Requip

Requip (ropinirole) is a prescription medication specifically formulated to manage the symptoms of Parkinson’s disease and moderate-to-severe primary Restless Legs Syndrome (RLS). As a non-ergoline dopamine agonist, it works by stimulating dopamine receptors in the brain, helping to restore neurotransmitter balance and improve motor control. Clinically proven and widely prescribed, Requip offers a targeted therapeutic approach to enhance mobility, reduce discomfort, and improve overall quality of life for patients navigating these neurological conditions.

Features

• Active ingredient: Ropinirole hydrochloride
• Available in tablet and extended-release formulations
• FDA-approved for Parkinson’s disease and Restless Legs Syndrome
• Non-ergoline dopamine agonist class
• Multiple dosage strengths for individualized titration
• Bioavailability of approximately 50%
• Half-life of approximately 6 hours (immediate-release)
• Metabolized primarily by the CYP1A2 enzyme system

Benefits

• Reduces tremor, stiffness, and slowness of movement in Parkinson’s disease
• Alleviates uncomfortable sensations and urge to move associated with Restless Legs Syndrome
• Improves overall motor function and coordination
• Enhances sleep quality for RLS patients by reducing nighttime symptoms
• Allows for flexible dosing regimens to match individual patient needs
• Demonstrated efficacy in both monotherapy and adjunctive treatment

Common use

Requip is primarily prescribed for the treatment of Parkinson’s disease, where it helps manage motor symptoms such as tremors, rigidity, bradykinesia, and postural instability. It is used both as monotherapy in early disease stages and as adjunctive therapy with levodopa in more advanced cases. Additionally, Requip is indicated for moderate-to-severe primary Restless Legs Syndrome, providing relief from the characteristic uncomfortable sensations and compelling urge to move the legs that typically worsen during periods of rest or inactivity, particularly in the evening and nighttime hours.

Dosage and direction

For Parkinson’s disease treatment, initial dosing typically begins with 0.25 mg three times daily. The dosage is gradually titrated upward based on therapeutic response and tolerability, with weekly increments of 0.25 mg per dose. Maintenance doses usually range from 3-9 mg daily divided into three doses, though some patients may require up to 24 mg daily. For Restless Legs Syndrome, treatment starts with 0.25 mg once daily 1-3 hours before bedtime. The dose may be increased to 0.5 mg after two days, then to 1 mg after one week, and further titrated as needed up to 4 mg daily. Extended-release tablets are taken once daily and should be swallowed whole without chewing or crushing. All doses should be taken with food to minimize potential nausea.

Precautions

Patients should be monitored for the development of sedation, somnolence, and sudden sleep onset episodes, which can occur without warning. Caution is advised when driving or operating machinery until the patient’s response to treatment is established. Orthostatic hypotension may occur, particularly during dose titration. Patients should be advised to rise slowly from sitting or lying positions. Regular monitoring for impulse control disorders, including pathological gambling, increased libido, hypersexuality, compulsive spending, or binge eating, is recommended. Dopamine agonist therapy has been associated with fibrosis, including retroperitoneal fibrosis, pulmonary fibrosis, and pleural effusions. Regular physical examinations and monitoring are advised.

Contraindications

Requip is contraindicated in patients with known hypersensitivity to ropinirole or any component of the formulation. Concomitant use with antipsychotics that are dopamine antagonists is not recommended as they may diminish the effectiveness of ropinirole. The medication is not recommended for patients with severe hepatic impairment or end-stage renal disease requiring hemodialysis. Use in pregnancy is contraindicated unless the potential benefit justifies the potential risk to the fetus. Breastfeeding is not recommended during treatment.

Possible side effects

Common side effects include nausea (40%), dizziness (12%), somnolence (12%), vomiting, fatigue, and orthostatic hypotension. Syncope may occur, particularly during initial titration. Less frequent side effects include hallucinations, confusion, peripheral edema, abdominal pain, and constipation. Dopamine agonist therapy may cause impulse control disorders including pathological gambling, compulsive shopping, binge eating, and hypersexuality. Some patients may experience augmentation of RLS symptoms with long-term use. Extended-release formulations may have a slightly different side effect profile compared to immediate-release tablets.

Drug interaction

CYP1A2 inhibitors such as ciprofloxacin, fluvoxamine, and certain oral contraceptives may increase ropinirole concentrations. Estrogens may decrease ropinirole clearance by approximately 30%. Dopamine antagonists including antipsychotics (phenothiazines, butyrophenones, thioxanthenes) and metoclopramide may diminish the effectiveness of ropinirole. Alcohol may enhance the sedative effects of ropinirole. Coadministration with other CNS depressants may produce additive sedative effects. Smoking may increase ropinirole clearance due to induction of CYP1A2.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not take a double dose to make up for a missed one. For the extended-release formulation, if a dose is missed, the next dose should be taken at the usual time the following day. Consistency in dosing is particularly important for Parkinson’s disease management to maintain stable symptom control.

Overdose

Symptoms of overdose may include agitation, chest pain, confusion, dizziness, drowsiness, dyskinesia, hypotension, nausea, and vomiting. In cases of suspected overdose, supportive measures should be instituted including continuous ECG monitoring for potential arrhythmias. Gastric lavage may be considered if performed soon after ingestion. Maintenance of adequate airway and ventilation is essential. There is no specific antidote for ropinirole overdose. Hemodialysis is unlikely to be of benefit due to ropinirole’s large volume of distribution and extensive protein binding. Symptomatic and supportive treatment should be provided.

Storage

Store at room temperature between 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C to 30°C (59°F to 86°F). Protect from light and moisture. Keep in the original container with the lid tightly closed. Do not store in bathroom areas where moisture levels may be higher. Keep all medications out of reach of children and pets. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard expired or no longer needed medication through medication take-back programs.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Individual responses to medication may vary. Always consult with a qualified healthcare professional before starting, stopping, or changing any medication regimen. Do not disregard professional medical advice or delay seeking it because of something you have read here. The complete prescribing information should be reviewed before initiating therapy. Only a healthcare provider can determine the appropriate treatment based on individual medical history and current condition.

Reviews

Clinical studies demonstrate that approximately 60-70% of Parkinson’s disease patients experience significant improvement in motor symptoms with ropinirole therapy. In Restless Legs Syndrome trials, over 70% of patients reported moderate to marked improvement in symptoms. Many patients report improved quality of life, better sleep patterns, and enhanced ability to perform daily activities. Some users note that side effects typically diminish after the initial titration period. However, individual experiences vary, and some patients may not achieve adequate symptom control or may experience bothersome side effects that require discontinuation. Long-term follow-up studies show maintained efficacy with proper dose adjustment over time.