Ropinirole is indicated for the treatment of signs and symptoms of idiopathic Parkinson’s disease. It is also indicated for the management of moderate to severe primary Restless Legs Syndrome (RLS).

Ropinirole is a non-ergoline dopamine agonist with high affinity for dopamine D3 receptors, which are mainly located in the limbic system of the brain and may contribute to neuropsychiatric effects. Although the exact mechanism in Parkinson’s disease is not fully understood, it is believed to act by selectively stimulating dopamine D2 receptors in the caudate-putamen region of the brain, which plays a key role in controlling movement. Ropinirole has minimal affinity for peripheral α2-adrenergic receptors and 5-HT1 receptors, and shows no significant activity at D1-like, benzodiazepine, or GABA receptors. In Restless Legs Syndrome, the exact mechanism is also unknown, but it is thought to be related to dopamine receptor stimulation.

Dosing for Parkinson’s disease: The recommended starting dose for Parkinson’s disease is 0.25 mg three times daily. Based on individual patient therapeutic response and tolerability, if necessary, the dose should then be titrated with weekly increments as described below. Maximum recommended total daily dose is 24 mg (8 mg three times daily).

• Week 1: 0.25 mg 3 times daily. Total daily dose 0.75 mg
• Week 2: 0.5 mg 3 times daily. Total daily dose 1.50 mg
• Week 3: 0.75 mg 3 times daily. Total daily dose 2.25 mg
• Week 4: 1 mg 3 times daily. Total daily dose 3 mg

Dosing for Restless Legs Syndrome (RLS): The recommended adult starting dose for RLS is 0.25 mg once daily, 1 to 3 hours before bedtime. After 2 days, if necessary, the dose can be increased to 0.5 mg once daily, and to 1 mg once daily at the end of the first week of dosing, then further titration as needed to achieve efficacy. Titration should be based on individual patient therapeutic response and tolerability, up to a maximum recommended dose of 4 mg daily.

• Days 1 and 2: 0.25 mg, 1 to 3 hours before bedtime, to be taken once daily
• Days 3–7: 0.5 mg, 1 to 3 hours before bedtime, to be taken once daily
• Day 2: 1 mg, 1 to 3 hours before bedtime, to be taken once daily
• Day 3: 1.5 mg, 1 to 3 hours before bedtime, to be taken once daily
• Day 4: 2 mg, 1 to 3 hours before bedtime, to be taken once daily
• Day 5: 2.5 mg, 1 to 3 hours before bedtime, to be taken once daily
• Day 6: 3 mg, 1 to 3 hours before bedtime, to be taken once daily
• Day 7: 4 mg, 1 to 3 hours before bedtime, to be taken once daily

Because Ropinirole is a dopamine agonist, concomitant use with dopamine antagonists such as neuroleptics (phenothiazines, butyrophenones, thioxanthenes) or metoclopramide may reduce its therapeutic efficacy.

Ropinirole is contraindicated in patients with known hypersensitivity to the drug or any of its components.

Common side effects include fainting, drowsiness, hallucinations, dizziness, nausea, vomiting, involuntary sudden movements, leg swelling, fatigue, confusion, headache, dyspepsia, abdominal pain or discomfort, and increased sweating.

Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women. Ropinirole should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It may inhibit prolactin secretion and potentially reduce lactation.

Patients may experience sudden sleep episodes during daily activities. Dopamine agonists may cause impairment in blood pressure regulation, leading to orthostatic hypotension.

Antiparkinson drugs

Protect from light and moisture. Store below 25°C. Keep out of reach of children.