BMA Concise Guide to Medicine & Drugs

Ropinirole

Brand names Adartrel (restless legs only), Requip, Requip XL

Used in the following combined preparations None

QUICK REFERENCE

Drug group Drug for parkinsonism

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Ropinirole mimics the neurotransmitter dopamine in the brain. It is used to treat Parkinson’s disease, in which there is a lack of dopamine in the brain. It may be used either alone or in combination with levodopa. Patients taking levodopa alone over several years may experience extremes of activity: overactivity after taking levodopa (“on effect”) and underactivity (“off effect”) before the next dose of levodopa is due. When used with levodopa, ropinirole helps to reduce these on-off fluctuations. Unlike some other drugs for Parkinson’s disease, ropinirole does not cause fibrosis (thickening of connective tissue) of the abdomen or heart. However, ropinirole may cause excessive sleepiness and a tendency to lower blood pressure on standing (postural hypotension). It may also be used for restless legs syndrome (Ekbom’s disease).

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, MR tablets.

Frequency and timing of doses Parkinson’s 3 x daily (tablets) or 1 x daily (MR tablets). Restless legs 1 x daily at night (tablets). In all cases, doses should be taken with or after food.

Adult dosage range Parkinson’s 750mcg–3mg daily (tablets), 750mcg–24mg (MR tablets). Initially a low dose is given; this is increased until there is a satisfactory response. If given with levodopa, the dose of ropinirole may be reduced. Restless legs 250mcg each night, increasing slowly to 4mg maximum.

Onset of effect 1–2 hours.

Duration of action 6–12 hours.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember. If your next dose is due within two hours, take a single dose now and skip the next.

Stopping the drug Do not stop the drug without consulting your doctor; symptoms may recur.

Exceeding the dose An occasional unintended extra dose is unlikely to be a cause for concern. If you notice any unusual symptoms, or if a large overdose has been taken, notify your doctor.

POSSIBLE ADVERSE EFFECTS

Nausea, drowsiness, and dizziness on standing are common side effects of ropinirole. In some cases, drowsiness can be severe, with the sudden onset of sleep during the day. Starting with low doses that are gradually increased helps to reduce the likelihood of side effects. If drowsiness or any of the other common side effects are severe, discuss with your doctor. Rarely, ropinirole may cause confusion, hallucinations, increased sexuality, and compulsive behaviours, such as compulsive gambling. If any of these effects occur, consult your doctor.

INTERACTIONS

Ciprofloxacin The effect of ropinirole may be increased, necessitating dose reduction of ropinirole or use of an alternative antibiotic.

Memantine May enhance the effects of ropinirole. Dose reduction of ropinerole may be required.

Metoclopramide and antipsychotics These drugs reduce the effect of ropinirole and may worsen symptoms.

Smoking reduces blood levels of ropinirole, so stopping smoking may produce side effects due to a significant rise in blood levels of ropinirole.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have postural hypotension or dizziness on standing.

· You have changed or intend to change your smoking habit.

· You have long-standing kidney problems.

· You have had psychotic mental problems.

Pregnancy Safety in pregnancy not established. Discuss with your doctor.

Breast-feeding Safety not established and may suppress lactation. Discuss with your doctor.

Infants and children Unlikely to be required.

Over 60 Reduced dose may be necessary.

Driving and hazardous work Avoid such activities until you have learned how ropinirole affects you as this drug may cause dizziness and severe drowsiness.

Alcohol No known problems, although ropinirole may enhance the sedative effects of alcohol.

PROLONGED USE

No special problems.