ropinirole
Ropinirole is a dopamine agonist that's used to treat Parkinson's disease (PD) and restless legs syndrome (RLS) in adults. For Parkinson's disease, the immediate-release tablets are taken by mouth three times per day, and the extended-release tablets are taken once per day. Ropinirole side effects include nausea, sleepiness, and dizziness.
What is Ropinirole?
What is Ropinirole used for?
- Parkinson's disease (PD)
- Moderate-to-severe restless legs syndrome (RLS) - immediate-release tablets only
How Ropinirole works
Ropinirole is a dopamine agonist. It's not completely known how the medication works. But it's thought to act like a chemical called dopamine in the brain.
Parkinson's disease and restless legs syndrome seem to be caused by problems in the dopamine system in the brain. So by acting like dopamine, ropinirole helps improve movement problems for people with Parkinson's disease or restless legs syndrome.
Drug facts
More on Ropinirole essentials
Side effects of Ropinirole
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
Parkinson's disease:
- Nausea (60%)
- Dizziness (40%)
- Sleepiness (40%)
- Weakness (16%)
- Feeling faint (12%)
- Vomiting (12%)
- Viral infection (11%)
- Indigestion (10%)
Restless legs syndrome:
- Nausea (40%)
- Sleepiness (12%)
- Vomiting (11%)
- Dizziness (11%)
Less Common Side Effects
Parkinson's disease:
- Stomach pain
- Confusion
- Anxiety
- Sweating
- Dry mouth
Restless legs syndrome:
- Weakness
- Diarrhea
- Stuffy nose
- Muscle cramps
Ropinirole serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious withdrawal symptoms (neuroleptic malignant syndrome): fever, sweating, stiff muscles, confusion, not aware of your surroundings, fast or irregular heartbeat
- Impulse-control behavior: intense urges for certain behaviors (e.g., gambling, shopping, binge eating, engaging in sexual activity)
- Changes in behavior or hallucinations (seeing or hearing things that aren't there)
The following Ropinirole side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Confusion
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
drowsiness
falling
seeing, hearing, or feeling things that are not there (hallucinations)
sleepiness or unusual drowsiness
swelling of the legs
twisting, twitching, or other unusual body movements
unusual tiredness or weakness
worsening of parkinsonism
Less common
Abdominal or stomach pain
bloating or swelling of the face, arms, hands, lower legs, or feet
blood in the urine
blurred vision
burning, pain, or difficulty in urinating
chills
cold sweats
double vision or other eye or vision problems
fainting
fear or nervousness
feeling of constant movement of self or surroundings
high or low blood pressure
irregular or pounding heartbeat
loss of memory
mental depression
pain in the arms or legs
pounding in the ears
rapid weight gain
sensation of spinning
slow or fast heartbeat
sweating
tightness in chest
tingling of the hands or feet
tingling, numbness, or prickly feelings
trouble in concentrating
troubled breathing
unusual weight gain or loss
vomiting
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Agitation
grogginess
increase in unusual body movements, especially of the face or mouth
increased coughing
increased sweating
lack or loss of strength
nightmares
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Abnormal dreams
acid or sour stomach
back pain
belching
decrease in sexual desire or performance
difficulty having a bowel movement (stool)
dryness of mouth
flushing
general feeling of discomfort or illness
indigestion
loss of appetite
yawning
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Ropinirole
Pros
- Works well to control movement problems
- Can take with or without food
- Available as a lower-cost generic
Cons
- Only available as a tablet that's swallowed whole
- Can have a lot of side effects, like impulsive behavior and hallucinations (seeing things that aren't real)
- Can't suddenly stop taking ropinirole because of risk of withdrawal symptoms
Pharmacist tips for Ropinirole
- Take ropinirole exactly as prescribed. Don't suddenly change your dose or stop taking ropinirole without talking to your provider first. Otherwise, you might have withdrawal symptoms, such as anxiety, panic attacks, depression, fatigue, pain, stiff muscles, high fever, and confusion. Follow your provider's instructions to lower your dose slowly over a period of time to stop the medication completely.
- You can take ropinirole with or without food. But nausea is a common side effect, so taking it with food can help prevent stomach upset.
- Don't chew, crush, or split either the immediate-release or extended-release tablets. They're formulated with a special coating that will damage the medication if it's crushed. Talk to your provider if you're having trouble swallowing ropinirole tablets.
- Ropinirole can make you sleepy and can even make you suddenly fall asleep without warning. Don't drive or and do other things that require concentration until you know how this medication affects you. Also avoid doing these activities if you feel sleepy. Tell your provider if you already have a problem with staying awake during the day or take other medications that make you sleepy.
- Avoid drinking alcohol while you're taking ropinirole because it can raise your risk for side effects (e.g., low blood pressure, sleepiness, dizziness). Talk to your provider about ways to lower how much you drink if you need guidance.
- Make sure to hold onto something when you stand up so you don't lose your balance from any dizziness you might feel. Ropinirole can suddenly lower your blood pressure when you get up after sitting or lying down, which can cause dizziness and lead to falls. Get medical help right away if you fall and hit your head.
- Tell your provider about all the medications that you're taking. This is especially important if you're taking an estrogen medication because it might affect your risk of side effects from ropinirole. Your provider might need to adjust your doses to keep you safe.
- Let your provider know if you smoke cigarettes or use nicotine products. Nicotine speeds up how fast your body gets rid of ropinirole, so the medication might not work as well for you. Discuss with your provider about your smoking habits because you might need dose adjustments to your ropinirole treatment.
- If you've stopped taking ropinirole for a long period of time, contact your provider for instructions. Don't just restart at the same dose that you were taking before. You'll probably need to restart at a lower dose and then slowly raise the dose.
- Ropinirole is generally not recommended during pregnancy because there's not enough information about how safe the medication is for unborn babies. It's also not recommended to breastfeed because ropinirole might affect your milk supply. Talk to your provider about safer alternatives you can take while pregnant or breastfeeding.
Common questions about Ropinirole
Ropinirole is not being discontinued. The manufacturer discontinued the brand-name product called Requip for business reasons. But lower-cost generic versions of the medication are still available and being used today.
No, ropinirole isn't a controlled substance. It doesn't have a risk of addiction or dependence.
In general, it takes about 1.5 to 2 hours for ropinirole to start working. This is why for restless leg syndrome, you should take the medication 1 to 3 hours before bedtime.
It can take a little over a day for most of ropinirole to leave the body. This time frame is estimated based on the half-life of the medication. Keep in mind that how long the medication stays in your system can differ for each person because it also depends on your age, liver function, and genetics.
No, ropinirole isn't typically taken as needed. You should take ropinirole every day for both Parkinson's disease and restless leg syndrome so the medication can work as best as it can. Taking it as needed raises your risk for withdrawal symptoms (e.g., nausea, vomiting, anxiety, distress). Make sure to take ropinirole exactly as prescribed.
Talk to your provider if you're interested in stopping ropinirole. Your provider will work with you to come up with a plan to safely stop the medication. This typically involves slowly lowering the dose over a period of time so the dopamine levels in your brain don't drop too quickly. Stopping ropinirole too suddenly can cause your PD or RLS symptoms to come back. Additionally, you can have withdrawal symptoms (e.g., anxiety, distress) or a serious side effect called neuroleptic malignant syndrome that causes high fever, muscle stiffness, and confusion.
Weight gain wasn't a reported side effect from people taking ropinirole in clinical studies. But ropinirole can cause compulsive behavior, or intense urges and behaviors that are hard to control. One possible urge is the urge to eat excessively, which can potentially lead to weight gain. Talk to your provider if you experience changes in weight and you're concerned about how your weight has changed since starting ropinirole.
Yes, sleepiness is one of the most common side effects of ropinirole. This medication can even make you suddenly feel sleepy without any warning. Tell your provider if you're taking other medications that can cause sleepiness because they can make the side effect feel more intense. It's also recommended to avoid alcohol because it can make sleepiness worse. Make sure to avoid driving or doing anything that requires concentration until you know how this medication affects you to prevent accidental injuries. Talk to your provider if ropinirole is making you too sleepy throughout the day and is interfering with your normal daily activities. Your provider might recommend lowering your dose or switching you to a different medication.
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Risks and warnings for Ropinirole
Ropinirole can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Extreme sleepiness
- Risk factors: Already feeling sleepy | History of sleep problems | Taking other sedatives or medications that make you sleepy | Drinking alcohol
Ropinirole can make you sleepy, sometimes to the point where you might fall asleep suddenly. Your risk is higher if you're also taking other medications that can cause sleepiness, such as benzodiazepines, muscle relaxants, and sleep medications. To avoid accidental injuries that might happen when you suddenly feel sleepy, make sure you know how ropinirole affects you before driving a car or doing activities that require your concentration. Talk to your healthcare provider if you feel too sleepy from ropinirole or have fallen asleep without warning while you're taking the medication.
Changes in blood pressure and higher risk of falls
- Risk factors: Low blood pressure | Taking medications that lower blood pressure | History of medical conditions that can lower blood pressure | Starting a higher dose of ropinirole
Ropinirole can cause changes to your blood pressure (either up or down). In particular, your blood pressure can drop when you stand from a sitting or lying position. This can lead to dizziness, loss of balance, or falls. Make sure to get up slowly and hold onto something after sitting or lying down. Contact your provider if you've felt lightheaded, fainted, or experienced a fall while you're taking ropinirole.
Intense urges
Ropinirole can sometimes cause compulsive behavior, which are intense urges and behaviors that are hard to control. Let your provider know if you or your loved ones notice new urges or habits when you're taking ropinirole. These can include gambling, sexual urges, shopping, or excessive eating. Your provider might need to adjust or stop your medication.
Hallucinations and behavior changes
- Risk factors: Age 65 years or older | History of mental health problems (e.g., psychosis) | Advanced Parkinson's disease
Some people taking ropinirole had hallucinations (seeing or hearing things that aren't there). Some also felt distressed, confused, or paranoid or had violent behavior. People with a history of mental health problems are generally not recommended to take ropinirole because the medication might worsen the condition. Contact your provider right away if you or your loved ones notice any hallucinations or other changes in behavior while you're taking ropinirole.
Difficulty controlling body movements
- Risk factors: Taking medications containing levodopa
Ropinirole can cause or worsen uncontrolled body movements, such as eye-twitching or lip-smacking. The risk for worsened uncontrolled body movements might be higher for people who are also taking other Parkinson's medications that contain levodopa (such as Sinemet). Talk to your provider right away if you experience any uncontrolled movements and aren't able to stop them. Your provider might recommend to lower your ropinirole dose to help manage this side effect.
Worsening symptoms of RLS (immediate-release tablets only)
The ropinirole immediate-release tablets can potentially worsen your RLS symptoms. They can be worse than before you started taking the medication. Ropinirole can also cause symptoms to spread to other parts of your body, make the restlessness feeling in your legs more intense, or cause your symptoms to start earlier in the day. Ropinirole can also cause symptoms to come back in the early morning hours the next day. Talk to your provider if you notice your RLS symptoms have worsened during treatment. Your provider will discuss with you whether you should lower your dose.
Ropinirole dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 0.25mg | 90 tablets | $15.26 | $0.17 |
| 0.5mg | 90 tablets | $15.01 | $0.17 |
| 2mg | 90 tablets | $17.06 | $0.19 |
| 3mg | 90 tablets | $18.17 | $0.20 |
| 4mg | 90 tablets | $18.40 | $0.20 |
| 5mg | 30 tablets | $11.93 | $0.40 |
| 1mg | 30 tablets | $9.00 | $0.30 |
Typical dosage for Ropinirole
- Parkinson's disease: The typical starting dose is 0.25 mg by mouth three times daily. The maximum dose is 24 mg per day.
- Restless legs syndrome: The typical starting dose is 0.25 mg by mouth once daily. The maximum dose is 4 mg per day. You should take the medication 1 to 3 hours before bedtime.
- Parkinson's disease: The typical starting dose is 2 mg by mouth once daily for the first 1 to 2 weeks of treatment. The maximum dose is 24 mg per day.
Your provider will adjust your dose based on how well the medication is working for you and whether you're having side effects. Your dose might differ if you have severe kidney problems.
More on Ropinirole dosage
Interactions between Ropinirole and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Sulpiride
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Ciprofloxacin
- Kava
How much does Ropinirole cost?
$9.00
What are alternatives to Ropinirole?
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