Oral: Uses, Side Effects, Dosages
What Is Ropinirole?
Ropinirole, previously sold under brand names Requip and Requip XL, is a non-ergoline dopamine agonist used to treat the symptoms of Parkinson’s disease and restless legs syndrome (RLS).
Ropinirole acts on the nervous system at dopamine receptors (a neurotransmitter or a chemical messenger). It stimulates the dopamine receptors that help restore the balance of natural dopamine in the brain needed to control movements.
This medication is available as immediate-release and extended-release tablets.
Drug Facts
Generic Name: Ropinirole
Brand Name(s): Requip (discontinued), Requip XL (discontinued)
Drug Availability: Prescription
Administration Route: Oral
Therapeutic Classification: Dopamine agonist
Available Generically: Yes
Controlled Substance: N/A
Active Ingredient: Ropinirole hydrochloride
Dosage Form(s): Tablet
What Is Ropinirole Used For?
The Food and Drug Administration (FDA) approved ropinirole for use alone or with other medicines to treat Parkinson’s disease, a condition associated with low dopamine levels in the brain. It acts at dopamine receptors and has the same effects as naturally occurring dopamine.
Nearly one million people in the United States are currently living with Parkinson’s, and about 60,000 Americans are diagnosed with the condition each year.
Symptoms often include, but are not limited to:
- Tremors
- Slowed movement
- Stiffness
- Imbalance
In Parkinson’s disease, ropinirole helps to improve movement and reduce tremors, stiffness, and poor muscle control.
It is also used to treat restless legs syndrome, a condition causing a strong urge to move the legs, often worsening at rest and bedtime.
How to Take Ropinirole
Read the patient information leaflet before you start ropinirole. Consult your healthcare provider or pharmacist if you have any questions about the treatment.
For Parkinson’s disease, ropinirole is available in immediate-release (IR) or extended-release (ER) tablets. If prescribed the IR tablets, you will usually take them three times a day. The ER pills are usually only taken once daily.
Take the tablet by mouth, with or without food. Taking your dose with food may help decrease nausea or stomach upset. Swallow the tablet whole; do not crush or chew the ER tablets. Doing so can release the drug all at once, increasing the risk of side effects.
The ER tablets are not prescribed for restless leg syndrome. For the immediate-release tablets, take them once a day, one to three hours before bedtime.
Your prescribed dose will depend on your medical condition and response to treatment. Your healthcare provider may start you at a low dose and gradually increase it to reduce the risk of side effects. Make sure to follow your provider’s instructions carefully.
It is important to remember that ropinirole improves the symptoms of Parkinson’s disease and restless legs syndrome but does not cure them. Do not stop taking it without consulting your healthcare provider, even if you feel better. Sudden discontinuation may cause withdrawal symptoms (such as fever, muscle stiffness, and confusion). Your provider may lower the dose slowly to help prevent withdrawal symptoms.
Storage
Keep the tablets in a tightly closed container with the desiccant, if provided. Store it at room temperature, away from sunlight, heat, and moisture. Keep all the medicines out of sight and reach of children. Do not store it in the bathroom.
Do not keep or use any expired medicines. Never discard unused or expired medicines down the drain, flush them in the toilet, or throw them in the garbage. Instead, the best way is to consult your pharmacist to return your medication through a medicine take-back program.
How Long Does Ropinirole Take to Work?
Ropinirole reaches the peak plasma concentration within one to two hours, but it takes around two days of regular dosing to attain stable blood levels in the body. The symptoms may start to improve after taking the first dose, but it can take up to one week to have its full effect.
What Are the Side Effects of Ropinirole?
This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.
Common Side Effects
Ropinirole may cause some side effects. Tell the healthcare provider if any of these symptoms do not go away or become severe:
- Drowsiness
- Dizziness
- Dry mouth
- Weakness
- Confusion
- Headache
- Hallucinations( to hear or see things that do not exist)
- High blood pressure
- Pounding in the neck or ears
- Nosebleed
- Nausea
- Vomiting
- Stomach problems
- Constipation
- Flu symptoms (fever, chills, body aches)
- Sudden muscle movements
- Increased sweating
- Swelling in the legs or feet
- Anxiety
- Difficulty in concentrating
- Uncontrolled shaking of body parts
- Body pain (muscles, joints, back)
- Numbness or tingling in the hands and feet
This may not be a complete list of side effects. You can talk to your healthcare practitioner or pharmacist if you have any other side effects.
Severe Side Effects
Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.
In some people, the side effects of ropinirole can be severe, such as:
- Fainting
- Irregular heartbeat
- Chest pain
- Shortness of breath
- Difficulty in swallowing
- Double vision or changes in vision
- Pleural effusion
- Pleural fibrosis
- Symptoms of allergy such as rashes, hives, itching, swelling of the face, lips, mouth, tongue, or throat
Dosage: How Much Ropinirole Should I Take?
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IBM Micromedex®
The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
-
For oral dosage form (extended-release tablets):
-
For Parkinson’s disease:
- Adults—At first, 2 milligrams (mg) once a day for 1 to 2 weeks. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 24 mg per day.
- Children—Use and dose must be determined by your doctor.
-
For Parkinson’s disease:
-
For oral dosage form (tablets):
-
For Parkinson’s disease:
- Adults—At first, 0.25 milligram (mg) 3 times a day. Your doctor will adjust your dose as needed and tolerated. However, the dose is usually not more than 24 mg per day.
- Children—Use and dose must be determined by your doctor.
-
For Restless Legs Syndrome:
- Adults—At first, 0.25 milligrams (mg) once a day, 1 to 3 hours before bedtime. Your doctor will adjust your dose as needed and tolerated. However, the dose is usually not more than 4 mg per day.
- Children—Use and dose must be determined by your doctor.
-
For Parkinson’s disease:
Modifications
Ropinirole is available as IR tablets and ER tablets. The IR pills are approved to treat Parkinson’s symptoms and restless leg syndrome. However, the ER tablets are approved to treat Parkinson’s disease only.
Missed Dose
If you forget to take your dose, take the tablet as soon as you remember. But if it is almost time for the next dose, skip the missed dose and continue taking your pills regularly. Do take a double dose to make up for a missed one.
Take ropinirole regularly at the same time each day to avoid missing a dose. If you stop taking it for several days, your healthcare provider may need to increase your dose again to reach your previous dosage slowly. Talk with your provider when restarting the medicine.
Overdose: What Happens If I Take Too Much Ropinirole?
Accidentally or intentionally taking more than the prescribed dose of ropinirole can result in side effects related to the drug’s dopaminergic activity. These include:
- Nausea
- Dizziness
- Visual hallucinations
- Hyperhidrosis (excessive sweating)
- Claustrophobia
- Chorea (uncontrollable body movements)
- Palpitations
- Muscle weakness
- Nightmares
If you overdose on ropinirole, you may also experience the following:
- Vomiting
- Coughing
- Fatigue
- Fainting
- Dyskinesia (involuntary muscle movements)
- Agitation
- Chest pain
- Orthostatic hypotension (feeling lightheaded or dizzy after standing up from a sitting or lying position)
- Sleepiness
- Confusion
What Happens If I Overdose on Ropinirole
If you or someone else has taken more than the prescribed dose of ropinirole, call your healthcare provider or the Poison Control Center (800-222-1222).
If someone collapses, has seizures, or has trouble breathing after taking ropinirole, immediately, call 911.
Precautions
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IBM Micromedex®
It is important that your doctor check your progress at regular visits to allow changes in your dose and to check for any unwanted effects.
Do not stop taking this medicine without first checking with your doctor. Your doctor may want you to reduce gradually the amount you are taking before stopping completely. Stopping this medicine suddenly may cause fever, confusion, or severe muscle stiffness.
People taking ropinirole have reported falling asleep without warning during activities of daily living, including driving, which sometimes resulted in accidents. This may happen as late as one year after taking the medicine. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert, well-coordinated, or able to think or see well.
Check with your doctor before using this medicine with alcohol or other medicines that affect the central nervous system (CNS). This medicine will add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert). Some examples of medicines that affect the CNS are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicines, prescription pain medicine or narcotics, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics.
Check with your doctor right away if you have confusion, trouble breathing, a fast heartbeat, a high fever, high or low blood pressure, increased sweating, or severe muscle stiffness. These could be symptoms of a serious condition called neuroleptic malignant syndrome (NMS).
Dizziness, lightheadedness, or fainting may occur, especially when you get up from a lying or sitting position. These symptoms are more likely to occur when you begin taking this medicine, or when the dose is increased. Getting up slowly may help. If you should have this problem, check with your doctor.
Hallucinations (seeing, hearing, or feeling things that are not there) may occur in some patients. This is more common with elderly patients. If you have hallucinations, check with your doctor.
Smoking may decrease the treatment effects of this medicine. It is best to avoid smoking while you are using it. If you have any questions about this, check with your doctor.
This medicine may increase your risk for skin cancer, including melanoma. It is important that your doctor check your skin regularly if you have Parkinson’s disease. Check your doctor right away if you have a new mole, change in size, shape, or color of existing mole, or mole that leaks fluid or bleeds.
Some people who have used this medicine had unusual changes in their behavior, including an urge to gamble, spend money, binge eat, or an increased sex drive. Talk with your doctor if this is a concern for you.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
What Are Reasons I Shouldn’t Take Ropinirole?
Ropinirole is a prescription drug and should only be used according to your healthcare provider’s guidance.
Before starting ropinirole, tell your healthcare provider if you have:
- High or low blood pressure
- Heart problems
- Heart disease
- Kidney disease
- Liver impairment
- Sleep disorders such as narcolepsy
Other reasons why ropinirole may not be the right medication for you:
- Pregnancy: No adequate research has been done to determine the effects of ropinirole in pregnant or breastfeeding people.
- Age: Ropinirole is not approved for people under 18.
- Certain side effects, like excessive sleepiness: Some people have suddenly fallen asleep during daily activities, such as talking, working, or driving. Tell your healthcare provider immediately if this happens to you.
What Other Medications Interact With Ropinirole?
Ropinirole may interact with other medicines, which may increase the risk of severe side effects:
- Antipsychotic medicines, including chlorpromazine, Haldol (haloperidol), and thiothixene
- Antiemetic drugs, such as Reglan (metoclopramide)
- Medicines that can affect the removal of ropinirole from the body or how it works: Examples include cimetidine, Luvox (fluvoxamine), Rimactane (rifampin), and others
- Anxiety medications, such as Xanax (alprazolam), Ativan (lorazepam), and Ambien (zolpidem)
- Opioid painkillers, such as codeine and hydrocodone
- Antihistamines, such as Zyrtec or Xyzal (cetirizine) and Benadryl (diphenhydramine)
- Muscle relaxants, such as Soma (carisoprodol) and Amrix (cyclobenzaprine)
- Allergy or cough-and-cold products that may cause drowsiness
- Alcohol
- Cannabis
It’s also important to note that cigarette smoking can reduce how well ropinirole works, as it can decrease levels of the drug in the blood.
This may not be a complete list of all the medicines that interact with ropinirole. Tell your healthcare provider about all the prescription and over-the-counter medications, vitamins, and herbal supplements you take. Do not start, stop, or change your dose of any medication without consulting a medical professional first, whether that’s your healthcare practitioner or a pharmacist.
What Medications Are Similar?
Some of the other medicines belonging to the class of dopamine agonists are:
- Apokyn (apomorphine) is a short-acting injectable medicine to relieve Parkinson’s symptoms. It takes effect within 10 minutes and its effect lasts about an hour.
- Mirapex (pramipexole) is a prescription medication available as a tablet in the brand and generic versions. The short and long-acting forms treat symptoms of Parkinson’s disease. It helps improve movement-related symptoms and helps treat patients younger than 60 to slow symptom progress. The short-acting version of Mirapex is also used to treat symptoms of restless legs syndrome.
- Neupro (rotigotine) is a once-a-day prescription medicine available as a transdermal patch in different strengths. It is used to treat Parkinson’s disease and restless legs syndrome.
How Can I Stay Healthy While Taking Ropinirole?
Nervous system disorders like Parkinson’s disease and RLS can cause disruptive and unpleasant symptoms. However, many of these symptoms are manageable. Ropinirole is an effective and well-tolerated drug. It has a lot of benefits, including a quick onset of action, long-term use, and mostly tolerable side effects.
If you experience side effects from your medications, don’t panic. Talk to your healthcare provider to see how you can adjust your treatment plan. Ask your healthcare provider what to expect before starting your medications. Being aware of the possible side effects of your medication(s) can help reduce some of the anxiety.
Importantly, keep an eye out for more severe reactions, such as sudden behavioral changes. This can include sudden, addictive behavior that can result in gambling, excessive spending, or other changes in behaviors. Tell your healthcare provider immediately if this happens to you.
Also, it might be helpful to set timed reminders or use a medication adherence app to keep track of your scheduled medication doses. Adhering to your regular doses is necessary to keep your symptoms under control.
Medical Disclaimer
Verywell Health’s drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.
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