1. Introduction
Ropinirole is a dopamine agonist used to manage symptoms of Parkinson’s disease and restless legs syndrome (RLS). It works by mimicking the effects of dopamine in the brain, helping to improve motor function and reduce the discomfort associated with RLS.
2. Indications
- Parkinson’s Disease: As monotherapy in early-stage disease or as an adjunct to levodopa in advanced-stage disease.
- Restless Legs Syndrome (RLS): Management of moderate to severe primary RLS.
3. Dosage
Adults:
- Parkinson’s Disease:
- Initial: 0.25 mg three times daily.
- Titrate weekly: Increase by 0.25 mg per dose to 1 mg three times daily by Week 4.
- Maintenance: 3–24 mg/day in divided doses.
- Maximum: 24 mg/day.
- Restless Legs Syndrome (RLS):
- Initial: 0.25 mg once daily 1–3 hours before bedtime.
- Titrate weekly: Increase to 0.5 mg after 2 days, then 1 mg by the end of Week 1 if needed.
- Maintenance: 0.5–4 mg once daily.
Elderly:
- Start at the lowest dose and titrate slowly due to increased sensitivity to side effects.
Children:
- Not recommended; safety and efficacy in paediatric patients have not been established.
4. Administration
- Take orally with or without food.
- If gastrointestinal upset occurs, take with food.
- Extended-release tablets should not be crushed, chewed, or split.
5. Forms Available
- Immediate-release tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg
- Extended-release tablets: 2 mg, 4 mg, 6 mg, 8 mg, 12 mg
6. Side Effects
6.1 Common Side Effects:
- Nausea
- Dizziness
- Fatigue or drowsiness
- Constipation
- Hallucinations
6.2 Less Common Side Effects:
- Vomiting
- Abdominal pain
- Increased sweating
6.3 Rare but Serious Side Effects:
- Sudden onset of sleep (sleep attacks)
- Impulse control disorders (e.g., compulsive gambling, shopping)
- Orthostatic hypotension (low blood pressure upon standing)
- Severe allergic reactions (e.g., angioedema)
7. Warnings
- Sleep Attacks: Ropinirole may cause sudden episodes of sleep, even during daily activities. Avoid driving or operating heavy machinery if drowsiness occurs.
- Hallucinations: Particularly in elderly patients and those with Parkinson’s disease.
- Impulse Control Disorders: Patients may develop compulsive behaviours such as gambling or overeating.
- Orthostatic Hypotension: Monitor blood pressure, especially during dose titration.
8. Precautions
- Use cautiously in patients with a history of psychiatric illness or hallucinations.
- Avoid abrupt discontinuation to prevent withdrawal symptoms or worsening of Parkinson’s symptoms.
- Monitor for behavioural changes, especially in patients with RLS or Parkinson’s disease.
9. Interactions
- Antipsychotics: May reduce the effectiveness of ropinirole by antagonising dopamine.
- CYP1A2 inhibitors (e.g., ciprofloxacin): Increased ropinirole levels; monitor for side effects.
- CYP1A2 inducers (e.g., smoking): Decreased ropinirole levels; may reduce effectiveness.
- Sedatives and alcohol: Enhanced sedative effects; avoid concurrent use.
10. Monitoring Parameters
- Symptom relief for Parkinson’s disease or RLS.
- Monitor for excessive daytime drowsiness or sudden sleep episodes.
- Observe for changes in mood, behaviour, or compulsive behaviours.
11. Use in Children
- Not recommended for paediatric use due to a lack of safety and efficacy data.
12. Use in Pregnancy
- Category C: Use only if the potential benefit justifies the risk to the foetus. Limited data is available on human use.
13. Use in Elderly
- Safe for use, but start at a lower dose and monitor for sedation, hallucinations, or orthostatic hypotension.
14. Use in Kidney Disease
- No dose adjustment is required in mild to moderate renal impairment.
- Use cautiously in severe renal impairment or end-stage renal disease.
15. Use in Liver Disease
- Use cautiously in patients with hepatic impairment, as ropinirole is extensively metabolised in the liver.
16. Patient Counselling Points
- Take ropinirole as prescribed, at the same time(s) each day.
- Avoid activities requiring mental alertness, such as driving, until you know how the medication affects you.
- Report unusual behaviours, such as compulsive gambling, shopping, or eating, to your doctor immediately.
- Do not stop taking ropinirole suddenly; taper the dose under medical supervision.
- If you experience severe dizziness or sudden sleep episodes, consult your doctor.
17. Table of Brand Names, Manufacturer, and Prices in USD
Brand Name | Manufacturer | Strength/Dosage Form | Price (USD) |
---|---|---|---|
Requip | GlaxoSmithKline | 2 mg Tablet | $90 (30 tablets) |
Requip XL | GlaxoSmithKline | 4 mg Extended-Release Tablet | $120 (30 tablets) |
Generic Ropinirole | Various | 1 mg Tablet | $25 (30 tablets) |
18. 15 FAQs (Frequently Asked Questions)
1. What is Ropinirole used for?
Ropinirole is used to treat Parkinson’s disease and restless legs syndrome (RLS).
2. How does Ropinirole work?
It acts as a dopamine agonist, mimicking dopamine’s effects in the brain to reduce symptoms.
3. Can Ropinirole cause drowsiness?
Yes, drowsiness or sleepiness is a common side effect, and some patients may experience sudden sleep attacks.
4. Can Ropinirole be stopped suddenly?
No, abrupt discontinuation may worsen symptoms. Consult your doctor for a gradual tapering plan.
5. Can Ropinirole cause hallucinations?
Yes, hallucinations are a possible side effect, especially in elderly patients or those with Parkinson’s disease.
6. How long does Ropinirole take to work?
It may take several weeks to notice improvement in symptoms.
7. Can Ropinirole cause impulse control issues?
Yes, it may lead to behaviours like compulsive gambling or eating.
8. Is Ropinirole safe during pregnancy?
It is not recommended unless the benefits outweigh the risks. Consult your doctor.
9. Can Ropinirole interact with other medications?
Yes, it interacts with antipsychotics, sedatives, and CYP1A2 inhibitors/inducers.
10. How should Ropinirole be taken?
Take it with or without food. If it causes stomach upset, take it with food.
11. Can Ropinirole treat other conditions?
It is specifically approved for Parkinson’s disease and RLS but may be used off-label for similar conditions.
12. Does Ropinirole cause weight gain?
Weight gain is not a typical side effect but may occur due to compulsive behaviours like overeating.
13. Can I drink alcohol while taking Ropinirole?
Alcohol may enhance drowsiness and should be avoided.
14. What should I do if I miss a dose of Ropinirole?
Take the missed dose as soon as you remember, but skip it if it’s close to the next dose. Do not double the dose.
15. Can smoking affect Ropinirole levels?
Yes, smoking can reduce the effectiveness of ropinirole by decreasing its levels in the body.