Requip: Restoring Movement Control in Parkinson's Disease
Requip
| Product dosage: 0.25mg | |||
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| Product dosage: 0.5mg | |||
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| Product dosage: 1mg | |||
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| Product dosage: 2mg | |||
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Synonyms | |||
Requip (ropinirole hydrochloride) is a dopamine agonist medication specifically formulated to address the motor symptoms of Parkinson’s disease and restless legs syndrome. As a non-ergot derivative, it mimics the action of dopamine in the brain, helping to improve motor control, reduce tremors, and alleviate stiffness. Clinical studies demonstrate its efficacy in both early and advanced Parkinson’s cases, often as monotherapy or in combination with levodopa. Its targeted mechanism offers neurologists a valuable tool for managing progressive neurological symptoms while potentially delaying the need for levodopa therapy in early-stage patients.
Features
- Contains ropinirole hydrochloride as active pharmaceutical ingredient
- Available in 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, and 5 mg tablet strengths
- Film-coated tablets for ease of swallowing
- Immediate-release formulation for rapid onset of action
- Manufactured under strict pharmaceutical quality control standards
- Bioavailability of approximately 55% following oral administration
- Peak plasma concentration reached within 1-2 hours post-administration
- Extensive hepatic metabolism primarily via CYP1A2 isoenzyme
Benefits
- Significantly improves motor function scores in Parkinson’s disease patients
- Reduces “off” time and improves “on” time in advanced Parkinson’s disease
- Alleviates symptoms of moderate-to-severe restless legs syndrome
- May allow for lower levodopa doses when used in combination therapy
- Demonstrates efficacy in improving activities of daily living
- Non-ergot structure reduces risk of fibrotic reactions associated with ergot derivatives
Common use
Requip is primarily indicated for the treatment of Parkinson’s disease, both as monotherapy in early disease and as adjunct therapy to levodopa in advanced stages. It effectively addresses cardinal motor symptoms including bradykinesia, rigidity, resting tremor, and postural instability. Additionally, it is FDA-approved for management of moderate-to-severe primary restless legs syndrome (RLS), significantly reducing sensory symptoms and motor restlessness. Off-label uses may include treatment of periodic limb movement disorder and augmentation strategies in RLS patients who have failed first-line therapies.
Dosage and direction
Parkinson’s Disease: Initiate at 0.25 mg three times daily. Titrate gradually based on therapeutic response and tolerability. Week 1: 0.25 mg three times daily; Week 2: 0.5 mg three times daily; Week 3: 0.75 mg three times daily; Week 4: 1 mg three times daily. After week 4, may increase by 1.5 mg per day weekly up to 9 mg/day, then by 3 mg/day weekly to maximum 24 mg/day. Maintenance dose typically ranges from 3-9 mg daily in divided doses.
Restless Legs Syndrome: Initiate at 0.25 mg once daily 1-3 hours before bedtime. May increase to 0.5 mg daily after 2 days, then to 1 mg daily after 7 days. May further increase to 2 mg daily after 7 days, then to 3 mg daily after 7 days, and to 4 mg daily after 7 days. Maximum recommended dose: 4 mg daily.
Administer with food to reduce potential nausea. Tablets should be swallowed whole with water; do not crush or chew.
Precautions
Exercise caution when prescribing to patients with cardiovascular disease, particularly those with hypotension or syncopal episodes. Monitor for signs of somnolence and sudden sleep onset episodes, which may occur without warning. Use cautiously in patients with hepatic impairment due to extensive hepatic metabolism. Psychiatric monitoring is recommended as dopamine agonists may exacerbate or cause impulse control disorders including pathological gambling, hypersexuality, and compulsive shopping. Regular skin examinations advised due to potential increased melanoma risk. Orthostatic hypotension may occur, particularly during dose escalation. Elderly patients may experience enhanced sensitivity to side effects.
Contraindications
Hypersensitivity to ropinirole or any component of the formulation. Concomitant use with fluvoxamine or other potent CYP1A2 inhibitors due to significantly increased ropinirole exposure. Severe hepatic impairment (Child-Pugh Class C). History of psychotic episodes, as dopamine agonists may exacerbate psychosis. Not recommended during pregnancy unless potential benefit justifies potential risk to fetus. Avoid use in patients with history of melanoma or undiagnosed skin lesions.
Possible side effect
Very common (>10%): Nausea, dizziness, somnolence, headache Common (1-10%): Syncope, vomiting, fatigue, dyspepsia, abdominal pain, constipation, orthostatic hypotension, edema, hallucinations, confusion, impulse control disorders Uncommon (0.1-1%): Bradycardia, atrial fibrillation, hypertension, nightmares, paranoia, libido disorders Rare (<0.1%): Hepatic enzyme abnormalities, hypersexuality, pathological gambling, compulsive shopping, sudden sleep onset episodes Frequency not known: Melanoma, neuroleptic malignant syndrome (upon withdrawal), fibrotic complications
Drug interaction
CYP1A2 inhibitors: Fluvoxamine significantly increases ropinirole exposure (contraindicated). Ciprofloxacin may increase levels—monitor and adjust dose. Dopamine antagonists: Neuroleptics (haloperidol, phenothiazines) and metoclopramide may diminish efficacy. Estrogens: May decrease ropinirole clearance—consider dose adjustment. Sedatives: Alcohol, benzodiazepines, and other CNS depressants may enhance sedative effects. Levodopa: Coadministration may increase levodopa bioavailability—may require levodopa dose reduction. Smoking: May increase clearance due to CYP1A2 induction—monitor efficacy.
Missed dose
If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose to make up for a missed dose. For the bedtime dose in restless legs syndrome, if missed, take only if several hours remain before waking. Consistent daily administration is crucial for maintaining stable plasma concentrations and symptom control.
Overdose
Symptoms may include nausea, vomiting, dizziness, visual hallucinations, hyperhidrosis, claustrophobia, chorea, palpitations, orthostatic hypotension, and syncope. General supportive measures are recommended including cardiac monitoring and symptomatic treatment. Vital signs should be monitored continuously. Consider gastric lavage if presented early. Dialysis is unlikely to be beneficial due to extensive protein binding. There is no specific antidote; manage symptoms appropriately with antiemetics for nausea/vomiting and vasopressors for hypotension if needed.
Storage
Store at 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F). Keep container tightly closed and protect from light and moisture. Keep out of reach of children and pets. Do not use after expiration date printed on packaging. Do not transfer tablets to other containers as this may affect stability. Discard any medication that appears discolored or shows signs of degradation.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Individual response to medication may vary. Always consult with a qualified healthcare professional before starting, changing, or stopping any medication. The prescribing physician should be aware of the complete medical history of the patient before initiating therapy. Dosage adjustments should only be made under medical supervision. Patients should report any unusual symptoms or side effects to their healthcare provider immediately.
Reviews
Clinical studies demonstrate: In randomized controlled trials, Requip showed significant improvement in UPDRS scores compared to placebo (mean difference: -4.5 points, p<0.001). For restless legs syndrome, 73% of patients reported much or very much improvement versus 51% with placebo (p<0.01).
Neurologist feedback: “Requip remains a valuable option in our Parkinson’s armamentarium, particularly for younger patients where we want to delay levodopa initiation. The titration requires patience but often yields good motor control with acceptable side effect profile.”
Patient reports: Many users report significant improvement in mobility and reduction in tremor severity. Some note initial nausea that often resolves with continued use. Several patients mention improved sleep quality when used for RLS. Concerns occasionally raised about daytime sleepiness and impulse control issues.
Long-term data: Studies following patients for 5 years show maintained efficacy in motor symptom control, though some require supplemental levodopa over time. Augmentation in RLS patients occurs in approximately 5-8% annually with higher doses.