Dopamine Agonist — Parkinson's Disease Pregnancy: There are no adequate data in pregnant women and animal studies have shown reproductive toxicity; ropinirole is not recommended during pregnancy unless the potential benefit to the patient outweighs the potential risk to the foetus. Ropinirole should not be used in nursing mothers as it may inhibit lactation.

Ropinirole

Brand names: Requip, Requip XL

Ropinirole is a dopamine agonist used in Parkinson's disease and for moderate-to-severe restless legs syndrome.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Parkinson's disease (immediate-release tablets): 0.25 mg three times daily for 1 week, then increase in 0.25 mg three-times-daily increments each week (week 2: 0.5 mg tds = 1.5 mg/day; week 3: 0.75 mg tds = 2.25 mg/day; week 4: 1 mg tds = 3 mg/day). After the initial titration, weekly increments of 0.5 to 1 mg three times daily (1.5 to 3 mg/day) may be given; a therapeutic response may be seen between 3 and 9 mg/day

Route: Oral — preferably with meals to improve gastrointestinal tolerance

Frequency: Three times daily for Parkinson's disease; once daily just before bedtime (or up to 3 hours before retiring) for Restless Legs Syndrome

Max: Parkinson's disease: up to 24 mg/day if symptomatic control is not achieved or maintained (doses above 24 mg/day have not been studied). Restless Legs Syndrome: maximum 4 mg once a day (doses above 4 mg once daily have not been investigated)

Individual dose titration against efficacy and tolerability is recommended for both indications. RESTLESS LEGS SYNDROME regimen: week 1 — 0.25 mg once daily for 2 days, then, if well tolerated, 0.5 mg once daily for the remainder of week 1; week 2 — increase to 1 mg once daily; then increase by 0.5 mg per week over the next two weeks to 2 mg once a day (the average dose in moderate-to-severe RLS trials was 2 mg once a day). In some patients the dose may be increased gradually up to a maximum of 4 mg once a day (trial titration: 0.5 mg weekly to 3 mg once daily, then by 1 mg to 4 mg once daily). Efficacy in RLS has not been shown beyond 12 weeks — evaluate response at 12 weeks and reconsider the need to continue. Interruption: if treatment is interrupted for one day or more (Parkinson's disease) or for more than a few days (RLS), re-initiate by dose titration. Discontinuation: as with other dopamine agonists, discontinue gradually by reducing the number of daily doses over one week. Adjunct to levodopa: the concurrent levodopa dose may be reduced gradually according to symptomatic response — in clinical trials it was reduced by around 20%; reducing levodopa may ameliorate dyskinesia occurring during ropinirole titration. Switching from another dopamine agonist: follow the other product's marketing authorisation holder guidance on discontinuation before initiating ropinirole. Elderly: clearance is decreased by approximately 15% in patients aged 65 or above; no dose adjustment is required but titrate individually with careful monitoring of tolerability. Paediatric: not recommended for use in children below 18 years of age due to a lack of data on safety and efficacy.

Dose adjustments

Renal

No dosage adjustment is necessary in mild to moderate renal impairment (creatinine clearance 30–50 mL/min). End-stage renal disease on haemodialysis: initiate 0.25 mg once daily (Restless Legs Syndrome) or 0.25 mg three times a day (Parkinson's disease), escalate on tolerability and efficacy, with a recommended maximum of 3 mg/day for RLS and 18 mg/day for Parkinson's disease; supplemental doses after haemodialysis are not required. Use in severe renal impairment (creatinine clearance <30 mL/min) without regular haemodialysis has not been studied and is contraindicated.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

· Ropinirole tablets can be taken with or without food. (2.1) · Retitration of ropinirole tablets may be warranted if therapy is interrupted. (2.1) Parkinson’s Disease: · The recommended starting dose is 0.25 mg taken three times daily; titrate to a maximum daily dose of 24 mg. (2.2) · Renal Impairment: The maximum recommended dose is 18 mg/day in patients with end-stage renal disease on hemodialysis. (2.2) Restless Legs Syndrome: · The recommended starting dose is 0.25 mg once daily, 1 to 3 hours before bedtime, titrate to a maximum recommended dose of 4 mg daily. (2.3) · Renal Impairment: The maximum recommended dose is 3 mg/day in patients with end-stage renal disease on hemodialysis. …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2024-10-07. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Severe renal impairment (creatinine clearance <30 mL/min) without regular haemodialysis
Severe hepatic impairment

Side effects

Somnolence (very common); sudden onset of sleep and excessive daytime somnolence (uncommon) — patients must be warned about driving and operating machinery
Nausea (very common); heartburn (common); vomiting and abdominal pain (common in monotherapy studies)
Syncope (very common in monotherapy studies); postural hypotension and hypotension (uncommon); dizziness including vertigo (common)
Dyskinesia (very common in adjunct-to-levodopa studies); hallucinations (common); psychotic reactions including delirium, delusion and paranoia (uncommon)
Impulse control disorders (pathological gambling, increased libido, hypersexuality, aggression, compulsive spending or buying, binge eating, compulsive eating), mania, and dopamine agonist withdrawal syndrome on tapering or discontinuation (frequency not known)

Interactions

Levodopa — when ropinirole is added as adjunct therapy the levodopa dose may need gradual reduction (around 20% in clinical trials); reducing levodopa may ameliorate dyskinesia (eMC §4.2)
CYP1A2 inhibitors (e.g. ciprofloxacin, which increases ropinirole AUC and Cmax) — may reduce ropinirole clearance; ropinirole dose adjustment may be required if such a drug is started or stopped [US label §7.1]
CYP1A2 inducers, including cigarette smoking — expected to increase ropinirole clearance; dose adjustment may be required if started or stopped [US label §7.1]
Oestrogens / hormone replacement therapy — higher oestrogen doses reduce ropinirole clearance; starting or stopping HRT may require a ropinirole dose adjustment [US label §7.2]
Dopamine antagonists (e.g. neuroleptics, metoclopramide) — may reduce the efficacy of ropinirole [US label §7.3]. Note: §4.5 of the UK SPC was not captured in the fetched text — check the UK SPC

Clinical monograph

How it works

It is a non-ergot dopamine (D2/D3) receptor agonist that stimulates dopamine receptors in the brain.

Prescribing in practice

Impulse-control disorders (pathological gambling, hypersexuality, compulsive shopping or eating) and sudden onset of sleep can occur — counsel patients and families and ask about them.
Nausea, hypotension and hallucinations occur; titrate slowly and do not stop abruptly.
In restless legs syndrome, long-term use can cause augmentation (symptoms becoming worse or earlier).

Monitoring

Ask specifically about impulse-control behaviours and daytime sleepiness; review motor or restless-legs benefit.

Counselling the patient

Tell us about any new urges to gamble, shop or other compulsive behaviour — they can be caused by this drug.
It can cause sudden sleepiness — be cautious driving.
Do not stop it suddenly.

Evidence & guidelines

Used in Parkinson's disease and restless legs syndrome (NICE NG71), with important counselling on impulse-control disorders.

Reference: NICE NG71 (Parkinson's Disease); MHRA ICD Warning; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways