Requip

Requip contains ropinirole, a non-ergot dopamine agonist used in the management of Parkinson's disease and restless legs syndrome.

In Parkinson's disease, Requip may be prescribed as initial monotherapy in early disease to delay the introduction of levodopa, or as an adjunct to levodopa in more advanced stages to improve symptom control and potentially allow a reduction in levodopa dose.

Ropinirole stimulates dopamine receptors in the brain, particularly D2 and D3 subtypes, compensating for the reduced dopamine production that causes the motor and non-motor symptoms of Parkinson's disease.

For restless legs syndrome, ropinirole addresses the dopaminergic dysfunction that produces the characteristic urge to move and uncomfortable limb sensations.

Requip is available in immediate-release tablets (taken three times daily for Parkinson's disease, once daily for RLS) and as Requip XL prolonged-release tablets (taken once daily for Parkinson's disease).

The prolonged-release formulation simplifies dosing and may provide smoother symptom control throughout the day.

For Parkinson's disease (immediate-release): take three times daily with or without food.

For Parkinson's disease (Requip XL): take once daily, swallowed whole at approximately the same time each day, preferably with food.

For restless legs syndrome: take once daily, one to three hours before bedtime.

Always start at a low dose and increase gradually as directed by your prescriber. Do not stop taking Requip suddenly, as this may cause a severe worsening of symptoms or withdrawal effects.

Parkinson's disease (immediate-release): start at 0.25 mg three times daily, increased weekly by 0.25 mg per dose to a typical range of 3 to 9 mg daily, with a maximum of 24 mg daily.

Requip XL: start at 2 mg once daily, increasing by 2 mg at weekly intervals. RLS: start at 0.25 mg once daily, increasing after two days to 0.

5 mg, then to 1 mg after one week, with a maximum of 4 mg daily. Titration should be slow and guided by response.

Common side effects include nausea (particularly during dose titration), dizziness, drowsiness, and syncope (fainting). Dyskinesia may occur when used alongside levodopa.

Hallucinations are possible, especially at higher doses and in elderly patients.

Impulse control disorders, including pathological gambling, compulsive shopping, binge eating, and hypersexuality, have been reported with dopamine agonists.

Sudden sleep onset without warning may occur. Peripheral oedema and postural hypotension are also recognised effects.

Requip may cause episodes of sudden sleep onset, which can be dangerous when driving. Patients should be advised not to drive if they experience daytime somnolence.

Monitor for impulse control disorders at every clinical review and educate patients and carers to recognise early signs.

If augmentation occurs in RLS (symptoms appearing earlier or spreading), treatment should be reviewed. Use with caution in severe cardiovascular disease, renal impairment, and psychotic disorders.

Gradual dose reduction is mandatory when discontinuing.

Requip is contraindicated in patients with known hypersensitivity to ropinirole or any excipient, and in patients with severe renal impairment (creatinine clearance below 30 ml/min) not on dialysis.

Severe hepatic impairment also warrants avoidance. Caution is required when combining with other dopaminergic medications or antipsychotics.