Requip (ropinirole) is a non-ergoline dopamine agonist indicated for the treatment of Parkinson’s disease and moderate-to-severe primary Restless Legs Syndrome (RLS). As a selective D2 and D3 receptor agonist, it mimics the action of dopamine in the brain, helping to restore motor control and alleviate sensory discomfort associated with movement disorders. Its efficacy is supported by extensive clinical research, making it a trusted option for neurologists and patients seeking symptomatic management with a well-characterized safety profile. This medication is available in both immediate and extended-release formulations, allowing for tailored treatment approaches based on individual patient needs and symptom patterns.

Features

• Active ingredient: ropinirole hydrochloride
• Available in immediate-release (Requip) and 24-hour extended-release (Requip XL) tablets
• Tablet strengths: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg (immediate-release); 2 mg, 4 mg, 6 mg, 8 mg, 12 mg (extended-release)
• Selective dopamine D2 and D3 receptor agonist
• Non-ergoline structure reduces risk of fibrotic reactions
• FDA-approved for Parkinson’s disease and Restless Legs Syndrome

Benefits

• Reduces tremor, rigidity, and bradykinesia in Parkinson’s disease
• Improves overall motor function and mobility
• Alleviates uncomfortable sensations and urge to move in Restless Legs Syndrome
• Enhances sleep quality by reducing nighttime RLS symptoms
• May allow for lower doses of levodopa in Parkinson’s patients, reducing dyskinesia risk
• Available in multiple formulations for individualized dosing schedules

Common use

Requip is primarily prescribed for the management of signs and symptoms of idiopathic Parkinson’s disease, both as monotherapy in early disease and as adjunct therapy to levodopa throughout the disease progression. It is also indicated for the treatment of moderate-to-severe primary Restless Legs Syndrome, characterized by an irresistible urge to move the legs accompanied by uncomfortable sensations, typically worsening during periods of rest or inactivity in the evening and night. Off-label uses may include treatment for certain types of dystonia or augmentation strategies in RLS patients who have developed tolerance to other medications, though these applications require careful specialist supervision.

Dosage and direction

For Parkinson’s disease:

• Initial dose: 0.25 mg three times daily (immediate-release) or 2 mg once daily (extended-release)
• Titration: Increase by 0.25 mg three times daily weekly (IR) or by 2 mg daily weekly (XR)
• Maintenance: 3-9 mg daily in divided doses (IR) or 8-24 mg once daily (XR)
• Maximum dose: 24 mg daily

For Restless Legs Syndrome:

• Initial dose: 0.25 mg once daily 1-3 hours before bedtime
• Titration: May increase to 0.5 mg after 2 days, then to 1 mg after 7 days, then by 0.5 mg weekly
• Maintenance: 1-3 mg once daily
• Maximum dose: 4 mg daily

Take with food to minimize nausea. Do not crush, chew, or split extended-release tablets. Dose adjustments may be necessary for patients with hepatic impairment or those taking interacting medications. Always follow the specific titration schedule provided by your healthcare provider.

Precautions

Patients should be monitored for the development of sedation, orthostatic hypotension, and impulse control disorders. Sudden sleep onset during activities of daily living, including driving, has been reported. Hallucinations may occur, particularly in elderly patients. Use caution when rising from sitting or lying positions due to potential blood pressure changes. Dopamine agonists have been associated with compulsive behaviors such as gambling, shopping, eating, or sexual urges. Patients with major psychotic disorders should generally not be treated with Requip due to risk of exacerbation. Regular ophthalmologic monitoring is recommended during long-term therapy.

Contraindications

Requip is contraindicated in patients with known hypersensitivity to ropinirole or any component of the formulation. Concurrent use with antipsychotics that are dopamine antagonists (such as phenothiazines, butyrophenones, thioxanthenes) is contraindicated due to mutual antagonism of therapeutic effects. Should not be used in patients with severe hepatic impairment without careful dose adjustment and monitoring. Not recommended during pregnancy unless potential benefits outweigh risks.

Possible side effects

Very common (>10%): nausea, dizziness, somnolence, headache Common (1-10%): vomiting, abdominal pain, constipation, dyspepsia, orthostatic hypotension, syncope, edema, fatigue, hallucinations, confusion, impulse control disorders Uncommon (0.1-1%): hypersexuality, pathological gambling, compulsive shopping, binge eating, hypotension, atrial fibrillation, visual disturbances Rare (<0.1%): hepatic enzyme elevations, allergic reactions, neuroleptic malignant syndrome (upon abrupt withdrawal)

Side effects are often dose-related and may diminish with continued therapy. Most common adverse reactions are mild to moderate and tend to occur during dose titration.

Drug interaction

• CYP1A2 inhibitors (fluvoxamine, ciprofloxacin): May increase ropinirole concentrations
• Dopamine antagonists (neuroleptics, metoclopramide): May diminish efficacy of both drugs
• Estrogens: May decrease ropinirole clearance
• Other CNS depressants (alcohol, benzodiazepines, opioids): May enhance sedative effects
• Antihypertensives: May potentiate hypotensive effects
• Smoking: May increase ropinirole clearance due to CYP1A2 induction

Dose adjustments may be necessary when adding or discontinuing interacting medications. Inform your healthcare provider of all prescription and non-prescription medications you are taking.

Missed dose

If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose to make up for a missed one. For the extended-release formulation, if missed within 12 hours of the usual dosing time, take as soon as remembered. If beyond 12 hours, skip the missed dose and resume the regular schedule. Do not crush or chew tablets to make up for a missed dose.

Overdose

Symptoms may include nausea, vomiting, dizziness, visual hallucinations, hyperhidrosis, claustrophobia, chorea, palpitations, orthostatic hypotension, and syncope. Cases of overdose have also been associated with ventricular tachycardia and agitation. General supportive measures are recommended, including ECG monitoring. Gastric lavage may be considered if performed soon after ingestion. Dialysis is unlikely to be beneficial due to high protein binding. Symptomatic treatment for hypotension may include intravenous fluids and vasopressors if necessary. Contact poison control center (1-800-222-1222) or emergency department immediately.

Storage

Store at room temperature (20-25°C or 68-77°F), with excursions permitted between 15-30°C (59-86°F). Keep in original container with lid tightly closed to protect from light and moisture. Do not store in bathroom or other humid areas. Keep out of reach of children and pets. Properly dispose of expired or unused medication through medication take-back programs or according to FDA guidelines.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Individual response to medication may vary. Only a qualified healthcare professional can determine the appropriate treatment based on individual medical history, current condition, and other factors. Do not initiate, discontinue, or change dosage without consulting your physician. Report any adverse effects to your healthcare provider promptly.

Reviews

“After struggling with Parkinson’s symptoms for years, Requip has significantly improved my quality of life. The titration process required patience, but the reduction in tremors and improved mobility have been remarkable.” - James L., 68

“As someone with severe RLS, Requip has been life-changing. I can finally sleep through the night without the constant urge to move my legs. The initial nausea was challenging but subsided after the first week.” - Maria K., 52

“My neurologist prescribed Requip XL alongside my levodopa regimen. The extended-release formulation provides smoother symptom control throughout the day with fewer peaks and troughs.” - Robert T., 71

“While Requip effectively managed my RLS symptoms, I experienced significant drowsiness during the daytime. My doctor adjusted the timing of my dose, which helped considerably.” - Susan W., 45

“After trying multiple medications for Parkinson’s, Requip provided the best balance of efficacy and tolerability for me. The impulse control issues were concerning initially, but with dose adjustment and awareness, they’ve been manageable.” - David R., 63