Ropinirole dosage, forms, and strengths

Ropinirole is a generic prescription drug that treats Parkinson’s disease and restless legs syndrome (RLS). It belongs to a family of drugs called dopamine agonists, that is, drugs that act like dopamine, a chemical that transmits signals between nerves. The symptoms of both Parkinson’s and RLS are related to low dopamine levels, so ropinirole activates dopamine receptors in place of dopamine. Dosages will depend on the formulation. Immediate-release tablets are taken three times daily while extended-release tablets are only taken once per day.

Ropinirole forms and strengths

People can take one of two ropinirole dosage forms: immediate-release or extended-release tablets. Extended-release tablets only treat Parkinson’s disease.

• Immediate-release tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg

• Extended-release tablets: 2 mg, 4 mg, 6 mg, 8 mg, 12 mg

Ropinirole dosage for adults

The Food and Drug Administration (FDA) has approved ropinirole to treat Parkinson’s disease and restless legs syndrome. The symptoms of both conditions are related to low dopamine levels. As a dopamine agonist, ropinirole acts like dopamine in the nervous system. In treating these conditions, physicians prescribe ropinirole as a day-long treatment for Parkinson’s but only prescribe ropinirole for bedtime use in people with RLS.

Not everyone can safely take ropinirole. Contraindications include alcohol abuse, liver failure, or known allergies to ropinirole.  

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Ropinirole dosage for Parkinson’s disease (PD)

Parkinson’s disease progressively reduces the brain’s production of dopamine. This chemical is an essential neurotransmitter that transmits signals from one nerve to another. It is vital for controlling muscle movement, mood, blood pressure, and the function of many of the body’s organs. When the disease starts, the first signs are usually problems with muscles and movement including slow movements, muscle stiffness, and tremor. People with Parkinson’s have other problems as well: heartbeat changes, blood pressure changes, depression, and hallucinations.

To treat movement problems, the first-line therapy is to use dopamine in the form of levodopa or carbidopa. First-line treatment includes drugs like ropinirole and pramipexole. Although they aren’t exactly dopamine, their mechanism of action in the nervous system is nearly identical to dopamine. They’re either added to levodopa/carbidopa therapy or used on their own for both early and advanced Parkinson’s disease.

For Parkinson’s, doses of ropinirole begin very small. The clinicians gradually increase the dose week after week until the most effective dose is reached. This titration process can take anywhere from a month to almost three months. Prescribers start with immediate-release ropinirole taken three times daily. At any time, the healthcare provider may switch to extended-release ropinirole for easier dosing.

• Standard adult dosage for Parkinson’s disease: 0.25–8 mg immediate-release tablets taken three times daily OR 2–24 mg extended-release tablets taken once daily

• Maximum adult dosage for Parkinson’s disease: 24 mg per day

Ropinirole dosage for restless legs syndrome (RLS)

Restless legs syndrome causes a strong urge to move the legs often accompanied by uncomfortable sensations or pain if the leg isn’t moved. Symptoms worsen when the legs are at rest and get better with activity. Symptoms are at their worst at night because dopamine levels significantly decrease after we fall asleep. 

Ropinirole acts like dopamine in the central nervous system. When an immediate-release ropinirole tablet is taken before bedtime, people get significant relief from the RLS symptoms at night. Although ropinirole is FDA approved to treat RLS, the American Academy of Sleep Medicine (AASM) recommends its use in people with moderate to severe RLS.

• Standard adult dosage for restless legs syndrome: 0.25–4 mg immediate-release tablets taken once daily 1–3 hours before bedtime

• Maximum adult dosage for restless legs syndrome: 4 mg daily

Ropinirole dosage for children

The FDA has not approved ropinirole for use in pediatric patients.

Ropinirole dosage restrictions

Dose reductions are reserved only for people with the most severe liver or kidney problems or who are on dialysis. Most other people don’t require dose adjustments.

• Patients with renal impairment (kidney disease): 

  • Mild to moderate renal impairment (creatinine clearance 30–89 mL/min): No dosage adjustment required

  • Severe renal impairment (end-stage renal disease): Initial dose of 0.25 mg once daily

  • Hemodialysis: Initial dose of 0.25 mg once daily

• Patients with hepatic impairment (liver disease): Initial doses are increased cautiously

• Patients with liver failure: Use with caution

Ropinirole dosage for pets 

Veterinarians use ropinirole eye drops in dogs to induce vomiting. Only veterinary professionals give this medicine. Anywhere from one drop to eight drops are used depending on the dog’s body weight. The dog usually begins to throw up about 10 minutes after the dose is administered. 

How to take ropinirole

Ropinirole tablets are easy to take but involve some special considerations. Most importantly, do not stop taking doses until speaking with the prescriber. You may experience serious withdrawal symptoms. If you do stop taking ropinirole, do not start again until talking to the prescriber. You may need to restart at the lowest possible dose. 

• Take this medication as directed.

• Doses will change in the first few weeks or months of treatment.

• Do not change the dose yourself. If treatment does not seem to be working, talk to the prescriber.

• Please read the Patient Information sheet included with the medicine.

• Take ropinirole tablets with or without food.

  • If the tablets bring on nausea, try taking ropinirole doses with food.

• Take immediate-release tablets three times daily.

  • If prescribed for restless legs syndrome, take the immediate-release dose before bedtime.

• Take extended-release tablets once daily.

  • Swallow the extended-release tablet whole without chewing, crushing, or breaking it.

• Store ropinirole tablets at room temperature protected from moisture and light.

Ropinirole dosage FAQs

Ropinirole vs. ropinirole XR/ER: What’s the difference in doses?

For Parkinson’s disease, the total daily target dose is the same whether people take immediate-release or extended-release ropinirole. The only difference involves how many times doses are taken each day. 

However, everyone will start therapy with immediate-release ropinirole at a low dose (0.25 mg three times daily). People are switched to extended-release only if they are currently taking immediate-release ropinirole. 

People with restless legs syndrome are not prescribed extended-release ropinirole.

How long does it take ropinirole to work?

For both Parkinson’s disease and restless legs syndrome, it takes several weeks of steadily increasing doses to reach an effective dose, sometimes as long as 10 weeks. In clinical trials, participants taking ropinirole experienced symptom improvement in the first 12 weeks. 

How long does ropinirole stay in your system?

With a half-life of six hours, ropinirole is usually cleared from the system in a little over a day.

What happens if I miss a dose of ropinirole?

Ask the prescriber what to do if a ropinirole dose is missed. Do not double the next dose to make up for the missed dose.

How long can you take ropinirole?

Ropinirole is a long-term treatment that can last for months, years, or even a lifetime. While there are no side effects specifically caused by long-term use, ropinirole does have serious side effects. The drug may need to be discontinued or the dose reduced if any of these side effects are experienced.

How do I stop taking ropinirole?

Do not stop taking ropinirole without first talking to the prescribing healthcare provider. The abrupt discontinuation of ropinirole can bring on withdrawal symptoms such as depression, anxiety, fatigue, trouble sleeping, sweating, pain, muscle stiffness, fever, and confusion. To avoid these problems, the prescriber will gradually reduce the dose over several weeks.

Although ropinirole is intended for long-term use, the prescriber may need to stop treatment if there are problems such as allergic reactions or severe side effects. The clinician may choose to use another dopamine agonist for Parkinson’s and restless leg syndrome.

What is the maximum dosage for ropinirole?

The maximum total daily dose of ropinirole is 24 mg daily. For restless legs syndrome, the maximum dose is 4 mg daily. Higher doses are not effective.

Can you overdose on ropinirole?

Immediately contact a poison helpline or go to an emergency room if too much ropinirole is taken. A ropinirole overdose can be fatal. 

Symptoms of an overdose include nausea, vomiting, dizziness, excessive sweating, involuntary movements, hallucinations, palpitations, coughing, chest pain, feeling weak, fatigue, fainting, nightmares, claustrophobia, and confusion.

What interacts with ropinirole?

To avoid possible drug interactions, tell the prescribing clinician about all the prescription drugs, over-the-counter medications, and supplements being taken, particularly:

• Fluoroquinolone antibiotics

• Antipsychotic medications or other dopamine inhibitors (dopamine antagonists) like metoclopramide

• Estrogens

• Fluvoxamine, mexiletine, omeprazole

Smoking can make ropinirole less effective, so get medical advice from the prescriber if you’re a smoker.

What happens when you mix ropinirole and alcohol?

Avoid alcohol when taking ropinirole; the combination could be deadly. Patients taking ropinirole should avoid alcohol consumption and inform their healthcare provider about any alcohol use. 

Is it safe to take ropinirole during pregnancy?

Ask the prescriber for medical advice if you get pregnant. Ropinirole can cause birth defects in animals but its effects on human pregnancy haven’t been studied.

Is it safe to take ropinirole while breastfeeding?

Although it hasn’t been studied in breastfeeding mothers, ropinirole theoretically could interfere with lactation. Women who are nursing a preterm or newborn infant may consider other treatment options.

What are the possible side effects of ropinirole?

The most common side effects of ropinirole are nausea, vomiting, drowsiness, somnolence, dizziness, feeling weak, feeling faint (syncope), abdominal pain, and dizziness.

What should I know before taking ropinirole?

The FDA advises healthcare professionals to explain all the risks of ropinirole before treatment begins. Patients should be aware of possible adverse reactions and call the prescriber if any of the symptoms of an adverse effect are experienced. 

People taking ropinirole may experience serious problems such as:

• Falling asleep or sudden daytime sleepiness while doing normal activities of daily living

• Passing out or feeling faint, especially when standing up (orthostatic hypotension)

• Involuntary movements (dyskinesia)

• Psychotic symptoms, including hallucinations, delusions, paranoia, confusion, and disorganized thinking

• Loss of impulse control, unusual urges, or compulsive behaviors like gambling, sex, binge eating, or spending money

• Low blood pressure

• Slow or fast heart rate

• Allergic reactions

The symptoms of restless leg syndrome may get worse when ropinirole therapy is first started.

Sources

• Clevor ropinirole hydrochloride solution animal drug information, DailyMed (NIH National Library of Medicine)

• Requip XL drug summary, Prescriber’s Digital Reference (PDR)

• Ropinirole, StatPearls

• Ropinirole tablet prescribing information, DailyMed (NIH National Library of Medicine)

• Ropinirole extended-release tablet prescribing information, DailyMed (NIH National Library of Medicine)

• The treatment of restless legs syndrome and periodic limb movement disorder in adults, Sleep