Requip: Restore Motor Control in Parkinson's Disease
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Synonyms | |||
Requip (ropinirole) is a non-ergoline dopamine agonist indicated for the treatment of Parkinson’s disease and moderate-to-severe primary Restless Legs Syndrome. It functions by stimulating dopamine receptors in the brain, compensating for the diminished dopamine production characteristic of Parkinson’s, thereby improving motor function, reducing rigidity, and alleviating tremors. As a monotherapy or adjunct to levodopa, it offers a tailored approach to neurological symptom management, helping patients achieve greater independence and daily functionality.
Features
- Active ingredient: ropinirole hydrochloride
- Available in immediate-release and extended-release (Requip XL) tablet formulations
- Dosage strengths: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg (immediate-release); 2 mg, 4 mg, 6 mg, 8 mg, 12 mg (extended-release)
- Oral administration, with or without food
- FDA-approved for both Parkinson’s disease and Restless Legs Syndrome (RLS)
Benefits
- Reduces motor symptoms of Parkinson’s disease, including bradykinesia, tremor, and rigidity
- Diminishes “off” episodes in patients undergoing levodopa therapy
- Alleviates uncomfortable sensations and urge to move associated with Restless Legs Syndrome
- May allow for lower doses of levodopa, reducing long-term side effects such as dyskinesias
- Improves overall quality of life, sleep, and daytime functioning
- Non-ergoline structure reduces risk of fibrotic reactions compared to older agonists
Common use
Requip is primarily prescribed for the management of signs and symptoms of idiopathic Parkinson’s disease. It is used both as initial monotherapy in early disease and as an adjunct to levodopa in more advanced stages to smooth motor fluctuations and reduce “off” time. It is also approved for the treatment of moderate-to-severe primary Restless Legs Syndrome, significantly reducing sensory symptoms and motor restlessness, especially in the evening and night.
Dosage and direction
For Parkinson’s disease, treatment typically initiates at a low dose (0.25 mg three times daily for immediate-release; 2 mg once daily for extended-release) and is titrated gradually based on therapeutic response and tolerability. Maintenance doses vary widely; for immediate-release, the effective dose is often between 3–9 mg daily in three divided doses, though some patients require up to 24 mg/day. For extended-release, the dose is usually once daily, titrated upward weekly. For RLS, the starting dose is 0.25 mg once daily, 1–3 hours before bedtime, with upward titration as needed. Tablets should be swallowed whole; extended-release tablets must not be crushed or chewed.
Precautions
Patients should be cautioned about the potential for sudden sleep onset during activities of daily living, including driving. Orthostatic hypotension may occur, particularly during dose escalation. Hallucinations, impulse control disorders (such as pathological gambling, binge eating, or hypersexuality), and syncope have been reported. Dose reduction or discontinuation may be necessary. Patients with major psychotic disorders should be treated with caution. Regular monitoring for signs of fibrosis and retinal changes is advised, though the non-ergoline nature of ropinirole reduces this risk.
Contraindications
Requip is contraindicated in patients with known hypersensitivity to ropinirole or any component of the formulation. Concomitant use with antipsychotics that are dopamine antagonists (e.g., phenothiazines, butyrophenones) should be avoided, as these may diminish the efficacy of ropinirole.
Possible side effect
Common adverse reactions include nausea, dizziness, somnolence, vomiting, fatigue, and orthostatic hypotension. Syncope, hallucinations, impulse control disorders, and peripheral edema may occur. Sudden sleep onset during activities has been reported. In clinical trials, adverse events were generally dose-dependent and more frequent when used as adjunct therapy to levodopa.
Drug interaction
Dopamine antagonists (e.g., antipsychotics, metoclopramide) may diminish the effectiveness of ropinirole. CYP1A2 inhibitors (e.g., ciprofloxacin, fluvoxamine) may increase ropinirole plasma concentrations, while inducers (e.g., omeprazole, smoking) may decrease them. Estrogens may reduce ropinirole clearance. Sedatives, alcohol, and other CNS depressants may enhance sedative effects. Dose adjustment may be necessary when co-administering with these agents.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Doubling up on doses is not recommended.
Overdose
Symptoms of overdose may include agitation, hypotension, nausea, vomiting, and enhanced dopaminergic side effects such as dyskinesias or hallucinations. General supportive measures are recommended, including ECG monitoring and management of hypotension. Dialysis is unlikely to be beneficial due to ropinirole’s large volume of distribution.
Storage
Store at room temperature (20–25°C or 68–77°F), in a tightly closed container, away from light, moisture, and heat. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging.
Disclaimer
This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting or altering any medication regimen. Individual patient responses may vary.
Reviews
Clinical studies and patient reports indicate that Requip is effective in reducing Parkinsonian symptoms and RLS discomfort. Many users report improved mobility and quality of life, though side effects such as nausea and drowsiness are noted, especially during titration. Adherence to gradual dose escalation is emphasized to improve tolerability.