Ropinirole

Background
1. Maximum benefit at 12 mg/day in early Parkinsonism, 8 mg/day in late Parkinsonism
Immediate Release
1. Start 0.25 mg orally three times daily
2. Titrate up by 0.25 mg/dose each week over first month to 1 mg orally three times daily
3. Above 3 mg/day, titrate as needed (1.5 mg/day each week) up to 9 mg/day
4. Above 9 mg/day, titrate as needed (3 mg/day each week) up to 24 mg/day
5. Maximum: 24 mg/day (18 mg/day if on Hemodialysis)
Extended Release
1. Start 2 mg orally daily for the first 1 to 2 weeks
2. May increase by 2 mg/dose each week as needed
3. Maximum: 24 mg/day (18 mg/day if on Hemodialysis)

Start: Requip 0.25 mg orally taken 2-3 hours before bedtime
Interval for increasing dose: 3-7 days
Titrating dose: Increase at set interval as above by one tablet if ineffective at current dose
1. Start at 0.25 mg one tablet nightly for set interval in days
2. Increase to two tablets (0.50 mg) nightly for set interval if ineffective at 0.25 mg
3. Increase to three tablets (0.75 mg) nightly for set interval if ineffective at 0.50 mg
Maximum dose: 6 tablets (1.5 mg) taken at bedtime
Stopping: Taper off when stopping

Avoid in pregnancy
Unknown safety in Lactation
Nausea (common)
Drowsiness (Limited to higher dosages)
1. May be sudden, severe without warning
2. May occur up to one year after starting Mirapex
3. Has resulted in falling asleep while driving
Augmentation of Restless Leg Symptoms
1. Occurs in 25% of RLS patients on longterm therapy
2. May progress in severity, and involve arms, trunk
3. Often better if dose timing changed to earlier in day
4. May be worse if dose increased
Other uncommon adverse effects (rare at low dose)
1. Hallucinations
2. Pathologic Gambling (related to Dopamine receptor Agonist activity, D3)
3. Orthostatic Hypotension
4. Hypersexuality