Generic name: ropinirole (oral) (roe PIN i role)
Brand name: Requip, Requip XL
Drug class: Dopaminergic antiparkinsonism agents
Requip (ropinirole) is a dopaminergic agent and it has some of the same effects as dopamine, a naturally occuring chemical found in your body. Low levels of dopamine in the brain are associated with Parkinson's disease.
Requip is used to treat symptoms of Parkinson's disease (stiffness, tremors, muscle spasms, and poor muscle control). Ropinirole is also used to treat restless legs syndrome (RLS).
Only immediate-release Requip is approved to treat either Parkinson symptoms or RLS. Extended-release Requip XL is approved only to treat Parkinson symptoms.
Parkinson's and RLS are two separate disorders. Having one of these conditions will not cause you to have the other condition.
Requip may cause you to fall asleep during normal daytime activities such as working, talking, eating, or driving. You may fall asleep suddenly, even after feeling alert. Tell your doctor if you have any problems with daytime sleepiness or drowsiness. If you are unsure of how this medicine will affect you, be careful if you drive or do anything that requires you to be awake and alert.
You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking this medication. Talk with your doctor if you believe you have any intense or unusual urges while taking Requip.
Do not share this medication with another person, even if they have the same symptoms you do. Avoid drinking alcohol, which can increase some of the side effects of Requip. Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by ropinirole. Tell your doctor if you regularly use any of these other medicines.
Requip may cause hallucinations (the sensation of hearing or seeing something that is not there), most commonly among elderly people. Call your doctor if you experience hallucinations.
Do not stop using Requip or change your dose without first talking to your doctor. You may have side effects such as fever, muscle stiffness, and confusion if you stop the medication suddenly or if you change doses.
Some people taking medicines for Parkinson's disease have developed skin cancer (melanoma). However, people with Parkinson's disease may have a higher risk than most people for developing melanoma. Talk to your doctor about your specific risk and what skin symptoms to watch for. You may need to have regular skin examinations.
Before taking this medicine
You should not use Requip if you are allergic to ropinirole.
To make sure Requip is safe for you, tell your doctor if you have:
- high or low blood pressure;
- kidney disease (or if you are on dialysis);
- heart disease, heart rhythm problems;
- a sleep disorder such as narcolepsy, or other conditions that may cause daytime sleepiness; or
- if you smoke.
People with Parkinson's disease may have a higher risk of skin cancer (melanoma). Talk to your doctor about this risk and what skin symptoms to watch for.
It is not known whether Requip will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
It is not known whether ropinirole passes into breast milk or if it could affect the nursing baby. Ropinirole may slow breast milk production. Tell your doctor if you are breast-feeding.
Requip is not approved for use by anyone younger than 18 years old.
How should I take Requip?
Take Requip exactly as it was prescribed for you. Follow all directions on your prescription label. Your doctor may occasionally change your dose. Do not take this medicine in larger or smaller amounts or for longer than recommended.
If you are taking immediate-release Requip tablets you should not take the extended-release tablets at the same time.
The dose and timing of Requip in treating Parkinson's disease is different from the dose and timing in treating RLS. Follow the directions on your prescription label. Ask your pharmacist if you have any questions about the kind of ropinirole you receive at the pharmacy.
Requip can be taken with or without food. Take the medicine at the same time each day.
Do not crush, chew, or break an extended-release Requip XL tablet. Swallow the tablet whole.
Call your doctor if you see part of the tablet in your stool. This is a sign that your body may not have absorbed all of the medicine.
If you are taking this medicine for RLS, tell your doctor if your symptoms get worse, if they occur in the morning or earlier than usual in the evening, or if you feel restless symptoms in your hands or arms.
It may take up to several weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve.
Do not stop using Requip suddenly, or you could have unpleasant withdrawal symptoms. Follow your doctor's instructions about tapering your dose.
Store at room temperature away from moisture, heat, and light. Keep the bottle tightly closed when not in use.
Usual Adult Dose of Requip for Parkinson's Disease:
Initial: 0.25 mg orally three times daily
After 1 week, the dose may be titrated up in weekly increments based on individual efficacy and tolerability:
Week 2: give 0.5 mg orally 3 times daily
Week 3: give 0.75 mg orally 3 times daily
Week 4: give 1 mg orally 3 times daily
After week 4, increase by 1.5 mg/day on a weekly basis up to a dose of 9 mg/day, then increase by 3 mg/day on a weekly basis up to a maximum daily dose of 24 mg
Maximum Dose: 8 mg orally three times a day
Initial: 2 mg orally once daily for 1 to 2 weeks, followed by increases of 2 mg/day at 1-week or longer intervals, depending on therapeutic response and tolerability
Maximum dose: 24 mg orally once a day
Patients may switch from immediate-release to extended-release: The initial dose of extended-release tablet should most closely match the total daily dose of immediate-release formulation. Following conversion, adjust dose depending on response and tolerability.
-If significant interruption in therapy occurs, retitration may be necessary; upon discontinuation, this drug should be gradually tapered over a 7-day period.
-The extended-release tablet is designed to release medication over a 24-hour period, if rapid gastrointestinal transit occurs, and tablet residue is observed in the stool, there is a risk of incomplete release of medication,
Use: For the treatment of Parkinson's disease.
Usual Adult Dose for Restless Legs Syndrome:
Initial: 0.25 mg orally once a day on Day 1 and Day 2
Dose titration: May titrate as follows based on individual efficacy and tolerability:
Days 3 to 7: give 0.5 mg orally once a day
-Week 2: give 1 mg orally once a day
-Week 3: give 1.5 mg orally once a day
-Week 4: give 2 mg orally once a day
-Week 5: give 2.5 mg orally once a day
-Week 6: give 3 mg orally once a day
-Week 7: give 4 mg orally once a day
Maximum Dose: 4 mg orally once a day
-Take 1 to 3 hours before bedtime.
-In clinical trials, this drug was not tapered prior to discontinuation.
Use: For the treatment of moderate to severe Restless Legs Syndrome.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What to avoid
Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall. Dizziness may impair your thinking or reactions. Avoid driving or operating machinery until you know how this medicine will affect you.
Drinking alcohol can increase certain side effects of Requip.
Requip side effects
Get emergency medical help if you have signs of an allergic reaction to Requip: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Some people taking Requip have fallen asleep during normal daytime activities such as working, talking, eating, or driving. Tell your doctor if you have any problems with daytime sleepiness or drowsiness.
You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking this medicine. Talk with your doctor if this occurs.
Call your doctor at once if you have:
- extreme drowsiness, falling asleep suddenly (even after feeling alert);
- worsening or no improvement in your symptoms;
- a light-headed feeling, like you might pass out;
- unusual changes in mood or behavior;
- tremors, twitching uncontrollable muscle movements; or
- hallucinations (seeing or hearing things that are not real).
Side effects such as confusion or hallucinations may be more likely in older adults.
Common Requip side effects may include:
- drowsiness, dizziness, weakness;
- headache, confusion, hallucinations;
- increased blood pressure (severe headache, pounding in your neck or ears, nosebleed, irregular heartbeats);
- nausea, vomiting, upset stomach, constipation;
- flu symptoms (fever, chills, body aches);
- sudden muscle movements;
- increased sweating; or
- swelling in your legs or feet.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What other drugs will affect Requip?
Taking Requip with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking a sleeping pill, narcotic medication, muscle relaxer, or medicine for anxiety, depression, or seizures.
Other drugs may interact with ropinirole, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.