Requip (ropinirole) is a non-ergoline dopamine agonist specifically formulated to address the motor symptoms of Parkinson’s disease and moderate-to-severe primary Restless Legs Syndrome (RLS). By selectively activating dopamine receptors in the brain, it helps restore neurotransmitter balance, improving motor control, reducing involuntary movements, and enhancing overall quality of life for patients. Clinically proven and widely prescribed, Requip offers a targeted therapeutic approach for neurological conditions characterized by dopamine dysfunction.

Features

• Active ingredient: ropinirole hydrochloride
• Available in tablet and extended-release formulations
• Selective D2 and D3 dopamine receptor agonist
• Non-ergoline structure reduces risk of fibrotic reactions
• Multiple dosage strengths for individualized titration
• Bioavailability of approximately 50%
• Half-life of approximately 6 hours (immediate-release)
• Hepatic metabolism via CYP1A2 enzyme

Benefits

• Improves motor function and reduces rigidity in Parkinson’s disease patients
• Significantly decreases episodes of restless legs syndrome, enabling better sleep
• Allows for dosage flexibility and gradual titration to minimize side effects
• May enable reduction of levodopa dosage in advanced Parkinson’s cases
• Non-ergoline formulation presents lower risk of pleuropulmonary fibrosis
• Improves overall quality of life through symptom management

Common use

Requip is primarily indicated for the treatment of Parkinson’s disease, both as monotherapy in early disease and as adjunct therapy to levodopa in advanced stages. It is also FDA-approved for the management of moderate-to-severe primary Restless Legs Syndrome. The medication works by stimulating dopamine receptors in the striatum, compensating for the dopamine deficiency that characterizes Parkinson’s disease, while its mechanism in RLS involves modulation of dopaminergic pathways affecting sensory and motor symptoms.

Dosage and direction

Parkinson’s Disease:

• Initial dose: 0.25 mg three times daily
• Titration: Increase by 0.25 mg/dose every week to target therapeutic effect
• Maintenance: 3-9 mg daily in divided doses (maximum 24 mg/day)

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 1 week
• Maximum dose: 4 mg daily

Take with food to minimize nausea. Do not crush, chew, or split extended-release tablets. Dosage adjustments required for patients with hepatic impairment.

Precautions

• Monitor for emerging dopamine dysregulation syndrome (compulsive behaviors)
• Regular assessment for orthostatic hypotension, particularly during dose escalation
• Caution in patients with cardiovascular disease due to potential for hypotension
• Monitor for sedation and somnolence, which may occur during treatment
• Regular ophthalmic examinations recommended due to potential for retinal changes
• Gradual discontinuation required (taper over 7 days) to avoid neuroleptic malignant syndrome
• Pregnancy Category C: Use only if potential benefit justifies potential risk

Contraindications

• Hypersensitivity to ropinirole or any component of the formulation
• Concurrent use with antipsychotics that may antagonize dopamine receptors
• Severe hepatic impairment (Child-Pugh Class C)
• History of melanoma or suspicious skin lesions (in Parkinson’s patients)
• Patients with major psychotic disorders

Possible side effects

Common (≥5%):

• Nausea (40%)
• Drowsiness (40%)
• Dizziness (20%)
• Headache (15%)
• Vomiting (10%)
• Fatigue (8%)

Less common (1-5%):

• Orthostatic hypotension
• Syncope
• Hallucinations
• Constipation
• Abdominal pain
• Edema

Rare (<1%):

• Pathological gambling
• Hyperhidrosis
• Vision abnormalities
• Impulse control disorders
• Sudden sleep attacks

Drug interaction

• CYP1A2 inhibitors (ciprofloxacin, fluvoxamine) may increase ropinirole levels
• Estrogens may decrease ropinirole clearance
• Dopamine antagonists (neuroleptics, metoclopramide) may diminish efficacy
• Alcohol may potentiate sedative effects
• Antihypertensics may increase risk of hypotension
• Smoking may decrease ropinirole concentrations (induces CYP1A2)

Missed dose

Take the missed dose as soon as remembered, unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed dose. For the extended-release formulation, take the next dose at the regular time. If multiple doses are missed, contact healthcare provider for retitration instructions.

Overdose

Symptoms may include nausea, vomiting, dizziness, visual hallucinations, hyperhidrosis, syncope, and cardiac arrhythmias. Management includes supportive care with ECG monitoring, antiemetics for nausea, and benzodiazepines for agitation. Dialysis is not likely to be effective due to high protein binding. Contact poison control center (1-800-222-1222) for latest guidance.

Storage

Store at 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F). Keep in original container with lid tightly closed. Protect from light and moisture. Do not store in bathroom or near kitchen sink. Keep out of reach of children and pets. Discard any unused medication after expiration date.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Individual response to medication may vary. Always consult with a qualified healthcare professional before starting, changing, or discontinuing any medication. The prescribing physician should be aware of the patient’s complete medical history and concurrent medications. Regular follow-up and monitoring are essential during treatment with Requip.

Reviews

“After six months on Requip, my Parkinson’s tremors have reduced significantly. The titration process was gradual, but the improvement in my quality of life has been remarkable. I can now perform daily activities with much greater ease.” - Michael T., 68

“As someone who suffered from severe RLS for years, Requip has been life-changing. I finally experience restful sleep without the constant urge to move my legs. The initial nausea was manageable with food, and it subsided after the first week.” - Sarah L., 52

“My neurologist prescribed Requip as an adjunct to my levodopa therapy. The combination has allowed me to reduce my levodopa dose while maintaining better symptom control throughout the day. The extended-release formulation provides consistent coverage.” - Robert K., 71

“While Requip effectively controlled my RLS symptoms, I experienced significant daytime drowsiness that affected my work performance. My doctor adjusted the timing of my dose, which helped somewhat, but the sedation remained challenging.” - Jennifer M., 45

“The improvement in my husband’s Parkinson’s symptoms has been noticeable since starting Requip. His mobility has improved, and he experiences fewer ‘off’ periods. We did notice some mild ankle swelling, but it’s been manageable with elevation.” - Linda W., caregiver