Is it safe to administer Requip (ropinirole) 1mg twice daily (bid)?

Can Requip 1mg BID Be Given Safely?

Yes, Requip (ropinirole) 1mg twice daily can be given safely, but this dose is below the typical therapeutic range for both Parkinson's disease and restless legs syndrome (RLS), and may require titration upward based on clinical response and tolerability. 1

FDA-Approved Dosing Guidelines

For Parkinson's Disease

• The recommended starting dose is 0.25 mg three times daily (0.75 mg total daily dose), which should be titrated weekly based on response 1
• By Week 4, patients typically reach 1 mg three times daily (3 mg total daily dose) 1
• Your proposed dose of 1mg BID (2 mg total daily) falls within the early titration range but is lower than the typical Week 4 target 1
• Maximum recommended dose is 24 mg/day (8 mg three times daily) 1

For Restless Legs Syndrome

• Initial dosing starts at 0.25 mg once daily taken 1-3 hours before bedtime 1
• By Week 2, patients typically reach 1 mg once daily 1
• Your proposed 1mg BID regimen (2 mg total daily) exceeds typical RLS dosing, as RLS is dosed once daily, not twice daily 1
• Maximum dose for RLS is 4 mg once daily 1

Safety Considerations

Tolerability Profile

• Ropinirole is generally well tolerated with an adverse-event profile consistent with other dopamine agonists 2
• The most common adverse effects include dyskinesia, nausea, dizziness, hallucinations, somnolence, abdominal pain, and orthostatic hypotension 3
• Side effects are typically mild and mostly transient 4

Dosing Frequency Concerns

• The FDA-approved dosing for Parkinson's disease is three times daily, not twice daily 1
• For RLS, dosing is once daily before bedtime, not twice daily 1
• A 1mg BID regimen does not align with standard FDA-approved dosing schedules for either indication 1

Renal Impairment Adjustments

• No dose adjustment needed for moderate renal impairment (creatinine clearance 30-50 mL/min) 1
• For end-stage renal disease on hemodialysis: start at 0.25 mg three times daily for Parkinson's disease (maximum 18 mg/day) or 0.25 mg once daily for RLS (maximum 3 mg/day) 1
• Supplemental doses after dialysis are not required 1

Clinical Evidence Supporting Efficacy

Parkinson's Disease

• Ropinirole shows comparable efficacy whether given as immediate release or prolonged release formulations 3
• Patients can be converted overnight between formulations without loss of efficacy 3
• In advanced Parkinson's disease, ropinirole reduced daily "off" time by an average of 2.1 hours compared to 0.4 hours with placebo 3

Restless Legs Syndrome

• Ropinirole significantly improved International Restless Legs Scale (IRLS) scores compared to placebo (adjusted mean treatment difference -3.7, P < .001) 2
• Mean effective dose in clinical trials was 0.78 ± 0.47 mg (range 0.25-1.50 mg) given once daily 4
• Ropinirole improved subjective measures of sleep disturbance, quality of life, and anxiety 2

Common Pitfalls to Avoid

• Do not use BID dosing for Parkinson's disease—the FDA-approved regimen is three times daily 1
• Do not use BID dosing for RLS—the FDA-approved regimen is once daily before bedtime 1
• Avoid abrupt discontinuation; taper gradually over 7 days for Parkinson's disease by reducing from three times daily to twice daily for 4 days, then once daily for 3 days 1
• Do not expect immediate therapeutic effects; allow adequate time for dose titration and clinical response 4, 2

Recommended Approach

If treating Parkinson's disease: Start with 0.25 mg three times daily and titrate weekly to 1 mg three times daily by Week 4, rather than using 1mg BID 1

If treating RLS: Use 1 mg once daily (not BID) taken 1-3 hours before bedtime, which is the Week 2 target dose 1