Requip (Ropinirole) Dosage and Treatment Protocol for Parkinson's Disease and Restless Legs Syndrome
For Parkinson's disease, Requip (ropinirole) should be started at 0.25 mg three times daily and gradually titrated up to a maximum of 24 mg/day, while for restless legs syndrome (RLS), treatment should begin with 0.25 mg once daily 1-3 hours before bedtime with gradual titration up to a maximum of 4 mg daily. 1
Dosing for Parkinson's Disease
Initial Dosing and Titration
- Starting dose: 0.25 mg three times daily
- Titration schedule:
- Week 1: 0.25 mg three times daily (0.75 mg total)
- Week 2: 0.5 mg three times daily (1.5 mg total)
- Week 3: 0.75 mg three times daily (2.25 mg total)
- Week 4: 1 mg three times daily (3 mg total)
- After Week 4: Increase by 1.5 mg/day weekly up to 9 mg/day
- Further increases: Up to 3 mg/day weekly if needed
- Maximum recommended dose: 24 mg/day (8 mg three times daily) 1
Administration
- Can be taken with or without food
- If therapy is interrupted, retitration may be necessary
- For discontinuation: Taper gradually over 7 days
- Reduce from three times daily to twice daily for 4 days
- Then reduce to once daily for 3 days before complete withdrawal 1
Dosing for Restless Legs Syndrome (RLS)
Initial Dosing and Titration
- Starting dose: 0.25 mg once daily, 1-3 hours before bedtime
- Titration schedule:
- Days 1-2: 0.25 mg once daily
- Days 3-7: 0.5 mg once daily
- Week 2: 1 mg once daily
- Week 3: 1.5 mg once daily
- Week 4: 2 mg once daily
- Week 5: 2.5 mg once daily
- Week 6: 3 mg once daily
- Week 7: 4 mg once daily
- Maximum recommended dose: 4 mg once daily 1
Administration
- Administer 1-3 hours before bedtime
- Gradual dose reduction recommended when discontinuing 1
Dosing Adjustments for Special Populations
Renal Impairment
- Moderate renal impairment (CrCl 30-50 mL/min): No dose adjustment needed
- End-stage renal disease on hemodialysis:
- For Parkinson's: Start with 0.25 mg three times daily; maximum 18 mg/day
- For RLS: Start with 0.25 mg once daily; maximum 3 mg/day
- No supplemental doses needed after dialysis 1
Monitoring and Follow-up
Efficacy Assessment
- For RLS: Evaluate symptom improvement using standardized scales (e.g., International Restless Legs Scale)
- Clinical improvement should be evident within the first week of treatment 2, 3, 4
Adverse Effects Monitoring
- Common side effects: Nausea, vomiting, drowsiness, sudden urge to sleep, syncope, hypotension, and hallucinations 5
- Watch for augmentation in RLS patients (worsening of symptoms, earlier onset, increased intensity, spread to other body parts) 6
- Regular follow-up is necessary to assess symptom control and adjust treatment 2
Non-pharmacological Approaches for RLS
Consider implementing these alongside medication:
- Moderate exercise
- Smoking cessation
- Alcohol avoidance
- Caffeine reduction or elimination
- Discontinuation of medications that may worsen RLS 6, 2
Laboratory Testing for RLS
- Check serum ferritin (iron deficiency common in RLS)
- Iron supplementation recommended if ferritin < 50 ng/mL 6, 2
Important Considerations
- Dopamine agonists like ropinirole are first-line for RLS but should be used for short-term treatment due to risk of augmentation 2
- Alpha-2-delta ligands (pregabalin, gabapentin) may be preferred for long-term RLS treatment due to lower augmentation risk 2
- Clinical trials show significant improvement in RLS symptoms, sleep quality, and quality of life with ropinirole compared to placebo 3, 4
- Benefits of treatment are typically apparent by week 1 of therapy 4