Common uses of Requip (ropinirole)
Requip is primarily used for two conditions: managing the motor symptoms of Parkinson’s disease and treating moderate-to-severe restless legs syndrome (RLS). In Parkinson’s disease, ropinirole can be started early as monotherapy or added to levodopa later to smooth out “off” periods and improve mobility. In RLS, it reduces the unpleasant leg sensations and urge to move, helping patients fall asleep faster and stay asleep longer. Clinicians choose the formulation—immediate-release (IR) or extended-release (ER)—based on symptom patterns, lifestyle, and tolerability. While many people experience meaningful relief, response varies, and careful dose titration helps optimize benefit with fewer side effects.
How Requip works: a dopamine agonist
Ropinirole is a non-ergoline dopamine agonist that binds to dopamine D2/D3 receptors. In Parkinson’s disease, where dopamine-producing neurons are depleted, this receptor stimulation helps restore signaling in motor pathways, reducing tremor, rigidity, and bradykinesia. In RLS, dopamine dysfunction in central nervous system circuits contributes to nocturnal sensory-motor symptoms; ropinirole’s dopaminergic activity decreases those sensations and leg movements that disrupt sleep. Unlike levodopa, which is converted to dopamine, dopamine agonists directly stimulate receptors and may have a longer duration of action per dose. However, they carry class-specific risks like sleepiness, orthostatic hypotension, hallucinations, and impulse-control disorders, necessitating careful monitoring.
Dosage and directions
Always use Requip exactly as prescribed. Do not start, stop, or change your dose without medical guidance. Tablets should be swallowed whole with water; extended-release tablets must not be crushed, split, or chewed.
Parkinson’s disease (immediate-release): A common starting regimen is 0.25 mg three times daily. The dose is typically increased weekly based on response and tolerability, for example to 0.5 mg three times daily in week 2, 0.75 mg three times daily in week 3, and 1 mg three times daily in week 4. Further increases may be made at intervals to achieve effect, with a usual total daily dose range individualized by the prescriber. The maximum recommended total daily dose is 24 mg.
Parkinson’s disease (extended-release): Many patients start at 2 mg once daily, taken at a consistent time. Dose increases (often by 2 mg per day) may occur no more frequently than weekly, guided by benefit and tolerability. Typical maintenance doses vary; the maximum is 24 mg once daily. Patients switching from immediate-release to extended-release usually do so under direct prescriber instructions to approximate the current total daily amount.
Restless legs syndrome (immediate-release): A common initiation is 0.25 mg once daily, taken 1 to 3 hours before bedtime. The dose may increase after several days and then weekly as needed (for example 0.5 mg, 1 mg, 1.5 mg, 2 mg, up to a recommended maximum of 4 mg once daily). Not every patient requires the maximum. Extended-release ropinirole is not typically used for RLS.
Administration tips: Take with food if nausea occurs. If you experience excessive drowsiness or sudden sleep episodes, contact a clinician immediately and avoid driving or hazardous tasks. When discontinuing, doses should be tapered gradually to lower the risk of withdrawal or a serious syndrome resembling neuroleptic malignant syndrome.
Adjustments and special populations
Kidney function: Mild to moderate renal impairment usually requires no dosage adjustment, but those on hemodialysis may need lower maximum doses. Liver function: Use caution and start low, go slow; hepatic impairment can increase exposure. Older adults: Greater sensitivity to orthostatic hypotension, hallucinations, and sleepiness warrants conservative titration and closer monitoring. Pregnancy and breastfeeding: Data are limited; ropinirole can reduce prolactin and may affect lactation. Discuss risks and benefits with a clinician before use in pregnancy or while nursing. Smoking status and estrogen therapy can alter ropinirole levels via CYP1A2 effects; your prescriber may adjust dosing accordingly.
Precautions and warnings
Sleepiness and sleep attacks: Ropinirole can cause profound drowsiness and, rarely, sudden sleep onset without warning. Until you know your response, avoid driving and activities requiring full alertness. Report any episodes immediately.
Orthostatic hypotension and syncope: Dizziness or fainting can occur, especially when standing up quickly or during dose increases. Rise slowly, maintain hydration, and discuss any antihypertensives with your clinician to reduce risk.
Psychiatric effects: Hallucinations, confusion, or worsening psychosis may occur, particularly in older adults or when combined with other dopaminergic therapy. Notify your clinician if you experience new or worsening mental status changes.
Impulse-control disorders: Compulsive behaviors (gambling, shopping, eating, hypersexuality) have been reported. If you or loved ones notice new urges or behaviors, seek prompt medical advice; dose changes or discontinuation may be required.
RLS augmentation and rebound: Over time, RLS symptoms can begin earlier in the day, intensify, or spread to arms (augmentation). Rebound symptoms can also occur late at night or early morning. If this happens, do not self-increase the dose—consult your prescriber to reassess the regimen.
Melanoma vigilance: People with Parkinson’s disease have a higher baseline risk of melanoma. Perform regular skin checks and report suspicious lesions, regardless of therapy.
Withdrawal and tapering: Abrupt discontinuation can precipitate serious symptoms, and some patients may experience dopamine agonist withdrawal syndrome (anxiety, depression, fatigue, pain, drug craving). Taper slowly under clinical supervision.
Contraindications
Requip is contraindicated in patients with known hypersensitivity to ropinirole or any tablet component. Severe caution is warranted with uncontrolled psychiatric illness, recurrent syncope, or significant orthostatic hypotension. Because extended-release tablets must be swallowed whole, individuals with certain swallowing disorders or gastrointestinal conditions may not be candidates for the ER formulation. Clinicians weigh risks and benefits in pregnancy, while nursing, and when significant hepatic impairment is present.
Possible side effects
Common side effects: Nausea, vomiting, abdominal discomfort, dizziness, somnolence, fatigue, headache, dry mouth, edema (swelling), and constipation. Many effects improve as the body adjusts or with food and slower titration.
Neurologic/psychiatric: Sleep attacks, vivid dreams, insomnia, confusion, hallucinations, agitation, and rarely mania. In Parkinson’s disease, dyskinesia can emerge or worsen, especially when combined with levodopa; dosage adjustments may help.
Cardiovascular: Orthostatic hypotension, palpitations, chest discomfort. Seek urgent care for severe dizziness, fainting, or chest pain.
Behavioral: Impulse-control disorders such as compulsive gambling, eating, shopping, or hypersexuality. These require prompt evaluation and typically dose reduction or discontinuation.
Hypersensitivity: Rash, pruritus, and rare severe allergic reactions (swelling of face/tongue, difficulty breathing). This is a medical emergency.
This is not a complete list. Report persistent, severe, or unusual symptoms to a healthcare professional.
Drug interactions
Metabolism: Ropinirole is primarily metabolized by CYP1A2. Strong CYP1A2 inhibitors (for example, ciprofloxacin, fluvoxamine) can increase ropinirole levels and side effects; dose reductions may be required. Cigarette smoking can induce CYP1A2 and lower ropinirole concentrations, potentially reducing efficacy; changes in smoking status may necessitate dose adjustments. Some estrogen therapies may increase ropinirole exposure.
CNS depressants and alcohol: Concurrent use can amplify sedation and impair motor coordination. Use caution or avoid alcohol.
Antihypertensives: Additive blood pressure lowering may increase dizziness or syncope; monitor closely during initiation and titration.
Dopamine antagonists: Certain antipsychotics and antiemetics (for example, haloperidol, risperidone, metoclopramide) may reduce ropinirole’s effect and worsen motor symptoms; avoid combinations when possible or monitor carefully.
Levodopa: Co-administration is common in Parkinson’s disease. Monitor for dyskinesia; prescribers often reduce levodopa dose when adding a dopamine agonist to maintain balance.
Missed dose
If you miss a dose of immediate-release Requip, take it as soon as you remember unless it is almost time for the next dose. If it is close to the next dose, skip the missed dose and resume your regular schedule. Do not double up. For extended-release, if you remember on the same day, take it when remembered; otherwise skip the missed day and take the next dose at the usual time. If you miss several doses, contact your clinician—re-titration may be necessary to avoid side effects.
Overdose
Symptoms of overdose may include severe nausea, vomiting, dizziness, marked drowsiness, agitation, hallucinations, involuntary movements, low blood pressure, or irregular heartbeat. If an overdose is suspected, call emergency services or poison control immediately. Supportive care typically includes airway and cardiovascular monitoring, intravenous fluids for hypotension, and symptomatic management. Because ropinirole has a large volume of distribution, dialysis is unlikely to be helpful. Do not attempt to self-treat with additional medicines unless directed by a medical professional.
Storage
Store Requip tablets at room temperature, ideally 20°C to 25°C (68°F to 77°F), with permitted excursions per label. Keep tablets in the original container, tightly closed, protected from moisture and excessive heat. Do not use tablets that are damaged, discolored, or expired. Keep out of reach of children and pets. Extended-release tablets must be swallowed whole; do not crush or split to “make them last,” as this can alter release and raise the risk of side effects.
U.S. sale and prescription policy
In the United States, ropinirole (Requip) is a prescription medication. Federal and state laws require an authorized clinician to assess appropriateness before it is dispensed. HealthSouth Hospital of Altamonte Springs offers a legal, structured pathway for access—without requiring you to upload a prior prescription—by using an online clinical intake reviewed by licensed professionals. When appropriate, a partnering prescriber authorizes therapy, ensuring treatment remains compliant and medically justified. This means you can buy Requip without prescription on hand, but not without clinical review.
What you can expect: secure checkout, a brief health questionnaire, identity and medication review, pharmacist counseling when needed, and prompt shipping to eligible states. We prioritize safety, continuity of care with your existing clinicians, price transparency, and HIPAA-compliant privacy. If Requip isn’t appropriate, we will not dispense it and can discuss alternatives or referral options.
Important note: Online availability varies by state regulations, inventory, and clinical suitability. Always use ropinirole under professional supervision and report side effects promptly. This content is for education and does not replace individualized medical advice.
Practical tips for safer use
Start low, go slow: Many side effects are dose-related and improve with gradual titration. Take with food if nausea occurs. Avoid alcohol and minimize other sedating drugs unless cleared by your clinician. Stand up slowly from sitting or lying positions to reduce dizziness. Maintain a symptom diary—note timing of doses, benefits, and any adverse effects; bring it to follow-ups to guide adjustments. If new behaviors or urges emerge, or if RLS symptoms start earlier or spread, contact your prescriber before making any changes yourself.
Who might consider alternatives to Requip?
Not everyone is an ideal candidate for a dopamine agonist. Those with a history of severe impulse-control disorders, recurrent hallucinations, uncontrolled orthostatic hypotension, or significant daytime sleepiness may do better with alternative strategies. In Parkinson’s disease, options include optimizing levodopa regimens, using MAO-B inhibitors, COMT inhibitors, amantadine, or device-assisted therapies in advanced stages. In RLS, low-dose alpha-2-delta ligands (such as gabapentin enacarbil) may be preferred, particularly when pain or insomnia predominate, or when augmentation has occurred on dopaminergic therapy. Your clinician will individualize the plan to your symptoms, goals, and risk profile.
