Ropinirole
REQUIP
Pronunciation: roe-PIN-i-roel (REE-kwip)
“Rope in a roll (to) Re-equip”
restless legs → treatment for RLS
What it isNon-ergot D2/D3 dopamine agonist; Parkinson disease and restless legs syndrome.
Why this oneUnlike pramipexole, it is cleared hepatically through CYP1A2, making renal impairment less limiting.
What limits itAsk directly about gambling, shopping, hypersexuality, and sudden sleep; hallucinations and orthostasis also limit use.
Ropinirole prescription history
Animated chart of estimated U.S. prescriptions per year, Parkinson medicines (1948–2026). Ropinirole enters in 1997 (estimated).
FDA-approved for
- Parkinson disease (1997)
- restless legs syndrome (2005)
Principal riskImpulse-control disorders and sudden sleep onset
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityOrthostasis, hallucinations, dyskinesia and impulse-control symptoms; abrupt withdrawal can be hazardous.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Parkinson's disease | Adults | 0.25 mg TID | titrate to response | 24 mg/day (8 mg TID); ESRD on hemodialysis 18 mg/day |
| Restless legs syndrome | Adults | 0.25 mg QD (1–3 h before bedtime) | titrate to response | 4 mg/day; ESRD on hemodialysis 3 mg/day |
Titration PD: increase at weekly intervals. RLS: increase after 2 days, then at weekly intervals.
Renal Moderate (CrCl 30–50): no adjustment. ESRD on hemodialysis: max 18 mg/day (PD), 3 mg/day (RLS); no post-dialysis supplement. Severe without dialysis: not studied.
Hepatic Undefined
Instructions
- Take with or without food
- PD: discontinue gradually over 7 days (reduce TID→BID for 4 days, then QD for 3 days)
- Retitrate if therapy is significantly interrupted
Available strengths
- tab 0.25, 0.5, 1, 2, 3, 4, 5 mg
- ER tab 2, 4, 6, 8, 12 mg
Cautions
- Falling asleep during activities of daily living / somnolence
- Syncope
- Hypotension / orthostatic hypotension
- Hallucinations / psychotic-like behavior
- Dyskinesia
- Impulse control / compulsive behaviors
- Withdrawal-emergent hyperpyrexia and confusion; withdrawal symptoms
- RLS augmentation and early-morning rebound
Adverse reactions
- Nausea
- Somnolence
- Dizziness
- Vomiting
- Syncope
- Asthenia
- Dyskinesia (advanced PD)
Pregnancy No adequate human data; animal data show fetal harm (teratogenicity, embryolethality).
Lactation Undefined
Cost
Generic entry2008
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Memory aids: interaction avatars
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Self-check
- Ropinirole: Which enzyme clears it?
CYP1A2. - What sleep-related adverse effect should be asked about with ropinirole?
Sudden sleep onset.