Maximum Recommended Dose of Requip (Ropinirole)

The maximum recommended dose of Requip (ropinirole) is 24 mg per day for Parkinson's disease and 4 mg per day for Restless Legs Syndrome (RLS). 1

Dosing for Different Indications

Starting dose is 0.25 mg three times daily 1
Dose should be titrated with weekly increments according to patient response and tolerability 1
After week 4, daily dose may be increased by 1.5 mg/day weekly up to 9 mg/day, then by up to 3 mg/day weekly 1
Maximum recommended total daily dose is 24 mg/day (8 mg three times daily) 1
Doses greater than 24 mg/day have not been tested in clinical trials 1

Starting dose is 0.25 mg once daily, 1-3 hours before bedtime 1
After 2 days, dose can be increased to 0.5 mg once daily, and to 1 mg once daily at the end of the first week 1
Titration should be based on individual therapeutic response and tolerability 1
Maximum recommended dose is 4 mg daily for RLS 1
Safety and effectiveness of doses greater than 4 mg once daily have not been established for RLS 1
The American Academy of Sleep Medicine suggests against the standard use of ropinirole for RLS (conditional recommendation) but notes it may be used in patients who place higher value on symptom reduction with short-term use 2

No dose adjustment necessary in moderate renal impairment (creatinine clearance 30-50 mL/min) 1
For end-stage renal disease on hemodialysis:
- For Parkinson's disease: Initial dose 0.25 mg three times daily with maximum total daily dose of 18 mg/day 1
- For RLS: Initial dose 0.25 mg once daily with maximum total daily dose of 3 mg/day 1
Supplemental doses after dialysis are not required 1

Ropinirole can be taken with or without food 1
For RLS, the dose should be taken 1-3 hours before bedtime 1
If significant interruption in therapy occurs, retitration may be warranted 1
When discontinuing ropinirole:
- For Parkinson's disease: Gradually taper over a 7-day period 1
- For RLS: Gradual reduction of the daily dose is recommended 1

Augmentation is a significant concern with long-term dopamine agonist use in RLS, leading to symptom worsening and further dose escalation 3
Approximately 20% of dopamine agonist-treated RLS patients are prescribed doses above the approved maximum daily dose 3
In clinical studies for RLS, the mean effective dosage was typically lower than the maximum (around 0.78-0.89 mg) 4, 2
Side effects may include nausea, somnolence, dizziness, and orthostatic hypotension 5

A once-daily prolonged release (PR) formulation of ropinirole is available in some markets, which allows for more stable plasma levels and improved convenience 6