Ropinirole

Antiparkinsonian Drug

Drug class: Dopaminergic Antiparkinsonian Agent

Ropinirole (REQUIP)（中文：羅匹尼羅） is a non-ergoline dopamine agonist primarily used to treat Parkinson's disease and Restless Legs Syndrome (RLS). It mimics the action of dopamine, a neurotransmitter that plays a crucial role in movement and coordination.

Common Strengths

• 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

Drug Trade Names

• Requip
• Requip XL

Drug Usage

Ropinirole is indicated for:

• Parkinson's Disease: To alleviate symptoms such as stiffness and tremors.
• Restless Legs Syndrome (RLS): To reduce the urge to move the legs.

Mechanism of Action

Ropinirole selectively stimulates dopamine D2 receptor in the brain, which is involved in movement control. It works by mimicking the action of dopamine, a neurotransmitter deficient in individuals with Parkinson's disease, helping improve motor control and reduce symptoms such as stiffness, tremors, and muscle spasms.

Route of Administration

Oral

Dosages

• Starting at 0.25 mg three time daily for Parkinson's; can be increased up to a maximum of 24 mg/day for patients not on levodopa.

Restless Legs Syndrome:

• Initial Dose: Begins at 0.25 mg once daily, taken 1-3 hours before bedtime.
• Maximum Dose: Generally capped at 4 mg per day.

Side Effects

Frequency	Adverse reactions
Common Side Effects	Drowsiness
	Dizziness
	Nausea
Serious Side Effects	Sudden sleep episodes
	Hallucinations
	Severe drowsiness or confusion
	Orthostatic hypotension
	Dyskinesias (involuntary movements)

Pharmacokinetics

• Ropinirole is primarily metabolized in the liver
• Half-life: 5-6 hours
• Onset Time: Typically, within several weeks for symptom improvement
• Duration of Action: Varies based on formulation (immediate vs extended release)

Drug Precautions

Pregnancy

Category C; potential risks should be discussed with a healthcare provider.

Breastfeeding

Not known if it passes into breast milk; may affect milk production.

Children and Elderly

Not approved for use in children under 18; caution advised in elderly due to increased risk of side effects.

Drug Monitoring Items

• Patients should be monitored for signs of orthostatic hypotension, particularly during dose escalations
• Withdrawal Symptoms

Gradual tapering is advised when discontinuing ropinirole to avoid withdrawal symptoms such as fever, confusion, or severe muscle stiffness. A typical tapering schedule involves reducing the dose over a week.

Drug Interactions

May interact with medications affecting dopamine levels, such as:

• Antidepressants: e.g. Duloxetine (Cymbalta), Fluvoxamine (Luvox)
• Antipsychotics: e.g. Haloperidol, Olanzapine
• Pain medications: Tramadol
• Other medications: e.g. Ciprofloxacin (a fluoroquinolone antibiotic), Metoclopramide (used for nausea).

FAQ

How Should I Take the Tablet?

Take orally with or without food; follow prescribed dosing schedule.

What Should I Avoid While Taking?

Avoid alcohol and activities requiring alertness until you know how Ropinirole affects you.

What Happens if I Miss a Dose?

Take it as soon as you remember unless it is almost time for the next dose; do not double up on doses.