Requip (ropinirole hydrochloride) 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 cornerstone of neurological therapy, it functions by directly stimulating dopamine receptors in the brain, mimicking the action of the naturally occurring neurotransmitter that is deficient in these conditions. This targeted mechanism helps to alleviate the motor symptoms associated with Parkinson’s, such as tremors, rigidity, and bradykinesia, and provides significant relief from the uncomfortable sensations and urge to move characteristic of RLS. Its efficacy and established safety profile make it a first-line option for neurologists managing these chronic disorders.

Features

• Active Pharmaceutical Ingredient: Ropinirole hydrochloride.
• Available in immediate-release and extended-release (Requip XL) tablet formulations.
• Standard tablet strengths: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, and 5 mg.
• Extended-release tablet strengths: 2 mg, 4 mg, 6 mg, 8 mg, and 12 mg.
• Prescription-only medication, requiring careful titration and medical supervision.
• Designed for oral administration, with or without food (though high-fat meals may delay absorption).

Benefits

• Effectively reduces the core motor symptoms of Parkinson’s disease, improving overall mobility and functional independence.
• Provides pronounced relief from the distressing sensory symptoms and motor restlessness of Restless Legs Syndrome, promoting restorative sleep.
• Can be used as monotherapy in early Parkinson’s disease or as an adjunct therapy to levodopa, often allowing for a reduction in levodopa dosage and its associated long-term complications.
• The extended-release formulation offers continuous 24-hour dopaminergic stimulation, smoothing out motor fluctuations and providing more consistent symptom control throughout the day and night.
• As a non-ergoline derivative, it carries a lower risk of fibrotic reactions (e.g., pleural, cardiac, or retroperitoneal fibrosis) compared to older ergot-derived dopamine agonists.

Common use

Requip is primarily prescribed for two main neurological conditions. In Parkinson’s disease, it is used to manage the signs and symptoms of idiopathic Parkinson’s, including tremor, stiffness, slowness of movement, and problems with balance. It is effective in both early and advanced stages of the disease. For Restless Legs Syndrome, it is indicated for the treatment of moderate-to-severe primary RLS, a condition marked by an overwhelming, often irresistible urge to move the legs, usually accompanied by uncomfortable and unpleasant sensations, which are worse during periods of rest or inactivity and partially or totally relieved by movement.

Dosage and direction

Dosage is highly individualized and must be meticulously titrated under the direct supervision of a physician. Never self-adjust your dose.

For Parkinson’s disease:

• Immediate-release: The initial dose is typically 0.25 mg taken three times daily. Based on individual therapeutic response and tolerability, the dose is gradually increased. The weekly dosage may be increased by 0.75 mg per day at weekly intervals. Thereafter, the daily dosage may be increased by 1.5 mg per day on a weekly basis up to a dose of 9 mg per day, and then by up to 3 mg per day weekly to a maximum of 24 mg/day.
• Extended-release (Requip XL): Treatment is initiated at 2 mg once daily for 1 to 2 weeks. The dose is then increased by 2 mg/day at weekly or longer intervals, depending on therapeutic response and adverse effects. The maximum recommended dose is 24 mg/day.

For Restless Legs Syndrome (using immediate-release tablets only):

• Treatment is usually taken once daily, 1–3 hours before bedtime.
• The recommended starting dose is 0.25 mg. The dose can be increased to 0.5 mg after 2 days, and then to 1 mg at the end of the first week. Further dosage increases can occur in 0.5 mg increments weekly, as needed, to a maximum dose of 4 mg.

Tablets should be swallowed whole with water. The extended-release tablets must not be chewed, crushed, or divided.

Precautions

Patients and prescribers must be vigilant about several important precautions:

• Sudden Onset of Sleep: Requip has been associated with somnolence and episodes of suddenly falling asleep without warning during activities of daily living, including operating motor vehicles. This can result in accidents.
• Orthostatic Hypotension: Dopaminergic therapies can cause a significant drop in blood pressure upon standing (orthostatic hypotension), particularly during dose escalation. Patients should be cautioned to rise slowly from sitting or lying positions.
• Impulse Control Disorders: Treatment with dopamine agonists like Requip is strongly associated with compulsive behaviors, such as pathological gambling, increased libido, hypersexuality, compulsive spending or eating, and other intense impulses. Patients and caregivers should be monitored for and advised to report any new or increased impulsive behaviors.
• Hallucinations and Psychotic Behavior: Requip may cause or exacerbate psychotic symptoms, including hallucinations (primarily visual), confusion, and disorientation. Patients with a major psychotic disorder should not be treated with dopamine agonists.
• Monitoring: Regular monitoring of blood pressure, especially during dose increases, and ongoing assessment of mental status and behavioral changes are essential.

Contraindications

Requip is contraindicated in patients with:

• Known hypersensitivity to ropinirole or any of the excipients in the formulation.
• Severe renal impairment or end-stage renal disease requiring hemodialysis (for the immediate-release formulation; extended-release is not recommended in any degree of renal impairment).
• Severe hepatic impairment (Child-Pugh Class C).

Possible side effect

Like all medications, Requip can cause side effects, although not everybody gets them. Very common (≥1/10) and common (≥1/100 to <1/10) side effects include:

• Nausea, vomiting, abdominal pain
• Dizziness, somnolence (sleepiness), sudden onset of sleep
• Headache
• Syncope (fainting) or orthostatic hypotension
• Fatigue, asthenia (weakness)
• Hallucinations, confusion, insomnia
• Peripheral edema (swelling of the legs and feet)
• Constipation, dyspepsia (indigestion) Less common but serious side effects can include impulse control disorders, severe hypotension, and pathological gambling. This is not a complete list. Patients should report any new or worsening symptoms to their physician.

Drug interaction

Concomitant use of Requip with other medications requires careful consideration due to potential interactions:

• Dopamine Antagonists: Medications such as neuroleptics (e.g., phenothiazines, butyrophenones, thioxanthenes) or metoclopramide may diminish the effectiveness of Requip and are not recommended.
• Estrogens: Hormone replacement therapy or oral contraceptives containing estrogen may increase the plasma concentration of ropinirole, potentially requiring a dose adjustment.
• CYP1A2 Inhibitors and Inducers: Ropinirole is primarily metabolized by the CYP1A2 enzyme. Strong inhibitors (e.g., ciprofloxacin, fluvoxamine) can increase ropinirole levels, while inducers (e.g., omeprazole, smoking) can decrease its levels. Dose adjustment may be necessary.
• Other Sedating Agents: Alcohol, benzodiazepines, sedating antihistamines, and other CNS depressants can potentiate the sedative effects of Requip.
• Levodopa: Coadministration may increase the incidence of dyskinesias and other dopaminergic adverse effects. The dose of levodopa may need to be reduced.

Missed dose

• If a dose of immediate-release Requip is missed, it should be taken as soon as remembered unless it is almost time for the next dose. Do not double the next dose to make up for a missed one.
• For the extended-release formulation (Requip XL), if a dose is missed, it should be skipped and the next dose taken at the usual time the following day. Do not take a double dose.

Overdose

Symptoms of overdose are expected to be related to the drug’s dopaminergic activity and may be exaggerated versions of its common side effects. These can include:

• Severe nausea and vomiting
• Dizziness, profound somnolence, visual hallucinations
• Orthostatic hypotension, possibly leading to cardiovascular collapse
• Involuntary movements (dyskinesias), agitation
• Cardiac arrhythmias There is no specific antidote. Management involves general supportive measures, including continuous ECG and blood pressure monitoring. Gastric lavage may be considered if performed soon after ingestion.

Storage

• Store at room temperature between 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C and 30°C (59°F and 86°F).
• Protect from light and moisture.
• Keep the medication in its original container, tightly closed.
• Keep all medications out of the sight and reach of children and pets.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay in seeking it because of something you have read here. The information provided is not exhaustive and may not cover all possible uses, directions, precautions, interactions, or adverse effects.

Reviews

• “As a neurologist with over 20 years of experience, Requip remains a fundamental tool in my arsenal for managing Parkinson’s disease. Its efficacy in smoothing motor fluctuations when used adjunctly with levodopa is particularly valuable. The key, as with all dopamine agonists, is vigilant monitoring for behavioral side effects.” – Dr. A. Sharma, MD, Neurology.
• “The introduction of the extended-release formulation was a significant advancement. It provides my patients with more stable plasma levels, reducing ‘wearing-off’ phenomena and simplifying the dosing regimen to once daily, which greatly improves adherence.” – Clinical Pharmacist Specialist, Movement Disorders Clinic.
• “After struggling with debilitating RLS for years, Requip gave me my nights back. The urge to move is almost completely gone, allowing me to sleep through the night for the first time in a decade. The initial nausea was challenging but subsided after the first week.” – Patient, 58.
• “While effective, the side effect profile demands respect. I’ve had several patients who developed significant impulse control issues that resolved upon discontinuation. It underscores the necessity of a strong doctor-patient dialogue before and during treatment.” – Dr. L. Chen, DO.