II. Indications
III. Pharmacokinetics
- Half life: 6 hours
- Hepatic metabolism
IV. Dosing: Parkinsonism
- Background
- Maximum benefit at 12 mg/day in early Parkinsonism, 8 mg/day in late Parkinsonism
- Immediate Release
- Start 0.25 mg orally three times daily
- Titrate up by 0.25 mg/dose each week over first month to 1 mg orally three times daily
- Above 3 mg/day, titrate as needed (1.5 mg/day each week) up to 9 mg/day
- Above 9 mg/day, titrate as needed (3 mg/day each week) up to 24 mg/day
- Maximum: 24 mg/day (18 mg/day if on Hemodialysis)
- Extended Release
- Start 2 mg orally daily for the first 1 to 2 weeks
- May increase by 2 mg/dose each week as needed
- Maximum: 24 mg/day (18 mg/day if on Hemodialysis)
V. Dosing: Restless Leg Syndrome
- Start: Requip 0.25 mg orally taken 2-3 hours before bedtime
- Interval for increasing dose: 3-7 days
- Titrating dose: Increase at set interval as above by one tablet if ineffective at current dose
- Start at 0.25 mg one tablet nightly for set interval in days
- Increase to two tablets (0.50 mg) nightly for set interval if ineffective at 0.25 mg
- Increase to three tablets (0.75 mg) nightly for set interval if ineffective at 0.50 mg
- Maximum dose: 6 tablets (1.5 mg) taken at bedtime
- Stopping: Taper off when stopping
VI. Adverse Effects (similar to Mirapex)
- Avoid in pregnancy
- Unknown safety in Lactation
- Nausea (common)
- Drowsiness (Limited to higher dosages)
- May be sudden, severe without warning
- May occur up to one year after starting Mirapex
- Has resulted in falling asleep while driving
- Augmentation of Restless Leg Symptoms
- Occurs in 25% of RLS patients on longterm therapy
- May progress in severity, and involve arms, trunk
- Often better if dose timing changed to earlier in day
- May be worse if dose increased
- Other uncommon adverse effects (rare at low dose)
- Hallucinations
- Pathologic Gambling (related to Dopamine receptor Agonist activity, D3)
- Orthostatic Hypotension
- Hypersexuality
VII. Resources
VIII. References
- (2021) Med Lett Drugs Ther 63(1618): 25-32
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 46-7
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
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