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Requip XL(trade name)
Pregnancy Category: C
Pharmacologic: dopamine agonists
ClassificationTherapeutic: antiparkinson agents
Pharmacologic: dopamine agonists
Management of signs and symptoms of idiopathic Parkinson’s disease.Restless leg syndrome (immediate-release only).
Stimulates dopamine receptors in the brain.
Decreased tremor and rigidity in Parkinson’s disease.
Decreased leg restlessness.
Absorption: 55% absorbed following oral administration.
Distribution: Widely distributed.
Metabolism and Excretion: Extensively metabolized by the liver (by cytochrome P450 CYP1A2 enzyme system); <10% excreted unchanged in urine.
Half-life: 6 hr.
Contraindicated in: Hypersensitivity.
Use Cautiously in: Hepatic impairment (slower titration may be required);Severe cardiovascular disease; Obstetric / Lactation / Pediatric: Safety not established; may inhibit lactation; Geriatric: ↑ risk of hallucinations.
Adverse Reactions/Side Effects
Central nervous system
- sleep attacks (life-threatening)
- dizziness (most frequent)
- syncope (most frequent)
- impulse control disorders (gambling, sexual)
Ear, Eye, Nose, Throat
- abnormal vision
- orthostatic hypotension
- peripheral edema
- dry mouth
Drug-Drug interactionDrugs that alter the activity of cytochrome P450 CYP1A2 enzyme system may affect the activity of ropinirole.Effects may be ↑ by estrogens.Effects may be ↓ by phenothiazines, butyrophenones, thioxanthenes, or metoclopramide.May ↑ effects of levodopa (may allow dose ↓ of levodopa).
Oral (Adults) Parkinson's disease—Immediate-release: 0.25 mg 3 times daily for 1 wk, then 0.5 mg 3 times daily for 1 wk, then 0.75 mg 3 times daily for 1 wk, then 1 mg 3 times daily for 1 wk; then may ↑ by 1.5 mg/day every wk up to 9 mg/day; then may ↑ by up to 3 mg/day every wk up to 24 mg/day; Extended-release: 2 mg once daily for 1–2 wk; may ↑ by 2 mg/day every wk up to 24 mg/day. Restless leg syndrome—0.25 mg once daily initially, 1–3 hr before bedtime. After 2 days, ↑ to 0.5 mg once daily and to 1 mg once daily by the end of first week of dosing, then ↑ by 0.5 mg weekly, up to 4 mg/day as needed/tolerated.
Availability (generic available)
Tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg Cost: Generic — 0.25 mg $250.21 / 100, 0.5 mg $250.21 / 100, 1 mg $250.21 / 100, 2 mg $250.21 / 100, 3 mg $259.54 / 100, 4 mg $259.85 / 100, 5 mg $259.85 / 100
Extended-release tablets: 2 mg, 4 mg, 6 mg, 8 mg, 12 mg Cost: Generic — 2 mg $82.05 / 30, 4 mg $164.10 / 30, 6 mg $246.16 / 30, 8 mg $246.16 / 30, 12 mg $410.47 / 30
- Assess BP periodically during therapy.
- Assess patient for drowsiness and sleep attacks. Drowsiness is a common side effect of ropinirole, but sleep attacks or episodes of falling asleep during activities that require active participation may occur without warning. Assess patient for concomitant medications that have sedating effects or may increase serum ropinirole levels (see Interactions). May require discontinuation of therapy.
- Parkinson's Disease: Assess patient for signs and symptoms of Parkinson’s disease (tremor, muscle weakness and rigidity, ataxic gait) prior to and during therapy.
- Restless Leg Syndrome: Assess sleep patterns and frequency of restless leg disturbances.
- Lab Test Considerations: May cause ↑ BUN.
Potential Nursing DiagnosesImpaired physical mobility (Indications)
Risk for injury (Indications, Side Effects)
- Do not confuse ropinirole with Risperdal (risperidone) or risperidone.
- Oral: May be administered with or without food. Administration with food may decrease nausea. Extended-release tablets should be swallowed whole; do not break, crush, or chew.
- Instruct patient to take medication exactly as directed. Missed doses should be taken as soon as possible, but not if almost time for next dose. Do not double doses.
- Caution patient to change positions slowly to minimize orthostatic hypotension.
- May cause drowsiness and unexpected episodes of falling asleep. Caution patient to avoid driving or other activities requiring alertness until response to medication is known. Advise patient to notify health care professional if episodes of falling asleep occur.
- Advise patient to avoid alcohol and other CNS depressants concurrently with ropinirole.
- Advise patient that increasing fluids, sugarless gum or candy, ice, or saliva substitutes may help minimize dry mouth. Consult health care professional if dry mouth continues for >2 wk.
- Advise patient to have periodic skin exams to check for lesions that may be melanoma.
- Advise patient to notify health care professional if new or increased gambling, sexual, or other impulse control disorders occur.
- Decreased tremor and rigidity in Parkinson’s disease.
- Decrease in restless legs and improved sleep.
A trademark for the drug ropinirole hydrochloride.