Ropinirole: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on July 3, 2023.

1. How it works

• Ropinirole may be used for the treatment of Parkinson's Disease or restless legs syndrome.
• Ropinirole is thought to work by stimulating dopamine receptors in the brain, although its precise mechanism of action is unknown.
• Ropinirole belongs to the class of medicines known as dopaminergic anti-parkinsonism agents.

2. Upsides

• Ropinirole (both immediate- and extended-release tablets) may be used for the treatment of Parkinson's Disease. Ropinirole helps relieve symptoms such as stiffness, tremors, muscle spasms, and poor muscle control associated with PD. May be used alone or alongside other medications such as levodopa for PD.
• Immediate-release ropinirole may be considered for the treatment of moderate-to-severe primary restless legs syndrome (Ekbom syndrome).
• May be preferred as initial therapy in patients aged 70 years and older.
• May be taken with or without food; however, taking it with food may reduce the occurrence of nausea.
• No dosage adjustment is recommended by the manufacturer for people with kidney or liver disease, but the dosage should be titrated carefully. Has not been studied in severe renal impairment.
• Generic ropinirole is available.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Dizziness, dyskinesia (abnormal movements), headache, falls, nausea, abdominal pain, and sleepiness.
• Dry mouth, increased sweating, joint aches and pains, vomiting, tremor, and infection have also been reported along with several other side effects.
• Some people have reported spontaneously falling asleep during the day while taking ropinirole. Many had no prior warning, such as excessive drowsiness. Some of these events occurred more than one year after ropinirole initiation and resulted in accidents.
• Slow upward titration of ropinirole is recommended over several weeks to lessen the risk of side effects developing. Ropinirole should also be discontinued slowly, over at least a week.
• May cause a drop in blood pressure which may cause a person to fall over or become unconscious, especially when going from a sitting or lying down position to standing.
• Some trials reported that 10% of people developed hallucinations while taking ropinirole. The incidence was higher in people over the age of 65.
• May cause or exacerbate pre-existing dyskinesia (abnormal voluntary movements) and promote impulsive behaviors (such as gambling, spending sprees, and sexual urges).
• May cause confusion and an elevated temperature on withdrawal; withdrawal should be done slowly on a doctor's advice.
• People with PD have a two to six-fold higher risk of developing melanoma compared with the rest of the population. It is unclear if this is a result of the disease or the medications used to treat PD.
• People with severe kidney disease receiving hemodialysis should be given a reduced dose of ropinirole.
• May not be suitable for some people including those with high or low blood pressure, heart disease, or narcolepsy.
• Some people taking ropinirole for RLS have reported a worsening of symptoms and an earlier onset of symptoms in the evening (or even in the afternoon). Reconsider ropinirole administration if this happens.
• People who smoke may get less symptom relief from ropinirole because smoking increases the clearance of ropinirole.
• Sometimes irreversible fibrotic complications (such as thickening of the inner layers of the lungs and pericarditis) have been associated with ropinirole.
• May interact with several other drugs including estrogens, metoclopramide, and neuroleptics.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Ropinirole is used in the treatment of restless legs syndrome and Parkinson's disease; however, it may cause drowsiness which has caused some people to fall asleep while driving - do not drive if affected.

5. Tips

• May be taken with or without food. If you miss a dose, do not double up on the next dose.
• May cause drowsiness, which may affect your ability to drive or operate machinery. Avoid alcohol and do not drive or perform hazardous tasks if you are affected. Reports of spontaneous, excessive drowsiness have been reported, even in people who have been taking ropinirole for over a year.
• Usually taken three times daily.
• When used for PD symptoms, a low starting dose should be used and the dose titrated slowly.
• If taking ropinirole for restless legs syndrome (RLS), take it once daily, one to three hours before bed.
• Dispensing errors have occurred with ropinirole and other medications that have similar names, such as risperidone (an antipsychotic agent). Always check your medication and talk with your pharmacist if it looks different or if you have other concerns.
• Ensure you get regular skin checks while on ropinirole as there is a possibility of a higher risk of melanoma in people with PD.
• Early-morning rebound symptoms of RLS have been reported in people taking ropinirole for RLS. Tell your doctor if you experience any changes in your restless legs symptoms.
• Tell your doctor if you develop any unusual urges (for example, an urge to gamble, shop, spend money, or eat; or uncontrollable sexual urges).
• Tell your doctor if you develop any hallucinations or other psychotic-like symptoms, uncontrolled sudden movements, feel dizzy, faint, or fall asleep during normal activities.

6. Response and effectiveness

Peak concentrations of ropinirole are achieved within one to two hours, but it takes approximately two days of regular dosing to reach stable blood levels in the body.

7. Interactions

Medicines that interact with ropinirole may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with ropinirole. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with ropinirole include:

• amisulpride
• antidepressants, such as amitriptyline, fluoxetine, or citalopram
• antipsychotics, such as chlorpromazine, fluphenazine, thioridazine, risperidone, or trazodone
• blood pressure-lowering agents, such as atenolol, metoprolol, or enalapril
• broccoli
• bupropion
• cannabis
• ciprofloxacin
• duloxetine
• estrogen derivatives
• grapefruit juice
• metoclopramide
• other antiparkinson agents, such as bromopride and levodopa
• other medications that induce or inhibit CYP1A2, such as cimetidine, fluvoxamine, rifampin, and barbiturates
• phosphodiesterase-5-inhibitors, such as sildenafil
• tobacco
• warfarin.

Avoid drinking alcohol while taking ropinirole.

Note that this list is not all-inclusive and includes only common medications that may interact with ropinirole. You should refer to the prescribing information for ropinirole for a complete list of interactions.

References

• Ropinirole. Revised 07/2023. https://www.drugs.com/pro/ropinirole.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use ropinirole only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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