Requip







Overview

Requip, generically known as ropinirole, is a dopamine agonist used to treat Parkinson’s disease and Restless Legs Syndrome (RLS). By mimicking dopamine in the brain, it helps control movement and relieve symptoms. Available in immediate-release and extended-release tablets, Requip accommodates diverse patient needs.

History of Development and Approval

Developed by GlaxoSmithKline, Requip was approved by the FDA in 1997 for Parkinson’s disease and later for RLS in 2005. Its efficacy and safety, validated through clinical trials, have established it as a key treatment for both conditions.

Key Benefits

  • Symptom Relief: Reduces tremors, stiffness, and movement difficulties in Parkinson’s; alleviates leg discomfort in RLS.
  • Convenient Dosing: Extended-release form allows once-daily administration.
  • Improved Quality of Life: Enhances mobility and sleep for better daily functioning.
  • Targeted Action: Acts on dopamine receptors with fewer side effects than some alternatives.

Unique Properties

Requip’s selective dopamine receptor agonism provides effective symptom control with a favorable side effect profile. Its extended-release formulation simplifies dosing, enhancing adherence, particularly for RLS patients needing nighttime relief.

Comparison with Similar Medications

Compared to other dopamine agonists, Requip offers:

  • Dual Indications: Effective for both Parkinson’s and RLS, unlike some single-indication drugs.
  • Extended-Release Option: Simplifies dosing compared to multiple daily doses of alternatives like pramipexole.
  • Rapid Efficacy: Faster symptom relief for RLS compared to non-dopaminergic treatments.

Safety and Tolerability

Requip is generally well-tolerated, with common side effects including nausea, dizziness, and sleepiness, often subsiding over time. Rare serious effects, such as hallucinations or sudden sleep onset, require monitoring. Gradual dose titration and regular healthcare provider oversight minimize risks.

Indications for Use

Requip is indicated for:

  • Parkinson’s Disease: Manages tremors, rigidity, and bradykinesia.
  • Restless Legs Syndrome: Reduces urge to move legs, especially during rest or sleep.

Dosage and Administration

Adults (Parkinson’s): Start 0.25 mg 3 times daily, titrate to 3–24 mg/day. Extended-release: 2–24 mg once daily.
Adults (RLS): Start 0.25 mg once daily 1–3 hours before bedtime, titrate to 1–4 mg/day.
Children: Not indicated.
Elderly: Start low, titrate cautiously.
Timing: With/without food; RLS dose in evening.
Notes: Gradual titration reduces side effects; do not stop abruptly.

Mechanism of Action

Ropinirole acts as a dopamine D2/D3 receptor agonist, stimulating dopamine pathways in the brain to improve motor control in Parkinson’s and reduce sensory disturbances in RLS.

Composition

Active Ingredient: Ropinirole, drives dopamine agonism.
Inactive Ingredients: Lactose, microcrystalline cellulose, magnesium stearate for tablet stability.

Side Effects

Common: Nausea, dizziness, somnolence, fatigue.
Rare: Orthostatic hypotension, compulsive behaviors.
Serious: Hallucinations, sudden sleep onset require urgent care.

Prevention of Side Effects

Start with low dose, titrate slowly, avoid alcohol, monitor for compulsive behaviors or sleepiness. Report serious symptoms promptly.

Contraindications

Avoid in hypersensitivity to ropinirole; caution in severe cardiovascular disease or psychosis.

Warnings and Precautions

Monitor for sudden sleep onset, hallucinations, or compulsive behaviors. Caution in patients with hypotension or psychiatric history.

Drug Interactions

CYP1A2 inhibitors (e.g., ciprofloxacin) increase ropinirole levels; dopamine antagonists (e.g., antipsychotics) reduce efficacy. Disclose all medications.

Overdose

Symptoms: nausea, confusion, hallucinations. Seek emergency care immediately.

Pharmacokinetics

Absorption: Rapid, peak 1–2 hours (immediate-release).
Distribution: Moderately protein-bound.
Metabolism: Liver via CYP1A2.
Elimination: Urine; half-life 6 hours.

Dosage Forms

Immediate-release tablets (0.25, 0.5, 1, 2, 3, 4, 5 mg), extended-release tablets (2, 4, 6, 8, 12 mg) for flexible administration.

Pregnancy and Breastfeeding

Use if benefits outweigh risks (Category C); limited data on breastfeeding, consult provider.

Storage

Store at 20°C–25°C (68°F–77°F), dry, light-protected, away from children. Dispose expired properly.

Clinical Evidence

Trials confirm Requip’s efficacy in reducing Parkinson’s motor symptoms and RLS discomfort, improving quality of life with sustained benefits.

Conclusion

Requip is an effective dopamine agonist for Parkinson’s disease and RLS, offering symptom relief and convenient dosing. Adhere to prescribed regimens, monitor side effects, and consult providers for optimal outcomes.