How to dose Requip (ropinirole) in patients with Chronic Kidney Disease (CKD)?

Dosing Ropinirole (Requip) in Patients with Chronic Kidney Disease

No dose adjustment is necessary for ropinirole in patients with moderate renal impairment (creatinine clearance 30-50 mL/min), but specific dosing recommendations are required for patients with end-stage renal disease on hemodialysis. 1

Dosing Guidelines for Parkinson's Disease

• For patients with normal to moderate renal impairment (CrCl >30 mL/min), follow standard dosing protocol starting with 0.25 mg three times daily with weekly titration as tolerated 1
• For patients with end-stage renal disease on hemodialysis:
  • Starting dose: 0.25 mg three times daily 1
  • Maximum recommended total daily dose: 18 mg/day 1
  • Supplemental doses after dialysis are not required 1

Dosing Guidelines for Restless Legs Syndrome

• For patients with normal to moderate renal impairment (CrCl >30 mL/min), follow standard dosing protocol starting with 0.25 mg once daily 1-3 hours before bedtime 1
• For patients with end-stage renal disease on hemodialysis:
  • Starting dose: 0.25 mg once daily 1
  • Maximum recommended total daily dose: 3 mg/day 1
  • Supplemental doses after dialysis are not required 1

Important Clinical Considerations

• The use of ropinirole in patients with severe renal impairment (CrCl <30 mL/min) without regular dialysis has not been adequately studied 1
• Drug dosing errors are common in patients with renal impairment and can cause adverse effects and poor outcomes 2
• Medication management in CKD patients requires estimating renal function, applying clinical judgment, and when available, therapeutic drug monitoring 3

Monitoring Recommendations

• Calculate creatinine clearance or glomerular filtration rate using online or electronic calculators for accurate dosing 2
• Monitor for adverse effects, particularly in patients with severe renal impairment, as pharmacokinetic behaviors of drugs are highly variable in CKD patients 3
• Consider that kidney disease may affect non-renal clearance mechanisms, which is often not adequately considered in pharmacokinetic studies 4

Clinical Pitfalls to Avoid

• Avoid using standard dosing in patients with end-stage renal disease, as this could lead to drug accumulation and toxicity 3
• Remember that CKD affects not only renal drug elimination but also other pharmacokinetic processes such as absorption, drug distribution, and non-renal clearance 2
• Be aware that patients with CKD often take multiple medications with potential for drug interactions that may further alter ropinirole metabolism 3