Formulary
Ropinirole: Indications, Dosing, Side Effects and Interactions
Ropinirole clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Ropinirole: Indications, Dosing, Side Effects and Interactions
Ropinirole clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Parkinson's disease, either used alone or as adjunct to co-beneldopa or co-careldopa**
- **Adult** (By Mouth Using Immediate-Release Medicines): Initially 750 micrograms daily in 3 divided doses, then increased in steps of 750 micrograms daily, dose to be increased at weekly intervals, increased to 3 mg daily in 3 divided doses, then increased in steps of 1.5-3 mg daily, adjusted according to response, dose to be increased at weekly intervals; usual dose 9-16 mg daily in 3 divided doses, higher doses may be required if used with levodopa, when administered as adjunct to levodopa, concurrent dose of levodopa may be reduced by approx. 20%, daily maximum dose to be given in 3 divided doses; maximum 24 mg per day.
- **Adult** (By Mouth Using Modified-Release Medicines): Initially 2 mg once daily for 1 week, then 4 mg once daily, increased in steps of 2 mg at intervals of at least 1 week, adjusted according to response, increased to up to 8 mg once daily, dose to be increased further if still no response; increased in steps of 2-4 mg at intervals of at least 2 weeks if required, consider slower titration in patients over 75 years, when administered as adjunct to levodopa, concurrent dose of levodopa may gradually be reduced by approx. 30%; maximum 24 mg per day.
**Parkinson's disease in patients transferring from ropinirole immediate-release tablets**
- **Adult** (By Mouth Using Modified-Release Medicines): Initially ropinirole modified-release once daily substituted for total daily dose equivalent of ropinirole immediate-release tablets; if control not maintained after switching, titrate dose as above.
**Moderate to severe restless legs syndrome**
- **Adult** (By Mouth Using Immediate-Release Medicines): Initially 250 micrograms once daily for 2 days, increased if tolerated to 500 micrograms once daily for 5 days, then increased if tolerated to 1 mg once daily for 7 days, then increased in steps of 500 micrograms daily, adjusted according to response, dose to be increased at weekly intervals; usual dose 2 mg once daily, doses to be taken at night; maximum 4 mg per day.
Cautions
Elderly; major psychotic disorders; severe cardiovascular disease (risk of hypotension-monitor blood pressure)
Side effects
Common or very common Confusion; dizziness; drowsiness; early morning awakening; fatigue; gastrointestinal discomfort; hallucination; movement disorders; nausea; nervousness; peripheral oedema; syncope; vertigo; vomiting Uncommon Hypotension; sexual dysfunction; sudden onset of sleep Rare or very rare Hepatic reaction Frequency not known Behaviour abnormal; compulsions; delirium; delusions; dopamine dysregulation syndrome; eating disorders; pathological gambling; psychotic disorder
Interactions
**Other interactions (10):**
- There is no pharmacokinetic interaction between ropinirole and L-dopa or domperidone which would necessitate dosage adjustment of these drugs.
- Neuroleptics and other centrally active dopamine antagonists, such as sulpiride or metoclopramide, may diminish the effectiveness of ropinirole and therefore, concomitant use of these medicinal...
- Ropinirole is principally metabolised by the cytochrome P450 enzyme CYP1A2.
- A pharmacokinetic study (with a ropinirole film-coated (immediate-release) tablet dose of 2 mg, three times a day) in Parkinson's disease patients, revealed that ciprofloxacin increased the C max...
- Hence, in patients already receiving ropinirole, the dose of ropinirole may need to be adjusted when medicinal products know to inhibit CYP1A2, e.g.
- A pharmacokinetic interaction study in patients with Parkinson's disease between ropinirole (with a ropinirole film-coated (immediate-release) tablet dose of 2 mg, three times a day) and...
Pregnancy
Avoid unless potential benefit outweighs risk-toxicity in animal studies.
Breast feeding
May suppress lactation-avoid.
Hepatic impairment
When used for Parkinson's disease: Manufacturer advises avoid (no information available). When used for Restless legs syndrome: Manufacturer advises caution in moderate impairment; avoid in severe impairment.
Renal impairment
Avoid if creatinine clearance less than 30 mL/minute (no information available). M See Prescribing in renal impairment .
Medicinal forms
Solution,Tablet,Tablet
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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