Onset of Action for Ropinirole (Requip) in Restless Legs Syndrome
Ropinirole typically begins working within the first week of treatment for restless legs syndrome, with significant symptom improvement often apparent by week 1 of therapy. 1, 2
Timeline of Symptom Relief
Immediate effects (first dose): Some patients report beneficial effects after the very first administration of ropinirole, with improvement noted as early as the first night of treatment 3
Early response (week 1): Clinical trials demonstrate that significant differences in both symptom severity scores and global improvement ratings become apparent by week 1 of treatment, with benefits continuing to accrue through week 12 2
Peak efficacy (12 weeks): Maximum therapeutic benefit is typically achieved after 12 weeks of dose titration and optimization 1, 2
Important Clinical Context: Current Treatment Guidelines
However, it is critical to note that ropinirole is no longer recommended as standard therapy for restless legs syndrome. 4, 5
The American Academy of Sleep Medicine now suggests against the standard use of ropinirole due to the significant risk of augmentation (paradoxical worsening of symptoms with long-term use), with a conditional recommendation and moderate certainty of evidence 4, 5
Alpha-2-delta ligands (gabapentin, gabapentin enacarbil, or pregabalin) are now strongly recommended as first-line therapy instead of dopamine agonists like ropinirole 4, 5
Ropinirole may only be considered for short-term treatment in patients who prioritize immediate symptom relief over long-term adverse effects 4
Dosing and Administration Details
Ropinirole is initiated at 0.25 mg once daily, taken 1-3 hours before bedtime 1
The dose is titrated over 7 weeks based on clinical response and tolerability, up to a maximum of 4 mg once daily 1
Mean effective doses in clinical trials ranged from approximately 1.9-2.0 mg/day 1, 2
Critical Warnings About Long-Term Use
Augmentation risk: Symptoms may worsen over time, appearing earlier in the day, increasing in intensity, or spreading to other body parts—this was not adequately evaluated in the original clinical trials 6
Common adverse effects include nausea, vomiting, drowsiness, sudden sleep attacks, syncope, hypotension, and hallucinations 6
The elimination half-life is approximately 6 hours, requiring daily dosing 7