Ropinirole

Aka: Ropinirole, Requip

1. See Also
   1. Dopamine Agonist
   2. Mirapex (Pramipexole)
2. Indications
   1. Parkinson's Disease
   2. Restless Leg Syndrome
3. Pharmacokinetics
   1. Half life: 6 hours
   2. Hepatic metabolism
4. Dosing: Parkinsonism
   1. Immediate Release start 0.25 mg three times daily (may increase by 0.25 mg/week up to 24 mg/day)
   2. Extended Release start 2 mg daily (may increase by 2 mg/week up to 24 mg/day)
5. Dosing: Restless Leg Syndrome
   1. Start: Requip 0.25 mg orally taken 2-3 hours before bedtime
   2. Interval for increasing dose: 3-7 days
   3. Titrating dose: Increase at set interval as above by one tablet if ineffective at current dose
      1. Start at 0.25 mg one tablet nightly for set interval in days
      2. Increase to two tablets (0.50 mg) nightly for set interval if ineffective at 0.25 mg
      3. Increase to three tablets (0.75 mg) nightly for set interval if ineffective at 0.50 mg
   4. Maximum dose: 6 tablets (1.5 mg) taken at bedtime
   5. Stopping: No titration needed
6. Adverse Effects (similar to Mirapex)
   1. Nausea (common)
   2. Drowsiness (Limited to higher dosages)
      1. May be sudden, severe without warning
      2. May occur up to one year after starting Mirapex
      3. Has resulted in falling asleep while driving
   3. Augmentation of Restless Leg Symptoms
      1. Occurs in 25% of RLS patients on longterm therapy
      2. May progress in severity, and involve arms, trunk
      3. Often better if dose timing changed to earlier in day
      4. May be worse if dose increased
   4. Other uncommon adverse effects (rare at low dose)
      1. Hallucinations
      2. Pathologic Gambling (related to Dopamine receptor agonist activity, D3)
      3. Orthostatic Hypotension
      4. Hypersexuality