Requip(罗平尼咯)被美国FDA批准用于治疗中-重度多动腿综合征(RLS)。该药1997年首次获准治疗帕金森病。人群中大约有10%患有RLS,其特征是患者经常急促地移动双腿,常伴有腿部不适感。多数患者的症状在休息、静态时开始或加重,活动后部分或完全缓解。典型症状仅在傍晚或夜间发作或加重,可对睡眠造成干扰。
    三项在中-重度RLS成年患者中进行的随机、双盲、安慰剂对照研究表明,Requip可有效治疗RLS。研究采用国际RLS等级标准评价该药的有效性,从RLS症状的不同方面划分等级,包括肌肉活动的严重性、不适感、睡眠干扰情况、情绪和整体的生活质量。研究还采用临床疗效总评量(CGI)-疗效总评表,通过对患者治疗后改善情况的调查评分来划分等级。三项研究都表明,Requip组与安慰剂组存在统计学上的显著差异。
    Requip在临床试验中表现出的常见副作用为恶心、头痛、呕吐。其药品标签也警告患者该药具有镇静作用,包括嗜睡和日间从事活动时(如操作机动车辆)入睡的可能性。晕厥和低血压也可能发生,特别是初次治疗或加大剂量时更容易发生。

美国批准罗匹尼罗缓释片Requip XL
    葛兰素史克公司(GSK)近日宣布罗匹尼罗缓释片(ropinirole,Requip XL)已在美国获得批准用于先天性帕金森病。本品成为首个一日1次口服用于治疗帕金森症的非麦角碱多巴胺激动剂。罗匹尼罗片专利已到期,因此公司推出缓释片希望能继续占据市场。
  帕金森病患者用药,当药物作用减弱时会出现症状复发的情况,III期临床研究结果显示在患者已使用的左旋多巴疗法基础上联用本品可减少患者症状不受控制的时间,研究中显示每天平均可减少2.1小时的症状不受控制时间。
  GSK公司表示,许多患者使用抗帕金森病药物时,每天需要多次服用,而在正确的时间服药对患者来说是个挑战,而且有的患者行动受限不方便自己服用。每天用药1次的Requip XL可使有效成分平稳释放,给患者带来方便。

英文药名: Requip (ropinirole tablets)

中文药名: 罗匹尼罗片

药品名称
通用名称:盐酸罗匹尼罗片
英文名称:Ropinirole Hydrochloride Tablets, RcQuip, Ropinirole Hydrochloride, Requip
化学名称:4-[2-(二正丙基氨基)-乙基]-1, 3-二氢-2H-吲哚-2-酮盐酸盐
分子式:C16H24N2OHCl
性状: 本品为类白色薄膜衣片,除去薄膜衣后显白色至类白色。

规格
0.25mg, 0.5mg, 1mg, 2mg, 5mg

药理毒理
药理
罗匹尼罗是非麦角碱类多巴胺受体激动剂,体外试验显示对多巴胺受体有高度选择性,对多巴胺D2、D3受体有内在活性,与D3受体的亲和力高于与D2、D4受体的亲和力。与D3受体的高亲和力与治疗帕金森氏病之间的关系不明。
体外试验显示罗匹尼罗对阿片受体有中度选择性。罗匹尼罗及其代谢产物与D1、5-HT1、5-HT2、苯二氮卓类、GABA、M、α1、α2和β-肾上腺素受体的亲和力小。
罗匹尼罗治疗帕金森氏病的确切作用机制不明,但认为与其激动大脑尾状核突触后D2受体有关。多种动物试验显示罗匹尼罗可以增强帕金森氏病动物模型的运动功能,尤其是当由1-甲基4-苯-1,2,3,6-四氢吡啶(MPTP)神经毒素破坏灵长类动物黑质纹状体多巴胺能上行通路出现病损,从而诱发动物的运动缺陷,使用罗匹尼罗后可以减轻动物的运动损伤。
毒理
(1)急性毒性
大鼠和小鼠口服给予盐酸罗匹尼罗的LD50分别为867和662mg/kg,远远高于临床使用剂量,服药后的临床症状与中枢神经系统多巴胺受体激活的发应一致。其主要代谢物的毒性明显小于盐酸罗匹尼罗的毒性。
(2)长期毒性
进行了大鼠6个月和12个月,恒河猴12个月口服罗匹尼罗的长期毒性研究。结果显示罗匹尼罗,高剂量组,即15mg/kg/day,体重获得降低。临床症状主要在给药后的9天内。观察到一些小的病理学的改变,包括睾丸和卵巢的改变,可能和泌乳素受到抑制有关。
罗匹尼罗慢性毒性研究中观察到的主要毒性反应可能与多巴胺受体的激动引起有关。
(3)致突变研究
细菌回复突变试验、哺乳动物培养细胞的染色体异常试验和小鼠微核试验均为阴性结果,罗匹尼罗无致突变毒性。
(4)生殖毒性研究
在雌性大鼠交配前,交配期和妊娠期给药,结果发现剂量≥50mg/kg/day时(相当于人最大推荐服用剂量的8倍),罗匹尼罗会影响受精卵着床,原因可能是罗匹尼罗减少了催乳素的分泌有关。但在人类,影响受精卵着床的是绒毛膜促性腺激素而不是催乳素。在妊娠早期(催乳素依赖期,0-8天)服用低剂量(5mg/kg)罗匹尼罗的大鼠动物试验中,当最大剂量达到100mg/kg/day时(相当于人最大推荐服用剂量的40倍),大鼠的生殖能力未受影响。

药代动力学
罗匹尼罗口服吸收迅速,口服后1-2小时达峰。临床试验显示,标记后的罗匹尼罗88%可出现在尿中,其的绝对生物利用度为55%。相对生物利用度为85%。进食对罗匹尼罗的进一步吸收无影响,但Tmax升高为 2.5小时。患者经口给予罗匹尼罗的清除率为47 L/hr,消除半衰期约为 6 小时。罗匹尼罗进一步在肝脏代谢为非活性物质。罗匹尼罗在治疗剂量1 mg- 8 mg,每天三次范围内 ,表现为线性代谢动力学,服药2天后达到稳态。
罗匹尼罗全身广泛分布,其表观分布容积为7.5 L/kg。其中 40%与血浆蛋白结合,其在全血与血浆中的比值为1:1。
罗匹尼罗的主要代谢途径为经N-去丙基化和羟基化代谢为非活性物质。体外研究显示罗匹尼罗的主要代谢酶系为细胞色素P450酶系中的 CYP1A2,此酶可被吸烟和奥美拉唑激活,或被氟伏沙明、美西律及其老一代的氟喹喏酮类药物,如环丙沙星、诺氟沙星抑制。N-去丙基化代谢产物被转化为氨甲酰基葡萄糖醛酸甙,羧酸,N-去丙基化代谢产物。羟基化代谢产物迅速葡萄糖醛酸化。只有低于10%以罗匹尼罗原形经尿排泄。N-去丙基化代谢产物为罗匹尼罗的主要代谢产物,为40%(尿中),下面依次为羧酸化代谢产物(10%)和羟基葡萄糖醛酸化代谢产物(10%)。

适应症
罗匹尼罗用于自发性帕金森氏病的治疗。

用法用量
先从低剂量开始逐渐增加到治疗量,可以单独或与食物一起服用。
推荐起始量是每次0.25mg,一天三次,然后根据每个患者的反应按照下表隔周逐渐增加剂量。如必要,4周后可以在每周的基础上再每天增加1.5mg,直至日服量9mg,然后再次每天增加3mg,直至日服量达24mg。
停药时需缓慢,时间要超过七天。先在前四天将一天服用三次降为两次,在后三天降为一天一次。
任何疑问,请遵医嘱!

不良反应
全身表现:少见-蜂窝织炎、周围水肿、发热、类流感症状、腹部增大、心前区疼痛、非特异性水肿;罕见-腹水。
心血管:少见-心衰、心动过缓、心动过速、室上性心动过速、心绞痛、传导阻滞、心脏骤停、心脏扩大、动脉瘤、二尖瓣缺损;罕见-室性心动过速。
中枢/外周神经系统:常见-神经痛;少见-非随意性肌肉收缩、肌张力亢进、发声困难、共济失调、锥体外系异常、偏头痛、手足徐动症、昏迷、失语、抽搐、肌张力减退、外周神经疾病、瘫痪;罕见-抽搐大发作、偏瘫。
内分泌:少见-甲状腺机能减退、男性乳房发育、甲状腺机能亢进;罕见-甲状腺肿、抗利尿激素分泌过多症。
胃肠道系统:少见-肝酶升高、胆红质血症、胆囊炎、胆石病、大肠炎、牙周炎、大便失禁、胃肠道返流、痔疮、牙痛、嗳气、胃炎、食管炎、打嗝、憩室炎、十二指肠溃疡、胃溃疡、黑便、十二指肠炎、胃肠道出血、舌炎、直肠出血、胰腺炎、口腔炎、口腔溃疡、舌肥厚;罕见-出血性胃炎、咯血、唾液腺管堵塞。
血液系统:少见-紫癜、血小板减少、血肿、Vitamin B12缺乏、低色素性贫血、嗜伊红细胞增高、白细胞增多或减少、淋巴细胞增多或减少、淋巴水肿。
代谢/营养:常见-血尿素氮升高、少见-低血糖、碱性磷酸酶升高、乳酸脱氢酶升高、体重增加、高磷血症、高尿酸血症、糖尿病、尿糖升高、低血钾、血胆脂醇升高、高血钾、酸中毒、低钠血症、口渴、肌酸磷酸激酶升高、脱水;罕见-低氯血症。
运动系统:少见-关节炎加重,肌腱炎、骨质疏松症、滑囊炎、风湿性多肌痛症、肌无力、骨痛、斜颈;罕见-Dupuytren挛缩症。
肿瘤: 少见-恶性乳房肿瘤;罕见-膀胱癌、良性脑瘤、食道癌、脂肪瘤、直肠癌、子宫肿瘤。
精神疾病:少见-性欲增加、激动、淡漠、人格解体、注意力分散、妄想症、性格紊乱、异常欣快、精神错乱、痴呆、错觉、情绪不稳、性欲降低、躁狂、梦游、好斗、神经衰弱;罕见-自杀、攻击他人。
生殖-泌尿:少见-闭经、阴道出血、阴茎功能失常、前列腺功能失常、阴茎阴茎头包皮炎、附睾炎、会阴痛、排尿困难、尿频、夜尿、蛋白尿、肾结石、罕见-乳房增大、佩罗尼氏(Peyronie’s Disease)病乳腺炎、子宫出血、射精异常、肾盂肾炎、急性肾衰、尿毒症。

禁忌
对本品有过敏反应的患者禁用。

注意事项
日常活动中易产生困倦:有报道罗匹尼罗治疗的患者在日常活动中(如驾驶车辆时)会出现困倦,而这经常会导致事故的发生。虽然许多患者称服用罗匹尼罗后有嗜睡表现,但并没有过度昏睡的先兆。据报道这些表现也可以到治疗1年后才出现。如果患者在白天日常活动中出现明显的困倦和嗜睡(如谈话、吃饭等),应该停用罗匹尼罗(见剂量和用法部分)。如果决定继续使用罗匹尼罗,患者应避免开车或其它危险的活动。目前还无法确定减少罗匹尼罗剂量就可以消除出现的困倦。
昏厥:早期帕金森氏病患者(未合用左旋多巴)和进展期帕金森氏病患者(合用左旋多巴)治疗过程中都会出现昏厥,有时还伴有心动过缓。
症状性低血压:临床试验和临床经验显示,多巴胺激动剂可能影响血压调节,从而导致体位性低血压,且剂量越高作用越明显。此外,帕金森氏病患者对体位改变的反应也较弱。因此,用多巴胺激动剂治疗帕金森氏病时要注意观察体位性低血压的症状,尤其在提高用药剂量的时候,同时患者应了解可能出现的风险。患者应忌突然坐起、躺倒和直立,尤其在长时间保持一定姿势或治疗初期更须注意。
运动障碍:罗匹尼罗可以加重左旋多巴的副作用,使已有的运动障碍更加严重。减少左旋多巴剂量可以消除这种副作用。
肝脏和肾脏:轻度至中度的肾功能损伤(肌酐清除率30~50ml/min)无需调整剂量。由于还没有相关研究,所以合并严重肝肾功能损伤的患者应慎用罗匹尼罗。
已报道的多巴胺治疗相关事件:
撤药后的急性高热和意识错乱:虽然没有关于罗匹尼罗的报道,但在撤药、突然减量或改变治疗时会发生类似恶性神经综合症(体温升高、肌肉僵硬、意识改变、自发性不稳)的表现。
并发纤维化:有报道称一些患者使用麦角碱类多巴胺制剂后出现腹膜后纤维化、肺部侵润、胸腔积液和胸膜增厚。停药可以缓解症状,但并不能完全消除这些并发症。
这些副作用与化合物的麦角结构有关,但是还无法知道是否非麦角碱类多巴胺激动剂也可以引起类似情况。

孕妇及哺乳期妇女用药
动物试验证实罗匹尼罗可以影响胚胎发育,如致畸胎效应。目前还没有足够的相关研究,故妊娠妇女服用罗匹尼罗应充分考虑到用药风险,权衡利弊。罗匹尼罗能抑制妇女催乳素的分泌从而减少哺乳。大鼠试验显示乳汁中含有罗匹尼罗或它的代谢物,但还不清楚罗匹尼罗是否会通过人乳排泄。由于许多药物都通过人乳排泄,可能会对婴儿造成影响,所以妊娠妇女要考虑是否需要停止哺乳或使用罗匹尼罗。

儿童用药
疗效和安全性尚未确定。

老年患者用药
65岁以上患者与65岁以下患者相比,罗匹尼罗的清除率降低30%,但因本药为剂量累加给药,逐渐加量,直到疗效满意而不出现毒副作用为止,故无需调整剂量。

药物相互作用
P450作用:体外研究发现CYP1A2是罗匹尼罗代谢过程中起主要作用的酶,服用了CYP1A2的作用底物或抑制剂就会改变罗匹尼罗的清除率,因此停止或使用CYP1A2强效抑制剂时应相应调整罗匹尼罗的剂量。
左旋多巴:罗匹尼罗(2.0 mg ,每天三次)联用卡比多巴+左旋多巴并不会改变罗匹尼罗药物代谢动力学。口服罗匹尼罗(2.0 mg ,每天三次)和左旋多巴可以使左旋多巴的稳态Cmax增加20%,但AUC不受影响。
地高辛:罗匹尼罗(2.0 mg ,每天三次)联用地高辛(0.125-0.25mg 每天四次)并不改变地高辛的药代谢动力学。
氨茶碱:罗匹尼罗(2.0 mg ,每天三次)联用氨茶碱(300 mg ,每天两次,CYP1A2的作用底物)不改变罗匹尼罗药代谢动力学。此外,罗匹尼罗(2.0 mg ,每天三次)不会改变氨茶碱(5mg/kg ,静脉注射)药代谢动力学。
群体分析表明服用司来吉兰、阿曼丁、三环类抗抑郁药、苯二氮卓类药、布洛芬、噻嗪类药、抗组胺药、抗胆碱能药不会影响罗匹尼罗的清除率。

药物过量
过量服用引起的症状与罗匹尼罗的多巴胺能作用有关,要采取支持治疗、同时维持生命体征的稳定、清除未吸收成份(如洗胃)。

Requip
Generic Name: ropinirole (oral) (roe PIN i role)
Brand Names: Requip, Requip XL

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What is Requip?
Requip has some of the same effects as a chemical called dopamine, which occurs naturally in your body. Low levels of dopamine in the brain are associated with Parkinson's disease.

Requip is used to treat symptoms of Parkinson's disease, such as stiffness, tremors, muscle spasms, and poor muscle control. Requip is also used to treat restless legs syndrome (RLS).

Requip may also be used for other purposes not listed in this medication guide.

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Important information about Requip
Requip may cause you to fall asleep during normal daytime activities such as working, talking, eating, or driving. You may fall asleep suddenly, even after feeling alert. Tell your doctor if you have any problems with daytime sleepiness or drowsiness. If you are unsure of how this medicine will affect you, be careful if you drive or do anything that requires you to be awake and alert.

You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking this medication. Talk with your doctor if you believe you have any intense or unusual urges while taking Requip.

Do not share this medication with another person, even if they have the same symptoms you do. Avoid drinking alcohol, which can increase some of the side effects of Requip. Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by Requip. Tell your doctor if you regularly use any of these other medicines.

Requip may cause hallucinations (the sensation of hearing or seeing something that is not there), most commonly among elderly people. Call your doctor if you experience hallucinations.

Do not stop using Requip or change your dose without first talking to your doctor. You may have side effects such as fever, muscle stiffness, and confusion if you stop the medication suddenly or if you change doses.

Some people taking medicines for Parkinson's disease have developed skin cancer (melanoma). However, people with Parkinson's disease may have a higher risk than most people for developing melanoma. Talk to your doctor about your specific risk and what skin symptoms to watch for. You may need to have regular skin exams.

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Before taking Requip
Requip may cause you to fall asleep during normal daytime activities such as working, talking, eating, or driving. You may fall asleep suddenly, even after feeling alert. Tell your doctor if you have any problems with daytime sleepiness or drowsiness. If you are unsure of how this medicine will affect you, be careful if you drive or do anything that requires you to be awake and alert. You should not use Requip if you are allergic to ropinirole.

If you have certain conditions, you may need a dose adjustment or special tests to safely take this medication. Before you take this medication, tell your doctor if you are allergic to any drugs, or if you have:
heart disease;
high or low blood pressure;
mental illness or compulsive behaviors;
kidney disease;
liver disease; or
if you smoke.

You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking Requip. It is not known whether the medicine actually causes this effect. Talk with your doctor if you believe you have any intense or unusual urges while taking Requip.

FDA pregnancy category C. It is not known whether Requip is harmful to an unborn baby. Before taking this medication, tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether ropinirole passes into breast milk or if it could harm a nursing baby.

Requip may reduce breast milk production. Do not take Requip without telling your doctor if you are breast-feeding a baby. Requip may cause hallucinations (the sensation of hearing or seeing something that is not there), most commonly among elderly people. Call your doctor if you experience hallucinations.

Some people taking medicines for Parkinson's disease have developed skin cancer (melanoma). However, people with Parkinson's disease may have a higher risk than most people for developing melanoma. Talk to your doctor about your specific risk and what skin symptoms to watch for. You may need to have regular skin exams.

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How should I take Requip?
Take Requip exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

The dose and timing of Requip in treating Parkinson's disease is different from the dose and timing in treating RLS.

You may receive Requip in a starting kit that has each pill marked with the day you should take it. Do not mix these pills up because they each contain different amounts of Requip. The pills must be taken in order so that you gradually receive higher doses of the medication.

You may have a brief increase in side effects whenever your dose is changed.

Requip can be taken with or without food. Taking the medicine with food may help prevent nausea, which is a common side effect of Requip. It may take several weeks or months of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Do not stop taking Requip suddenly or change your doses, or you could have unpleasant withdrawal symptoms such as fever, muscle stiffness, and confusion. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication. Do not share this medication with another person, even if they have the same symptoms you do.

Store Requip at room temperature away from moisture and heat.

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What happens if I miss a dose?
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

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What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include nausea, vomiting, weakness, fainting, agitation, confusion, hallucinations, muscle twitching, tingly feeling, and chest pain.

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What should I avoid while taking Requip?
Requip can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid smoking, which can make Requip less effective. Avoid drinking alcohol. It can increase some of the side effects of Requip.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

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Requip side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:
feeling like you might pass out;
fever, stiff muscles, confusion, sweating, fast or uneven heartbeats (especially if you stop taking Requip or use a lower dose);
hallucinations;
tremors (uncontrolled shaking); or
tight feeling in your chest, trouble breathing.

Call your doctor promptly if you fall asleep during a daily activity, if you faint, or if you have hallucinations (hearing or seeing something that is not there). Your doctor may want you to stop taking Requip, or take a lower dose.

Less serious Requip side effects may occur, such as:
mild nausea, vomiting, stomach pain, or loss of appetite;
worsened RLS symptoms early in the morning;
diarrhea or constipation;
dry mouth, sweating;
headache;
dizziness, drowsiness;
sleep problems (insomnia); or
agitation or anxiety.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

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What other drugs will affect Requip?
Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by Requip. Tell your doctor if you regularly use any of these other medicines, or any other Parkinson's medications.

Before taking Requip, tell your doctor if you are using any of the following drugs:
levodopa;
ciprofloxacin (Cipro);
fluvoxamine (Luvox);
metoclopramide (Reglan);
omeprazole (Prilosec);
a medication used to treat nausea and vomiting or mental illness, such as chlorpromazine (Thorazine), fluphenazine (Prolixin), mesoridazine (Serentil), perphenazine (Trilafon), thioridazine (Mellaril), promazine (Sparine), trifluoperazine (Stelazine), thiothixene (Navane), or haloperidol (Haldol); or
an estrogen such as Premarin, Prempro, Estratest, Ogen, Estraderm, Climara, Vivelle, estradiol, and others.

This list is not complete and there may be other drugs that can interact with Requip. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

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Where can I get more information?
Your pharmacist can provide more information about Requip.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

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 详细处方信息以本药内容附件PDF文件(2009111121412313.pdf)的“原文Priscribing Information”为准
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更新日期: 2012-5-17
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