Requip: Restore Movement Control in Parkinson's Disease
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Synonyms | |||
Requip (ropinirole) is a non-ergoline dopamine agonist indicated for the treatment of Parkinson’s disease and moderate-to-severe primary Restless Legs Syndrome. As a therapeutic agent acting directly on dopamine receptors in the brain, it mimics the effects of dopamine, helping to improve motor control, reduce rigidity, and alleviate symptoms associated with dopaminergic deficiency. It is available in both immediate-release and extended-release formulations, allowing for tailored treatment regimens under specialist supervision.
Features
- Active ingredient: ropinirole hydrochloride
- Available formulations: immediate-release tablets (0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg) and extended-release tablets (2 mg, 4 mg, 6 mg, 8 mg, 12 mg)
- Mechanism of action: dopamine D2, D3 receptor agonist
- Administration: oral
- Prescription status: prescription-only medication
Benefits
- Improves motor symptoms in Parkinson’s disease, including bradykinesia, rigidity, and tremor
- Reduces “off” time and enhances “on” time in patients experiencing motor fluctuations
- Alleviates symptoms of Restless Legs Syndrome, improving sleep quality and daytime functioning
- Non-ergoline structure reduces risk of fibrotic reactions compared to older ergot-derived agonists
- Flexible dosing options support individualized treatment plans
Common use
Requip is primarily prescribed for the management of signs and symptoms of idiopathic Parkinson’s disease, either as monotherapy in early disease or as adjunctive therapy to levodopa in advanced stages. It is also approved for the treatment of moderate-to-severe primary Restless Legs Syndrome (RLS), characterized by an irresistible urge to move the legs, often accompanied by uncomfortable sensations.
Dosage and direction
Parkinson’s Disease:
- Initial dose: 0.25 mg three times daily; may increase gradually based on tolerability and response
- Maintenance dose: 3-9 mg daily in divided doses (immediate-release) or once daily (extended-release)
- Maximum dose: 24 mg daily
Restless Legs Syndrome:
- Initial dose: 0.25 mg once daily, 1-3 hours before bedtime
- May increase to 0.5 mg after 2 days, then to 1 mg after 7 days, and up to 4 mg based on response
- Take with food to minimize nausea
Dose titration should occur at weekly intervals under medical supervision. Extended-release tablets should be swallowed whole and not crushed or chewed.
Precautions
- Orthostatic hypotension may occur, especially during dose escalation; monitor blood pressure
- Patients may experience somnolence or sudden sleep attacks during activities; caution when driving or operating machinery
- Hallucinations and psychotic-like behaviors may develop, particularly in elderly patients
- Monitor for impulse control disorders (pathological gambling, hypersexuality, compulsive spending)
- Dopamine agonist withdrawal syndrome may occur upon abrupt discontinuation
- Not recommended for patients with severe renal impairment or end-stage renal disease
Contraindications
- Hypersensitivity to ropinirole or any component of the formulation
- Concurrent use with antipsychotics that are dopamine antagonists
- Patients with a history of hypersensitivity reactions to dopamine agonists
Possible side effects
Very common (>10%):
- Nausea
- Dizziness
- Somnolence
- Headache
Common (1-10%):
- Vomiting
- Fatigue
- Orthostatic hypotension
- Abdominal pain
- Constipation
- Edema
- Hallucinations
- Syncope
- Impulse control disorders
Uncommon (0.1-1%):
- Pathological gambling
- Hypersexuality
- Compulsive spending
- Sudden sleep onset
Drug interaction
- CYP1A2 inhibitors (ciprofloxacin, fluvoxamine) may increase ropinirole concentrations
- Dopamine antagonists (neuroleptics, metoclopramide) may diminish therapeutic effect
- Estrogens may reduce clearance of ropinirole
- Alcohol may potentiate sedative effects
- Caution with other CNS depressants (benzodiazepines, opioids)
Missed dose
If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose to make up for a missed one. For extended-release formulation, take the next dose at the regular time.
Overdose
Symptoms may include nausea, vomiting, dizziness, visual hallucinations, and hypotension. General supportive measures are recommended, including ECG monitoring. Dialysis is unlikely to be beneficial due to extensive protein binding. Symptomatic treatment for hypotension may include intravenous fluids and vasopressors if necessary.
Storage
Store at 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F). Keep in original container, tightly closed, and protect from light and moisture. Keep out of reach of children and pets.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting or changing any medication regimen. Individual response to medication may vary, and proper medical supervision is essential throughout treatment.
Reviews
Clinical studies demonstrate that ropinirole significantly improves Unified Parkinson’s Disease Rating Scale (UPDRS) scores and reduces “off” time in Parkinson’s patients. In Restless Legs Syndrome trials, patients reported significant improvement in symptom severity and sleep quality. Many patients report improved quality of life and functional capacity, though individual experiences with side effects vary. Long-term studies show maintained efficacy with appropriate dose management.