ropinirole (Rx)

Brand and Other Names:Requip, Requip XL
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 0.25mg
  • 0.5mg
  • 1mg
  • 2mg
  • 3mg
  • 4mg
  • 5mg

tablet, extended release

  • 2mg
  • 4mg
  • 6mg
  • 8mg
  • 12mg

Parkinson Disease

Immediate release

  • 0.25 mg PO q8hr for 1 week initially, then increased weekly by 0.25 mg q8hr; if necessary, after week 4, may be increased weekly by 1.5 mg/day up to 9 mg/day, then increased weekly by 3 mg/day up to 24 mg/day
  • See Administration for discontinuation instructions

Extended release

  • 2 mg/day PO initially for 1-2 weeks; increased by 2 mg/day at intervals >1 week; not to exceed 24 mg/day
  • See Administration for discontinuation instructions
  • Maximum dose
    • Although the maximum recommended is 24 mg/day, patients with advanced Parkinson disease should generally be maintained at lower doses
    • In fixed-dose studies designed to characterize dose-response, no additional therapeutic benefit was shown in advanced stage Parkinson disease with doses >8 mg/day or with early stage Parkinson disease with doses >12 mg/day
    • Early Parkinson disease: ≤12 mg/day
    • Advanced Parkinson disease: ≤8 mg/day

Restless Leg Syndrome (Moderate-Severe)

Immediate release: 0.25 mg/day PO 1-3 hr before bedtime; after day 2, may be increased to 0.5 mg/day PO; at end of week 1, increased to 1 mg/day, then increased weekly by 0.5 mg/day up to 4 mg/day

See Administration for discontinuation instructions

Dosage Modifications

Renal impairment

  • CrCl 30-50 mL/min: Dose adjustment not necessary
  • CrCl <30 mL/min: Safety and efficacy not established; use with caution; use of ropinirole XL not studied
  • End-stage renal disease on hemodialysis: Maximum recommended dose is 18 mg/day in Parkinson disease and 3 mg/day in restless legs syndrome

Hepatic impairment

  • Safety and efficacy not established; use with caution

Safety and efficacy not established

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Interactions

Interaction Checker

and ropinirole

No Results

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (26)

              • abametapir

                abametapir will increase the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP1A2 substrates. If not feasible, avoid use of abametapir.

              • aripiprazole

                aripiprazole decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • chlorpromazine

                chlorpromazine decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • clozapine

                clozapine decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • droperidol

                droperidol decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • fluphenazine

                fluphenazine decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • fluvoxamine

                fluvoxamine will increase the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • givosiran

                givosiran will increase the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP1A2 substrates with givosiran. If unavoidable, decrease the CYP1A2 substrate dosage in accordance with approved product labeling.

              • haloperidol

                haloperidol decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • iloperidone

                iloperidone decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • loxapine

                loxapine decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • loxapine inhaled

                loxapine inhaled decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • metoclopramide

                metoclopramide decreases levels of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • metoclopramide intranasal

                ropinirole, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

                metoclopramide intranasal, ropinirole. dopaminergic effects. Avoid or Use Alternate Drug. Opposing effects of metoclopramide and the interacting drug on dopamine. Potential exacerbation of symptoms (eg, parkinsonian symptoms) or decreased therapeutic effects of metoclopramide.

              • olanzapine

                olanzapine decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • paliperidone

                paliperidone decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • perphenazine

                perphenazine decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • pimozide

                pimozide decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • prochlorperazine

                prochlorperazine decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • promethazine

                promethazine decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • quetiapine

                quetiapine decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • risperidone

                risperidone decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • thioridazine

                thioridazine decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • thiothixene

                thiothixene decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • trifluoperazine

                trifluoperazine decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • ziprasidone

                ziprasidone decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              Monitor Closely (39)

              • apomorphine

                apomorphine and ropinirole both increase dopaminergic effects. Use Caution/Monitor.

              • bromocriptine

                bromocriptine and ropinirole both increase dopaminergic effects. Use Caution/Monitor. Combining drugs may be therapeutic in patients with Parkinsonism.

              • cabergoline

                cabergoline and ropinirole both increase dopaminergic effects. Use Caution/Monitor.

              • cannabidiol

                cannabidiol, ropinirole. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Owing to the potential for both CYP1A2 induction and inhibition with the coadministration of CYP1A2 substrates and cannabidiol, consider reducing dosage adjustment of CYP1A2 substrates as clinically appropriate.

              • captopril

                ropinirole, captopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.

              • carbamazepine

                carbamazepine will decrease the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • cenobamate

                cenobamate, ropinirole. Either increases effects of the other by sedation. Use Caution/Monitor.

              • cigarette smoking

                cigarette smoking will decrease the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • cimetidine

                cimetidine will increase the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • ciprofloxacin

                ciprofloxacin will increase the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Ciprofloxacin may decrease the metabolism of ropinirole; monitor for increased effects of ropinirole.

              • clobazam

                ropinirole, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

              • clonidine

                clonidine, ropinirole. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration enhances CNS depressant effects.

              • deferasirox

                deferasirox increases levels of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • dichlorphenamide

                dichlorphenamide and ropinirole both decrease serum potassium. Use Caution/Monitor.

              • erythromycin base

                erythromycin base will increase the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • erythromycin ethylsuccinate

                erythromycin ethylsuccinate will increase the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • erythromycin lactobionate

                erythromycin lactobionate will increase the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • erythromycin stearate

                erythromycin stearate will increase the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • ethinylestradiol

                ethinylestradiol will increase the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

                ethinylestradiol increases levels of ropinirole by unspecified interaction mechanism. Use Caution/Monitor.

              • fexinidazole

                fexinidazole will increase the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • isoniazid

                isoniazid will increase the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • levodopa

                levodopa and ropinirole both increase dopaminergic effects. Use Caution/Monitor.

              • lurasidone

                lurasidone decreases effects of ropinirole by Other (see comment). Use Caution/Monitor. Comment: Antipsychotics may diminish the therapeutic effect of anti-parkinson's agents.

              • methyldopa

                methyldopa and ropinirole both increase dopaminergic effects. Use Caution/Monitor.

              • methylphenidate

                ropinirole, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive CNS stimulation.

              • mexiletine

                mexiletine will increase the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • midazolam intranasal

                midazolam intranasal, ropinirole. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

              • peginterferon alfa 2a

                peginterferon alfa 2a will increase the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • phenobarbital

                phenobarbital will decrease the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • pramipexole

                pramipexole and ropinirole both increase dopaminergic effects. Use Caution/Monitor.

              • primidone

                primidone will decrease the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • rifampin

                rifampin will decrease the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • rucaparib

                rucaparib will increase the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP1A2 substrates, if clinically indicated.

              • smoking

                smoking will decrease the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • solriamfetol

                ropinirole and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • stiripentol

                stiripentol, ropinirole. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP1A2 inhibitor and inducer. Monitor CYP1A2 substrates coadministered with stiripentol for increased or decreased effects. CYP1A2 substrates may require dosage adjustment.

                stiripentol, ropinirole. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

              • teriflunomide

                teriflunomide decreases levels of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • tobacco use

                tobacco use will decrease the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • zileuton

                zileuton will increase the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              Minor (8)

              • bazedoxifene/conjugated estrogens

                bazedoxifene/conjugated estrogens increases levels of ropinirole by unspecified interaction mechanism. Minor/Significance Unknown.

              • benazepril

                ropinirole, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

              • conjugated estrogens

                conjugated estrogens increases levels of ropinirole by unspecified interaction mechanism. Minor/Significance Unknown.

              • conjugated estrogens, vaginal

                conjugated estrogens, vaginal increases levels of ropinirole by unspecified interaction mechanism. Minor/Significance Unknown.

              • estradiol

                estradiol increases levels of ropinirole by unspecified interaction mechanism. Minor/Significance Unknown.

              • estrogens conjugated synthetic

                estrogens conjugated synthetic increases levels of ropinirole by unspecified interaction mechanism. Minor/Significance Unknown.

              • estropipate

                estropipate increases levels of ropinirole by unspecified interaction mechanism. Minor/Significance Unknown.

              • mestranol

                mestranol increases levels of ropinirole by unspecified interaction mechanism. Minor/Significance Unknown.

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              Adverse Effects

              >10%

              Nausea (40-60%)

              Dizziness (6-40%)

              Somnolence (11-40%)

              Syncope (1-12%)

              Vomiting (12%)

              Fatigue (8-11%)

              Viral infection (11%)

              Dyspepsia (10%)

              Falls (10%)

              1-10%

              Hypertension (5%)

              Flushing (3%)

              Orthostasis (1-6%)

              Chest pain (4%)

              Palpitation (3%)

              Extrasystoles (2%)

              Tachycardia (2%)

              Hyperhidrosis (3%)

              Abnormal pain (3-7%)

              Anorexia (4%)

              Flatulence (3%)

              Malaise (3%)

              Hypoesthesia (4%)

              Urinary tract infection (5%)

              Impotence (3%)

              Alkaline phosphatase (3%)

              Abnormal vision (6%)

              Xerophthalmia (2%)

              Increased diaphoresis (3-6%)

              <1%

              Agitation

              Aneurysm

              Aphasia

              Bradycardia

              Cardiac arrest

              Valvulopathy

              Cellulitis

              Colitis

              Delusion

              Delirium

              Diaphoresis

              Dyspnea

              Ulceration

              Glaucoma

              Psychotic-like behavior

              Impulse control/compulsive behavior

              Withdrawal-emergent hyperpyrexia and confusion

              Melanoma

              Fibrotic complications

              Postmarketing Reports

              Retinal pathology

              Withdrawal symptoms upon tapering drug

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              Warnings

              Contraindications

              Known hypersensitivity/allergic reaction (including urticaria, angioedema, rash, pruritus) to ropinirole or to any of the excipients

              Cautions

              Risk of somnolence associated with use for restless legs syndrome, as well as (rare) risk of syncope, hypotension, and hallucinations

              May cause psychotic-like behavior; abnormal thinking and behavior can consist of one or more of a variety of manifestations including paranoid ideation, delusions, hallucinations, confusion, disorientation, aggressive behavior, agitation, and delirium; risk may be increased in the elderly; consider dose reduction or stopping the medication if a patient develops psychiatric symptoms while taking the medication

              Risk of orthostatic hypotension with extended-release formulation

              Possible risk of erratic behavior associated with dopamine agonists, compulsive behavior including urge to gamble and increased sexual urges

              Potential for elevation in blood pressure and changes in heart rate should be considered when treating patients with cardiovascular disease with extended release formulation

              Dyskinesia seen with concurrent use of levodopa

              Increased risk of melanoma development and pleural retroperitoneal fibrosis reported, but causation not established; monitoring warranted

              Use caution in patients with history of hepatic/renal impairment, psychotic disorders, dyskinesias, restless leg syndrome

              In patients with advanced Parkinson’s disease dyskinesia may occur

              Before initiating treatment, patients should be advised of potential to develop drowsiness and specifically asked about factors that may increase risk such as concomitantly taking sedating medications or alcohol; the presence of sleep disorders (other than RLS), and concomitant medications that increase ropinirole plasma levels (e.g., ciprofloxacin); if patient develops significant daytime sleepiness or episodes of falling asleep during activities that require active participation (e.g., driving a motor vehicle, conversations, eating); therapy should be discontinued; if decision is made to continue therapy patients should be advised to not drive and avoid other potentially dangerous activities; there is insufficient information to establish whether dose reduction will eliminate episodes of falling asleep while engaged in activities of daily living

              Patients with Parkinson’s disease may have impaired ability to respond normally to a fall in blood pressure after standing from lying down or seated position; patients receiving therapy should be monitored for signs and symptoms of orthostatic hypotension, especially during dose escalation, and should be informed of risk for syncope and hypotension

              Withdrawal symptoms

              • Abrupt withdrawal or significant dosage reduction associated with syndrome resembling neuroleptic malignant syndrome (characterized by elevated temperature, muscular rigidity, altered consciousness, and autonomic instability); see Administration section for how to gradually discontinue drug
              • Symptoms including insomnia, apathy, anxiety, depression, fatigue, sweating, and pain reported during taper or after discontinuation of dopamine agonists; these symptoms generally do not respond to levodopa
              • Prior to discontinuation, patients should be informed about potential withdrawal symptoms, and monitored during and after discontinuation; in case of severe withdrawal symptoms, a trial re-administration of a dopamine agonist at the lowest effective dose may be considered

              Augmentation and rebound in restless leg syndrome

              • Augmentation is a phenomenon in which dopaminergic medication causes a worsening of symptom severity above and beyond the level at the time the medication was started
              • Augmentation symptoms may include earlier onset of symptoms in the evening (or even the afternoon), increase in symptoms, and spread of symptoms to involve other extremities
              • Rebound refers to new onset of symptoms in the early morning hr
              • Therapy should be reviewed and dosage adjustment or discontinuation of treatment considered with augmentation and early-morning rebound in restless syndrome; when discontinuing therapy in patients with restless leg syndrome, gradual reduction of the daily dose is recommended whenever possible
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              Pregnancy & Lactation

              Pregnancy

              There are no adequate data on developmental risk associated with use in pregnant women; in animal studies, ropinirole had adverse effects on development when administered to pregnant rats at doses similar to (neurobehavioral impairment) or greater than (teratogenicity and embryolethality at >36 times) maximum recommended human dose (MRHD) for Parkinson’s disease

              Lactation

              There are no data on presence of ropinirole in human milk, the effects of ropinirole on breastfed infant, or effects of ropinirole on milk production; however, inhibition of lactation is expected because ropinirole inhibits secretion of prolactin in humans; ropinirole or metabolites, or both, are present in rat milk

              Developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant from ropinirole or from the underlying maternal condition

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Potent nonergoline dopamine agonist specific for D2 and D3 subtypes, possibly within caudate putamen in brain

              Absorption

              Bioavailability: 55%

              Peak plasma time: Immediate release, 1-2 hr; extended release, 6-10 hr

              Distribution

              Protein bound: 40%

              Vd: 525 L

              Metabolism

              Metabolized in liver by CYP1A2

              Elimination

              Half-life: 6 hr (extended release)

              Total body clearance: 47 L/hr

              Excretion: Urine

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              Administration

              Oral Administration

              May take with or without food

              If a significant interruption in therapy has occurred, retitration of the drug is warranted

              Conversion from immediate-release to extended-release formulation

              • Choose extended-release strength that most closely matches total daily dose of immediate-release formulation

              Discontinuation

              • Abrupt withdrawal or significant dosage reduction associated with syndrome resembling neuroleptic malignant syndrome (see Cautions)
              • Parkinson disease: Discontinued gradually over a 7-day period; administration frequency should be reduced from TID to BID for 4 days, and then once daily for the remaining 3 days prior to completely withdrawing the drug
              • Restless leg syndrome: Gradually reduce the daily dose
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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              ropinirole oral
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              0.5 mg tablet
              ropinirole oral
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              0.25 mg tablet
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              2 mg tablet
              ropinirole oral
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              4 mg tablet
              ropinirole oral
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              5 mg tablet
              ropinirole oral
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              4 mg tablet
              ropinirole oral
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              3 mg tablet
              ropinirole oral
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              2 mg tablet
              ropinirole oral
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              1 mg tablet
              ropinirole oral
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              ropinirole oral
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              0.25 mg tablet
              ropinirole oral
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              0.25 mg tablet
              ropinirole oral
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              1 mg tablet
              ropinirole oral
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              4 mg tablet
              ropinirole oral
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              5 mg tablet
              ropinirole oral
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              ropinirole oral
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              2 mg tablet
              ropinirole oral
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              3 mg tablet
              ropinirole oral
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              1 mg tablet
              ropinirole oral
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              0.25 mg tablet
              ropinirole oral
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              0.5 mg tablet
              ropinirole oral
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              1 mg tablet
              ropinirole oral
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              2 mg tablet
              ropinirole oral
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              2 mg tablet
              ropinirole oral
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              1 mg tablet
              ropinirole oral
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              5 mg tablet
              ropinirole oral
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              4 mg tablet
              ropinirole oral
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              3 mg tablet
              ropinirole oral
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              2 mg tablet
              ropinirole oral
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              1 mg tablet
              ropinirole oral
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              ropinirole oral
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              0.25 mg tablet
              ropinirole oral
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              2 mg tablet
              ropinirole oral
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              4 mg tablet
              ropinirole oral
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              8 mg tablet
              ropinirole oral
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              6 mg tablet
              ropinirole oral
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              12 mg tablet
              ropinirole oral
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              4 mg tablet
              ropinirole oral
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              5 mg tablet
              ropinirole oral
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              4 mg tablet
              ropinirole oral
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              3 mg tablet
              ropinirole oral
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              8 mg tablet
              ropinirole oral
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              5 mg tablet
              ropinirole oral
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              3 mg tablet
              ropinirole oral
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              2 mg tablet
              ropinirole oral
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              0.5 mg tablet
              ropinirole oral
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              8 mg tablet
              ropinirole oral
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              4 mg tablet
              ropinirole oral
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              2 mg tablet
              ropinirole oral
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              12 mg tablet
              ropinirole oral
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              6 mg tablet

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              ropinirole oral

              ROPINIROLE - ORAL

              (row-PIN-uh-roll)

              COMMON BRAND NAME(S): Requip

              USES: This medication is used alone or with other medications to treat Parkinson's disease. It can improve your ability to move and decrease shakiness (tremor), stiffness, slowed movement, and unsteadiness. It may also decrease the number of episodes of not being able to move ("on-off syndrome").Ropinirole is also used to treat restless legs syndrome (RLS). It may improve your sleep by decreasing the urge to move your legs and decreasing uncomfortable/unpleasant feelings in the legs.This medication works by helping to restore the balance of a certain natural substance (dopamine) in the brain.

              HOW TO USE: Read the Patient Information Leaflet provided by your pharmacist before you start taking ropinirole and each time you get a refill. If you have any questions regarding the information, consult your doctor or pharmacist.If you are taking this medication for Parkinson's disease, take this medication by mouth with or without food, usually 3 times a day as directed by your doctor. Taking this medication with food may reduce nausea. To decrease the risk of side effects (e.g., drowsiness, low blood pressure) when you first start taking ropinirole, your doctor will slowly increase your dosage until the best dose for you is reached.If you are using this medication for RLS, take this medication by mouth, usually once daily with or without food, 1-3 hours before bedtime or as directed by your doctor.Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same time(s) each day. Take this medication as prescribed. Do not increase your dose or take it more often than directed.If you stop taking this medication for several days, you may need to increase your dose slowly back to your previous dosage. Talk with your doctor about how to restart the medication.Do not stop taking this medication without consulting your doctor. If you suddenly stop using this medication, you may have withdrawal symptoms (such as fever, muscle stiffness, confusion). To help prevent withdrawal, your doctor may lower your dose slowly. Withdrawal is more likely if you have used ropinirole for a long time or in high doses. Tell your doctor or pharmacist right away if you have withdrawal.If you are taking this medication for RLS, tell your doctor if your symptoms increase or get worse in the early morning, or if you start getting symptoms earlier in the evening or late afternoon. Your doctor may need to change your treatment.The dosage is based on your medical condition and response to therapy. It may take a few weeks for this medication to take effect. Inform your doctor if your symptoms do not improve or if they worsen.

              SIDE EFFECTS: Nausea, vomiting, constipation, dizziness, drowsiness, weakness, unusual sweating, headache, and dry mouth may occur. If these effects persist or worsen, notify your doctor promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.You may also develop a sudden drop in blood pressure, which can cause dizziness, nausea, and fainting. This is more likely when you are first starting the medication or when your dose is increased, or when you get up suddenly. To lower your risk, get up slowly from a sitting or lying position.This medication may also raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.Tell your doctor right away if you have any serious side effects, including: difficulty moving or walking, mental/mood changes (e.g., confusion, depression, hallucinations, memory problems, trouble sleeping), muscle cramps/spasms, decreased sexual ability, unusual strong urges (such as increased gambling, increased sexual urges), swelling of the ankles/feet, chest pain, unusually fast/slow/irregular heartbeat, vision changes.Some people taking ropinirole have fallen asleep suddenly during their usual daily activities (such as talking on the phone, driving). In some cases, sleep occurred without any feelings of drowsiness beforehand. This sleep effect may occur anytime during treatment with ropinirole even if you have used this medication for a long time. If you experience increased sleepiness or fall asleep during the day, do not drive or take part in other possibly dangerous activities until you have discussed this effect with your doctor. Your risk of this sleep effect is increased by using alcohol or other medications that can make you drowsy. See also Precautions section.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking ropinirole, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart problems (including irregular heartbeat), mental/mood disorders (e.g., confusion, hallucinations, psychoses, schizophrenia), difficulty walking, kidney problems, liver problems, high or low blood pressure, sleep disorder (e.g., sleep apnea, narcolepsy).This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis). See also Side Effects section.Older adults may be more sensitive to the side effects of this drug, especially mental/mood changes (such as hallucinations), nausea, and vomiting.This drug should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: antipsychotics (e.g., chlorpromazine, haloperidol, thiothixene), metoclopramide.Other medications can affect the removal of ropinirole from your body, which may affect how ropinirole works. Examples include cimetidine, fluvoxamine, mexiletine, omeprazole, rifampin, among others.Tell your doctor or pharmacist if you are taking other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.Cigarette smoking decreases the level of this medication in your bloodstream. Tell your doctor if you smoke or if you have recently stopped smoking.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Do not share this medication with others.People with Parkinson's disease may have an increased risk for developing skin cancer (melanoma). If you are taking this drug to treat Parkinson's disease, tell your doctor promptly if you notice a change in the appearance or size of moles or other unusual skin changes. Ask your doctor if you should have regular skin exams.

              MISSED DOSE: If you are taking this for Parkinson's and you miss a dose, take it as soon as you remember. If it is almost time for the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.If you are taking this for RLS and you miss a dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.