From the Guidelines
Ropinirole should not be used as a standard treatment for Restless Legs Syndrome (RLS) due to the risk of augmentation, although it may be considered in patients who place a higher value on short-term symptom reduction and a lower value on long-term adverse effects 1. The use of ropinirole, a dopamine agonist, is a topic of discussion in the treatment of RLS. According to the American Academy of Sleep Medicine clinical practice guideline, the standard use of ropinirole is suggested against in adults with RLS, with a conditional recommendation and moderate certainty of evidence 1.
Key Points to Consider
- Ropinirole may be used to treat RLS in patients who prioritize short-term symptom reduction over long-term adverse effects, particularly augmentation 1.
- The medication works by stimulating dopamine receptors in the brain, compensating for the dopamine deficiency that causes uncomfortable sensations in RLS.
- Common side effects of ropinirole include nausea, dizziness, drowsiness, and sometimes impulse control disorders like compulsive gambling or shopping.
- Patients should be aware that ropinirole may cause sudden sleep onset, so caution is needed when driving or operating machinery, especially when starting treatment or adjusting dosage.
Clinical Decision Making
When considering the use of ropinirole for RLS, clinicians should weigh the potential benefits against the risks of augmentation and other adverse effects. The American Academy of Sleep Medicine guideline suggests that ropinirole may be used in certain patients, but with careful consideration of the potential risks and benefits 1. As noted in a recent discussion on the treatment of RLS, dopamine agonists like ropinirole were rapidly adopted as first-line therapy, but concerns about augmentation have emerged over time 1.
Treatment Approach
For patients with RLS, treatment usually begins with 0.25 mg of ropinirole taken 1-3 hours before bedtime, potentially increasing to 4 mg daily based on response. However, given the risks associated with ropinirole, alternative treatments should be considered, such as ferrous sulfate, which is suggested for use in adults with RLS and appropriate iron status 1. Ultimately, the decision to use ropinirole should be made on a case-by-case basis, taking into account the individual patient's priorities and medical history.
From the FDA Drug Label
Ropinirole tablets are a prescription medicine containing ropinirole used to treat moderate-to-severe primary RLS. It is also used to treat Parkinson’s disease Having one of these conditions does not mean you have or will develop the other condition.
The use of ropinirole (a dopamine agonist) is to treat:
- Moderate-to-severe primary Restless Legs Syndrome (RLS)
- Parkinson’s disease 2
From the Research
Uses of Ropinirole
- Ropinirole is a dopamine agonist used in the treatment of Parkinson's disease and restless legs syndrome 3, 4, 5, 6, 7
- In Parkinson's disease, ropinirole is used as monotherapy or as adjunctive therapy with levodopa to improve symptoms and delay the appearance of motor complications 5, 7
- In restless legs syndrome, ropinirole is used to reduce motor symptoms and improve overall sleep quality 3, 4, 6
Efficacy of Ropinirole
- Clinical studies have shown that ropinirole can effectively reduce the motor symptoms of restless legs syndrome and improve overall sleep quality 4, 6
- In Parkinson's disease, ropinirole has been shown to be as effective as levodopa in patients with early stages of the disease, and as effective as bromocriptine in patients with advanced disease 5
- Ropinirole has also been shown to have a low potential to interact with other drugs likely to be administered to Parkinson's disease patients 5
Adverse Effects of Ropinirole
- Common adverse effects of ropinirole include nausea, vomiting, drowsiness, sudden urge to sleep, syncope, hypotension, and hallucinations 3, 5
- Ropinirole can also cause an increase in the severity of restless legs symptoms, typically seen with levodopa, although this was not evaluated in clinical trials 3
- Postmarketing surveillance has reported problems with daytime somnolence, and patients should be counseled appropriately 6