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Dopamine Agonist — Parkinson's Disease Pregnancy: Avoid — limited data; levodopa preferred if treatment essential

Ropinirole

Brand names: Requip, Requip XL

Adult dose

Dose: Immediate-release: start 0.25 mg three times daily, titrate to 3–9 mg TDS; XL: start 2 mg once daily, titrate to 8–24 mg once daily
Route: Oral
Frequency: Three times daily (IR) or once daily (XL)
Max: 24 mg/day
Non-ergot dopamine agonist — preferred over ergot-derived agonists (bromocriptine, cabergoline) due to better safety profile (no fibrosis risk). Used as monotherapy in early Parkinson's or adjunct to levodopa. Also licensed for restless legs syndrome (RLS) at lower doses.

Paediatric dose

Route:
Seek specialist opinion — not licensed in children.

Dose adjustments

Renal

No dose adjustment if eGFR >30. Avoid in severe renal impairment.

Hepatic

Caution — titrate slowly in hepatic impairment.

Clinical pearls

  • MHRA/EMA warning: impulse control disorders (ICD) occur in up to 17% of dopamine agonist users — screen at every visit using the Questionnaire for Impulsive-Compulsive Disorders in PD (QUIP). Reduce or stop agonist if ICD develops.
  • Sudden sleep onset ('sleep attacks') — advise patients not to drive until established on therapy and effects known
  • Domperidone (not metoclopramide — which crosses blood-brain barrier) used to manage nausea in early dopamine agonist therapy

Contraindications

  • Hypersensitivity to ropinirole
  • Severe hepatic impairment

Side effects

  • Impulse control disorders (ICD — gambling, hypersexuality, compulsive eating/shopping)
  • Nausea and vomiting (especially early)
  • Somnolence and sudden sleep onset
  • Postural hypotension
  • Hallucinations
  • Peripheral oedema

Interactions

  • Antipsychotics (dopamine antagonism — reduce ropinirole efficacy)
  • Ciprofloxacin (CYP1A2 inhibition — increases ropinirole levels; reduce dose by 50%)
  • HRT/oestrogen (increases ropinirole levels)

Monitoring

  • ICD screening (QUIP questionnaire)
  • Blood pressure (postural)
  • Sleep assessment
  • Cardiac monitoring (echocardiogram annually in ergot agonists — not needed for ropinirole)

Reference: BNFc; BNF 90; NICE NG71 (Parkinson's Disease); MHRA ICD Warning; BNFc. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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