Top 300 Pharmacy Drug Cards

ROPINIROLE: Requip, Requip XL, Various

Class: Dopamine Agonist

Dosage Forms. Tablet: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg; Tablet, Extended Release: 2 mg, 4 mg, 6 mg, 8 mg, 12 mg

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Common FDA Label Indication, Dosing, and Titration.

1. Parkinson disease: Immediate release, 0.25 mg po tid × 1 wk; then 0.5 mg po tid × 1 wk, then 0.75 mg po tid × 1 wk, then 1 mg po tid, may titrate to 24 mg/d; Extended release, 2 mg po daily × 1-2 wk, then may titrate to 24 mg/d

2. Restless legs syndrome: 0.25 mg po daily hs × 2 d, then 0.5 mg po daily hs × 5 d, then 1 mg po daily × 1 wk, then 1.5 mg po daily hs for 1 wk, then 2 mg po daily hs, may titrate to 4 mg po daily hs

Off-Label Uses. None

MOA. Ropinirole is a non-ergoline dopamine agonist that has a higher specificity to D3 than to D2 and D4 subtypes of dopamine receptors. The drug has a moderate affinity for opioid receptors and has insignificant effects on D1, 5-hydroxytryptamine(1) (5-HT1), 5-HT2, benzodiazepine, gamma-aminobutyric acid (GABA), muscarinic, α,1-, α-2-, and β-adrenoreceptors. It is suggested that it stimulates the postsynaptic D2-type receptor found in the brain’s caudate putamen in Parkinson disease.

Drug Characteristics: Ropinirole

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Medication Safety Issues: Ropinirole

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Drug Interactions: Ropinirole

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Adverse Reactions: Ropinirole

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Efficacy Monitoring Parameters. Reduction of extrapyramidal movements, rigidity, tremor, gait disturbances; decrease in desire to move limbs.

Toxicity Monitoring Parameters. Signs/symptoms of postural hypotension, BP, decreased heart rate, periodic dermatologic screening.

Key Patient Counseling Points. Take drug with food to reduce nausea. Avoid driving and other activities requiring mental alertness or coordination until drug effects are realized. Rise slowly from sitting/lying-down position. Report new onset or exacerbation of dyskinesia, changes in BP, fainting, or unusual urges. Avoid sudden discontinuation of drug. Do not drink alcohol or take other CNS depressants while using this drug.

Clinical Pearls. May switch directly from immediate-release ropinirole; start an extended-release dose that matches most closely with the total daily immediate-release dose.