Ropinirole (Oral)

Ropinirole, also known under US brand names Requip and Requip XL, is a drug used in the treatment of Parkinson's disease and Restless Leg Syndrome.

Overview

Ropinirole can be either used alone or in combination with other medicines in the treatment of Parkinson's disease. The tablets are also used to treat a condition known as RLS, Restless Leg Syndrome. This is a neurological disorder that affects the movement and sensation in your legs causing them to feel uncomfortable. This results in an overwhelming feeling of needing to move to legs to help make them feel comfortable. This drug works by helping to restore the balance of a dopamine in the brain. This medication is only available via prescription from your doctor and is available in the following dosage form of a tablet and extended-release tablet for oral consumption.

Conditions Treated

  • Parkinson's disease
  • Restless Leg Syndrome (RLS)

Type of Medicine

  • Tablet
  • Extended-release tablet

Side Effects

Along with the intended effects of Ropinirole, the consumption of this tablet can produce unwanted side effects. Not all of these side effects may occur, but if they do, they may require medical attention.

Inform your doctor urgently if you suffer from any of the following side effects whilst taking ropinirole. The following side effects are ranked in terms of more common, less common and rare.

More common side effects:

  • Faintness, dizziness, or lightheadedness when getting up suddenly from a sitting or lying position
  • Confusion
  • Drowsiness
  • Nausea
  • Falling
  • Hearing, seeing or feeling things that are not there (hallucinations)
  • Swelling of the legs
  • Sleepiness or unusual drowsiness
  • Twitching, twisting or other unusual body movements
  • Worsening of parkinsonism
  • Unusual weakness or tiredness

Less common side effects:

  • Stomach or abdominal pain
  • Blood in the urine
  • Swelling or bloating of the face, hands, arms, lower legs, or feet
  • Blurred vision
  • Chest pain
  • Pain, burning, or difficulty in urinating
  • Chills
  • Cough
  • Cold sweats
  • Double vision or other eye or vision problems
  • Nervousness or fear
  • Fainting
  • Feeling of constant movement of self or surroundings
  • Irregular or pounding heartbeat
  • Low or high blood pressure
  • Mental depression
  • Loss of memory
  • Pain
  • Pounding in the ears
  • Pain in the legs or arms
  • Rapid weight gain
  • Fast or slow heartbeat
  • Sensation of spinning
  • Sore throat
  • Tightness in the chest
  • Sweating
  • Tingling in the feet or hands
  • Trouble with concentrating
  • Numbness, tingling or prickly feelings
  • Troubled breathing
  • Vomiting
  • Unusual weight gain or loss

Rare side effects:

  • Ringing or buzzing in the ears
  • Fever
  • Anxiety
  • Changes in vision
  • Headache
  • Loss of bladder control
  • Joint pain
  • Muscle cramps, pain, or spasms
  • Runny nose
  • Nasal congestion
  • Sneezing
  • Unusual urges
  • Trouble with swallowing

Seek emergency help urgently if any of the following symptoms of an overdose appear whilst taking ropinirole:

Symptoms of overdose:

  • Agitation
  • Increase in unusual body movements, especially of the face or mouth
  • Grogginess
  • Increased coughing
  • Loss or lack of strength
  • Increased sweating
  • Nightmares

Some side effects that occur won't need medical attention. You usually find that these side effects begin to disappear as your body becomes adjusted to the medication. If however, you find that these side effects are disrupting your day-to-day life, you should contact your local pharmacist or doctor for advice on ways to reduce or prevent these side effects from occurring. Remember you can report all side effects to the FDA on 1-800-FDA-1088.

Less common side effects:

  • Sour or acid stomach
  • Belching
  • Back pain
  • Decrease in performance or sexual desire
  • Abnormal dreams
  • Dryness of mouth
  • Difficulty having a bowel movement (stool)
  • Flushing
  • Gas or heartburn
  • General feeling of illness or discomfort
  • Hot flashes
  • Loss of appetite
  • Indigestion
  • Tremor
  • Yawning
  • Weight loss

Dosage

The final dosage of any medication will depend on a number of factors. These include your age, weight and height, your past medical history, any medications you are currently taking, the condition being treated and its severity and how you react to the first dose. The following dose recommendations should be taken as a guideline. Do not start, stop or change your doses if they do not reflect what is noted below. You should never alter a dose without speaking with your doctor or a healthcare professional first.

Typical Adult Dose for Parkinson's Disease

Immediate-release tablets:

An initial dose of 0.25 mg taken three times daily via oral consumption.

  • After 1 week: the dose may be titrated up in weekly increments based on individual tolerability levels and efficacy
  • Week 2: give 0.5 mg, three times daily via oral consumption
  • Week 3: give 0.75 mg three times daily via oral consumption
  • Week 4: give 1 mg three times daily via oral consumption
  • After week 4, increase by 1.5 mg per day on a weekly basis up to a dose of 9 mg per day, then increase by 3 mg per day on a weekly basis up to a maximum daily dose of 24 mg.

The maximum dose given should be 8 mg three times a day via oral consumption.

Extended-release tablets:

An initial dose of 2 mg given daily via oral consumption for one-two weeks. This should be followed by 2mg per day increases at one week or longer intervals. This will depend on the individual tolerability and therapeutic response to the drug.

The maximum dose given should be 24 mg once a day via oral consumption.

Patients can switch from immediate-release to extended-release. On these occasions, the initial dose of extended-release tablet should try and match the total daily dose of immediate-release tablets as close as possible. Following conversion, the dose should be adjusted depending on individual tolerability and response.

This drug may be taken with or without food

Missed dose

If you miss a dose, the next dose should be taken as scheduled. Do not double up your next dose.

Extended-release products should be taken once a day at the same or similar time each day. They should not be crushed, chewed or split.

  • If there is a significant interruption in therapy, re-titration may be necessary. Upon discontinuation, this drug should be gradually tapered over a 7-day period.
  • The extended-release tablet is designed to release medication over a 24-hour period. There is a risk of incomplete release of medication if rapid gastrointestinal transit occurs, and tablet residue is observed in the stool.

Typical Adult Dose for Restless Legs Syndrome

Immediate-release tablets:

An initial dose of 0.25 mg given once a day on days one and two via oral consumption.

Dose titration: May titrate as follows based on individual tolerability and efficacy.

  • Days 3 to 7: give 0.5 mg once daily, via oral consumption
  • Week 2: give 1 mg once daily via oral consumption
  • Week 3: give 1.5 mg once daily via oral consumption
  • Week 4: give 2 mg once daily via oral consumption
  • Week 5: give 2.5 mg once daily via oral consumption
  • Week 6: give 3 mg once daily via oral consumption
  • Week 7: give 4 mg once daily via oral consumption

The maximum dose given should be 4 mg given once daily via oral consumption

This drug should be taken around one-three hours prior to bedtime.

Interactions

Interactions between drugs can cause serious side effects and reduce the effectiveness of the drugs. To protect against interactions, it's important that you give your doctor or healthcare professional a full list of all the medications you are currently taking, along with medications you have taken in the past. This includes prescription, non-prescription drugs, herbal remedies, and vitamins. You should also inform them of any current or past medical conditions you have suffered from. This should include any serious medical conditions that run in the family.

The use of this medication with any of the following drugs is not recommended. Your doctor may decide to avoid treating you with this medicine or alter the dose or frequency of other medications you are taking. Inform your doctor if you are taking any of these medications.

  • Sulpiride
  • Warfarin
  • Ciprofloxacin
  • Kava

Over 600 drugs can react moderately with ropinirole. Some of them are listed below. This list is not complete and you should still inform your doctor of all the medications you are taking.

  • Alfentanil
  • Acetylcarbromal
  • Alprazolam
  • Amiodarone
  • Amobarbital
  • Amitriptyline
  • Amoxapine
  • Anhydrous calcium iodide
  • Anagrelide
  • Apomorphine
  • Aripiprazole
  • Apraclonidine ophthalmic
  • Asenapine
  • Azatadine
  • Aspirin
  • Baclofen
  • Brexpiprazole
  • Butorphanol
  • Brimonidine ophthalmic
  • Buspirone
  • Benztropine
  • Brimonidine topical
  • Butabarbital
  • Butalbital
  • Caffeine
  • Cannabis
  • Carbetapentane
  • Carbamazepine
  • Cariprazine
  • Chlorzoxazone
  • Carisoprodol
  • Cetirizine
  • Chlophedianol
  • Ciprofloxacin
  • Cimetidine
  • Clemastine
  • Clonazepam
  • Clobazam
  • Clomipramine
  • Clonidine
  • Clorazepate
  • Codeine
  • Clozapine
  • Chlormezanone
  • Chlorpheniramine
  • Chlorotrianisene
  • Chlorphenesin
  • Chloral hydrate
  • Cyproheptadine
  • Cyclizine
  • Cyclobenzaprine
  • Deferasirox
  • Dantrolene
  • Desipramine
  • Dronabinol
  • Desvenlafaxine
  • Deutetrabenazine
  • Droperidol
  • Dienestrol topical
  • Dezocine
  • Diazepam
  • Doxepin
  • Doxylamine
  • Doxepin topical
  • Duloxetine
  • Enoxacin
  • Estradiol
  • Estradiol topical
  • Escitalopram
  • Eslicarbazepine
  • Estazolam
  • Estrone
  • Estropipate
  • Estropipate topical
  • Eszopiclone
  • Ethanol
  • Ethinyl estradiol
  • Ethosuximide
  • Ethotoin
  • Ezogabine
  • Flibanserin
  • Fluoxetine
  • Felbamate
  • Fentanyl
  • Flavoxate
  • Fluphenazine
  • Fluvoxamine
  • Flurazepam
  • Grepafloxacin
  • Halazepam
  • Heroin
  • Hydrocodone
  • Haloperidol
  • Homatropine/hydrocodone
  • Hydroxyprogesterone
  • Hydroxyzine
  • Hydromorphone
  • Iloperidone
  • Interferon alfa-2a
  • Imipramine
  • Interferon alfa-2b
  • Interferon alfa-n1
  • Interferon alfa-2b / ribavirin
  • Interferon alfa-n3
  • Interferon beta-1a
  • Interferon alfacon-1
  • Interferon beta-1b
  • Ioflupane I 123
  • Isocarboxazid
  • Interferon gamma-1b
  • Isoniazid
  • Kava
  • Levocetirizine
  • Ketamine
  • Levetiracetam
  • Levomethadyl acetate
  • Lorazepam
  • Levorphanol
  • Lithium
  • Loxapine
  • Meperidine
  • Lurasidone
  • Maprotiline
  • Mephenytoin
  • Meprobamate
  • Mephobarbital
  • Mesoridazine
  • Metaxalone
  • Mestranol/norethindrone
  • Methadone
  • Methotrimeprazine
  • Methdilazine
  • Methocarbamol
  • Methsuximide
  • Metyrosine
  • Metoclopramide
  • Mexiletine
  • Mirtazapine
  • Mibefradil
  • Midazolam
  • Molindone
  • Morphine liposomal
  • Morphine
  • Nabilone
  • Nalidixic acid
  • Nalbuphine
  • Naloxone / oxycodone
  • Nefazodone
  • Nortriptyline
  • Niclosamide
  • Norfloxacin
  • Obeticholic acid
  • Olopatadine nasal
  • Olanzapine
  • Opium
  • Osimertinib
  • Orphenadrine
  • Oxazepam
  • Oxymorphone
  • Oxcarbazepine
  • Oxycodone
  • Paliperidone
  • Paramethadione
  • Paraldehyde
  • Peginterferon alfa-2a
  • Paroxetine
  • Peginterferon alfa-2b
  • Pentobarbital
  • Pentazocine
  • Perampanel
  • Phenytoin
  • Pergolide
  • Pimozide
  • Primaquine
  • Pregabalin
  • Primidone
  • Promethazine
  • Prochlorperazine
  • Promazine
  • Propafenone
  • Quetiapine
  • Propiomazine
  • Quazepam
  • Quinestrol
  • Remifentanil
  • Ramelteon
  • Rasagiline
  • Risperidone
  • Rofecoxib
  • Ropivacaine/sufentanil
  • Rufinamide
  • Rotigotine
  • Secobarbital
  • St. John's wort
  • Sertraline
  • Sufentanil
  • Tapentadol
  • Suvorexant
  • Tasimelteon
  • Thalidomide
  • Temazepam
  • Tetrabenazine
  • Thiabendazole
  • Thiethylperazine
  • Ticlopidine
  • Thioridazine
  • Thiothixene
  • Tizanidine
  • Tranylcypromine
  • Tramadol
  • Trazodone
  • Triflupromazine
  • Triazolam
  • Trifluoperazine
  • Trimeprazine
  • Trimipramine
  • Tripelennamine
  • Trimethadione
  • Trimethobenzamide
  • Valerian
  • Triprolidine
  • Valbenazine
  • Valproic acid
  • Venlafaxine
  • Vemurafenib
  • Ziconotide
  • Vigabatrin
  • Zaleplon
  • Ziprasidone
  • Zonisamide
  • Zolpidem

Other interactions

The presence of other medical conditions can affect the use of this medication. Ensure you inform your doctor if you suffer from any other medical conditions especially:

  • Dyskinesia (trouble controlling your muscles)
  • Hallucinations
  • Heart or heart rhythm problems
  • Hypertension (high blood pressure)
  • Hypotension (low blood pressure)
  • Mental illness
  • Postural hypotension ( lightheadedness, dizziness or fainting when getting up from a sitting or lying position). Cautions should be exercised as this tablet could make this condition worse.
  • Kidney problems- this tablet could increase your chance of side effects.
  • Liver problems—Higher levels of ropinirole in the blood could result when using this medication and an increase in side effects.
  • Lung problems resulting from treatment with some other Parkinson's disease medicines
  • Sleep disorders
  • Sleepiness or a history of—this drug could cause side effects to be worse.

Warnings

Allergies

Before taking ropinirole, inform your pharmacist or doctor if you are allergic to it and/or if you have any other allergies including to, animals, foods, dyes, preservatives etc. This product could contain inactive ingredients, which could cause allergic reactions or other problems. Speak with your pharmacist for more information.

Use in Pediatric patients

Studies have not been conducted on the relationship of age to the effects of ropinirole in the pediatric population. Therefore efficacy and safety have not been established.

Use in Geriatric patients

Studies performed to date have not indicated any geriatric-specific problems that could limit the effectiveness of this drug in the elderly. However, elderly patients are more likely to develop hallucinations (hearing, see or feeling things that aren't there), which may require extra caution to be exercised in those older patients receiving ropinirole.

Use in pregnancy and breastfeeding

This drug is under pregnancy category C. It should be used only when clearly needed during pregnancy and the benefits outweigh the risks. You should discuss the risks and benefits associated with taking ropinirole with a healthcare professional or your doctor.

With regards to breastfeeding, it is unknown whether this drug passes into breast milk whilst feeding an infant. You should discuss with your doctor before you decide to breastfeed your child whilst taking this medication.

There have been reporting of people falling asleep without any prior warnings during day-to-day activities whilst taking ropinirole. This included driving and resulted in accidents. This can happen up to one year after taking the medication. Ensure you know how you react to this medicine before you use a machine, drive or do anything else that requires you to be well-coordinated, alert or able to see and think well.

This medicine will add to the effects of CNS depressants and alcohol. Some examples of CNS depressants are antihistamines or medicine for colds, hay fever, colds, other allergies, sedatives, tranquilizers, or sleeping medicine. Check with a healthcare professional before taking any of the above while you are using this medication.

Dizziness, fainting, lightheadedness can occur, especially when you get up from a sitting or lying position. These symptoms are more likely to occur when you first start taking this medicine, or as your dose is being increased. You can help by getting up slowly.

Smoking can decrease the treatment effects of this medication so it's best to avoid smoking whilst taking this drug.

If you have Parkinson's disease, it's important that your doctor regularly checks your skin for melanoma. This is because people who suffer with Parkinson's disease may have an increased risk for developing skin cancer. If you are taking this medication to specifically treat Parkinson's disease, you should inform your doctor urgently if you notice any changes in the size of appearance or moles or any other unusual skin changes. Speak with your doctor about having regular skin examinations.

Some people have reported unusual changes in their behavior whilst taking this medication. Discuss with your doctor, if you start having problems with an increased sex drive or gambling whilst using this medication.

Storage

This medication should be stored at a controlled room temperature of 68°-77°F (20°-25°C). It should also be protected from moisture and light. The container should be closed tightly after each use.

Do not share this medication with anyone else. For correct disposal of this medication after expiration or you have finished treatment using this drug, contact your local pharmacy for advice.

Summary

When used correctly, ropinirole is successful in treating Parkinson's disease and Restless Leg Syndrome. There are many drugs and illnesses that can cause an interaction with this drug, so it is vital you inform your doctor or a healthcare professional of absolutely every drug you are taking. It's best to avoid smoking while taking this drug as it can reduce the effectiveness of the drug and avoid drinking alcohol when taking this drug due to increased risk of dizziness and lightheadedness. Safety and efficacy have not been established under those of 18 years of age and this drug is also recommended during pregnancy if the benefits outweigh the potential risks.

 

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Last Reviewed:
January 31, 2018
Last Updated:
January 27, 2018