From the FDA Drug Label
2.3 Dosing for Restless Legs Syndrome The recommended adult starting dose for RLS is 0.25 mg once daily 1 to 3 hours before bedtime. After 2 days, if necessary, the dose can be increased to 0.5 mg once daily, and to 1 mg once daily at the end of the first week of dosing, then as shown in Table 2 as needed to achieve efficacy. Titration should be based on individual patient therapeutic response and tolerability, up to a maximum recommended dose of 4 mg daily.
Table 2 Dose Titration Schedule of Ropinirole Tablets for Restless Legs Syndrome Day/Week Dose to be taken once daily 1 to 3 hours before bedtime Days 1 and 2 0.25 mg Days 3 to 7 0.5 mg Week 2 1 mg Week 3 1.5 mg Week 4 2 mg Week 5 2.5 mg Week 6 3 mg Week 7 4 mg
The recommended dosage of ropinirole for Restless Legs Syndrome (RLS) is:
- Starting dose: 0.25 mg once daily, 1 to 3 hours before bedtime
- Titration: based on individual patient therapeutic response and tolerability, up to a maximum recommended dose of 4 mg daily 1 Key points:
- The dose can be increased to 0.5 mg once daily after 2 days, and to 1 mg once daily at the end of the first week of dosing
- Further dose escalations should be based on tolerability and need for efficacy, as shown in Table 2
From the Research
Ropinirole is typically started at a low dose of 0.25 mg taken once daily, 1-3 hours before bedtime, and can be gradually increased as needed and tolerated, up to a maximum recommended dose of 4 mg daily, as supported by the most recent study 2. The dose can be increased to 0.5 mg daily after 2 days, and after one week to 1 mg daily, with further adjustments made in 0.5 mg increments at weekly intervals.
- Most patients respond to doses between 0.5-2 mg daily, as shown in a study comparing ropinirole to gabapentin 3.
- Ropinirole works by stimulating dopamine receptors in the brain, which helps reduce the uncomfortable sensations and urge to move the legs that characterize restless legs syndrome.
- Common side effects include nausea, dizziness, fatigue, and headache, which often improve with continued use, as reported in a study on the efficacy and tolerability of ropinirole 4.
- Taking the medication with food may help reduce nausea.
- It's essential to avoid suddenly stopping ropinirole, as this can cause worsening of symptoms, and if the medication needs to be discontinued, it should be tapered gradually under medical supervision, as emphasized in a review of restless legs syndrome treatments 5. Key considerations for ropinirole dosage include:
- Starting with a low dose and gradually increasing as needed and tolerated
- Monitoring for common side effects and adjusting the dose accordingly
- Avoiding sudden discontinuation and tapering gradually under medical supervision if necessary
- Considering alternative treatments, such as gabapentin or opioids, for refractory cases, as discussed in a narrative review of lesser-known medications for restless legs syndrome 2.