Can Ropinirole Cause High Blood Pressure?
Ropinirole is more commonly associated with decreasing blood pressure (hypotension) rather than increasing it, though the FDA label does note that it may increase blood pressure in some patients. 1
Primary Blood Pressure Effects
Ropinirole predominantly causes hypotension and orthostatic hypotension, particularly when initiating therapy or increasing doses. 1 The FDA drug label explicitly warns that:
- Ropinirole can decrease blood pressure (hypotension), especially at treatment initiation or dose changes 1
- Orthostatic hypotension (feeling dizzy, nauseated, or sweaty when standing) is a recognized adverse effect 1
- Fainting can occur, sometimes with decreased heart rate 1
Evidence for Hypertensive Effects
While the FDA label mentions that "ropinirole tablets may increase your blood pressure," 1 this appears to be a less common effect compared to hypotension. The clinical research evidence does not strongly support hypertension as a primary concern:
- A study of 12 Parkinsonian patients found ropinirole had only a "small but nonsignificant influence" on blood pressure response, which was "much less prominent than the change observed with ergot dopamine agonists" 2
- The same study showed ropinirole caused minimal impact on noradrenaline release and blood pressure regulation compared to controls 2
Clinical Significance of Hypotension
The hypotensive effects of ropinirole can be clinically significant and lead to serious complications:
- A case report documented a 71-year-old man who experienced recurrent falls, four hospitalizations, and required midodrine and compression stockings due to ropinirole-induced orthostatic hypotension 3
- This case illustrates a prescribing cascade where ropinirole's hypotensive effects led to additional medications being prescribed 3
- Orthostatic hypotension from ropinirole has been documented in both Parkinson's disease and restless leg syndrome patients 3, 4
Practical Management Recommendations
For patients with pre-existing hypertension starting ropinirole:
- Monitor blood pressure carefully during initiation and dose titration, as hypotension is the more likely concern 1
- Instruct patients to change positions slowly from lying/sitting to standing 1
- Watch for orthostatic symptoms (dizziness, lightheadedness, fainting) 1
- Consider that ropinirole is listed among medications that may impair orthostatic blood pressure response 5
Important Caveats
The FDA label's mention of potential blood pressure increases should not be dismissed entirely, but clinicians should recognize that hypotension represents the predominant cardiovascular risk with ropinirole therapy. 1 The elderly population is particularly susceptible to adverse drug effects including orthostatic hypotension from ropinirole. 3
In patients with poorly controlled hypertension, ropinirole is unlikely to worsen blood pressure control and may actually lower it, though this is not a therapeutic indication for the medication. 2