Session Title: Section Info: Annual Assembly Posters (Non Presentations)
Session Time: 11:15am-12:45pm
Location: Research Hub - Kiosk 8
Disclosures: Roshan Chhatlani, DO: Nothing to disclose
Case Description: This patient was experiencing nightly episodes of left hand/arm jerky movements due to having abnormal sensations that made him want to move his left upper extremity repeatedly. Due to concerns for restless arm syndrome, patient was started on a trial of ropinirole (0.25 milligram tablet by mouth once daily) by the neurology team. Two days after starting ropinirole, the patient was found to have elevated liver function tests.
Setting: Acute inpatient rehabilitation floor.
Patient: A 57-year-old African American male admitted for acute strokes in the right MCA and ACA territories.
Assessment/Results: Liver function tests were monitored daily and continued to trend upwards: alanine aminotransferase (high of 429 U/L), aspartate aminotransferase (high of 191 U/L), and alkaline phosphatase (high of 286 U/L). Hepatology was consulted and recommended discontinuation of ropinirole due to concern of hepatotoxicity. Liver function tests began to trend downwards 4 days after ropinirole was discontinued. The only recent medication change was adding ropinirole. A complete abdominal ultrasound with Doppler was completed, which revealed diffuse fatty infiltration of the liver.
Discussion: It has been reported that restless arm symptoms are usually only present in severe cases of restless leg syndrome. However, this patient did not have any urges to move his legs or have any unpleasant sensations in the lower extremities bilaterally. According to studies, there is a one to ten percent chance of ropinirole causing hepatic dysfunction and specifically there is an increase in alkaline phosphatase. Uniquely, this patient had a significant increase in both alanine aminotransferase and aspartate aminotransferase along with an increase in alkaline phosphatase level after ropinirole was started.
Conclusion: Although ropinirole can be helpful for treating symptoms of restless arm syndrome, liver function tests should be monitored for possible hepatotoxicity.
Level of Evidence: Level V
To cite this abstract in AMA style:Chhatlani R, Bayol M. The Use of Ropinirole for Restless Arm Syndrome and Its Potential for Being Hepatotoxic: A Case Report [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/the-use-of-ropinirole-for-restless-arm-syndrome-and-its-potential-for-being-hepatotoxic-a-case-report/. Accessed September 28, 2023.
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