1. About ropinirole
Ropinirole is a medicine used for conditions that affect the way you move. It is used to treat the symptoms of Parkinson's disease and restless legs syndrome.
If you have Parkinson's disease, ropinirole can improve symptoms like shaking (tremors), slowness and stiffness. If you have restless legs syndrome, it helps control your leg muscles.
Ropinirole is only available on prescription and comes as tablets, including slow-release tablets.
2. Key facts
- If you’re taking ropinirole for restless legs syndrome, take it just before you go to bed.
- You’ll usually start on a low dose. This will be increased gradually to help reduce side effects, like feeling sick.
- Some people find that ropinirole makes them fall asleep suddenly. This is more likely to happen while your dose is being increased. Do not drive, ride a bike, or use tools and machinery until you know how this medicine affects you.
- Other possible side effects include twitching or twisting movements (dyskinesias). Your doctor may try changing your dose if this happens.
- Do not stop taking this medicine suddenly. If you need to stop taking it, your doctor or specialist nurse will reduce your dose gradually.
3. Who can and cannot take ropinirole
Most adults (aged 18 and above) can take ropinirole. However, it's not suitable for everyone.
To make sure it's OK for you, tell your doctor if you:
- have ever had an allergic reaction to ropinirole or any other medicine
- have kidney disease or liver disease
- have a serious heart condition or problems with your blood pressure
- have a serious mental health condition such as psychosis
- are pregnant, trying to get pregnant, or breastfeeding
4. How and when to take ropinirole
Ropinirole comes as
- standard tablets (immediate release)
- slow-release tablets (also called prolonged release) that release the medicine into your body gradually
Try to take your ropinirole at the same time, or times, every day.
You can take ropinirole with or without food. However, you're less likely to feel sick if you have it with food.
Swallow the tablets whole with a drink of water. Do not crush or chew the slow-release tablets. This is because they have a coating that lets the medicine into your body gradually.
If you have problems swallowing tablets, speak to a pharmacist or doctor.
Dosage and strength
Standard tablets come as 0.25mg, 0.5mg, 1mg, 2mg and 5mg strength tablets.
Slow-release tablets come as as 2mg, 3mg, 4mg, 6mg and 8mg strength tablets.
Doses vary from person to person. Always follow the instructions from your doctor or specialist nurse.
You will usually start on a low dose. Your doctor or specialist nurse will increase your dose gradually until your symptoms are under control. It's best to take the lowest dose to control your symptoms because this helps reduce the chance of side effects.
Dosage for restless legs syndrome
You will usually start on 0.25mg, taken once a day. It’s best to take it just before bed to help with restless legs syndrome. Your dose will be increased gradually after a few days or weeks, up to a maximum dose of 4mg a day.
Dosage for Parkinson’s disease
You will usually start on 0.25mg, taken 3 times a day. Your dose will be increased each week, up to a usual daily dose of 9mg to 16mg.
However, if you take ropinirole with co-beneldopa or co-careldopa (or any other medicine containing levodopa), the maximum dose can go up 24mg a day.
What if I miss a dose?
If you forget to take a dose of ropinirole, skip the missed dose and take your next one at the usual time.
Do not take a double dose to make up for a forgotten one.
If you take ropinirole for Parkinson's disease and miss your doses for 1 day or more, ask your doctor or specialist nurse for advice on how to start taking it again.
If you take ropinirole for restless legs syndrome and miss your doses for more than 2 days, ask your doctor for advice on how to start taking it again.
Important
Do not stop taking ropinirole suddenly. You can have serious withdrawal symptoms, such as changes in mood, tiredness, sweating and pain. If you need to stop taking it, your doctor or specialist nurse will reduce the dose gradually.
What if I take too much?
Taking 1 extra tablet is unlikely to harm you, but talk to your doctor, specialist nurse or pharmacist if you are concerned.
If you take more than your usual dose, you may get symptoms such as:
- feeling or being sick
- headaches, sweating or feeling dizzy
- feeling confused, or seeing, feeling or hearing things that other people cannot (hallucinations)
- feeling more sleepy or physically weak
- twitching or twisting
Urgent advice: Contact 111 for advice now if:
- you take more than double your total daily dose of ropinirole
- you take more than your usual dose of ropinirole and have any of the symptoms above
Go to 111.nhs.uk or call 111
Immediate action required: Call 999 or go to A&E now if:
You have taken more than your usual dose of ropinirole and:
- you have chest pain
- you have fast or irregular heart beats
If you need to go to hospital, take the medicines packet and any remaining medicine with you. Do not drive yourself. Get someone else to drive you or call for an ambulance.
5. Side effects
Like all medicines, ropinirole can cause side effects. However, many people have no side effects or only minor ones.
Common side effects
These common side effects of ropinirole happen in more than 1 in 100 people.
Keep taking the medicine, but talk to your doctor or pharmacist if these side effects bother you or do not go away:
- dizziness when you get up from sitting or lying down
- feeling tired and weak
- stomach pain
- heartburn
- feeling sick or being sick
- feeling anxious or nervous
- uncontrollable twitching or twisting movements – this is more likely if you've been taking ropinirole for a long time or at a high dose.
Serious side effects
It is possible to have serious side effects with ropinirole. Some are rare and happen in less than 1 in 1,000 people, but others can be more common.
Tell your doctor or specialist nurse if:
- you start binge eating, gambling or shopping uncontrollably or having an unusually high sex drive – these are signs of impulse control disorder
- you feel unusually sleepy or suddenly fall asleep during the day
- you see, feel or hear things that are not there (hallucinations) or feel confused – this is more likely to happen in older people
- your legs, feet or hands become swollen
- your restless legs syndrome gets worse
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to ropinirole.
Immediate action required: Call 999 now if:
- your lips, mouth, throat or tongue suddenly become swollen
- you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
- your throat feels tight or you're struggling to swallow
- your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
- you suddenly become very confused, drowsy or dizzy
- someone faints and cannot be woken up
- a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)
You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.
These can be signs of a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of ropinirole. For a full list, see the leaflet inside your medicines packet.
You can report any suspected side effect using the Yellow Card safety scheme.
6. How to cope with the side effects of ropinirole
What to do about:
- dizziness when you get up from sitting or lying down – try getting up very slowly, or stay sitting down until you feel better. If you still feel dizzy, lie down so you do not faint, then sit up for a while until you feel OK again. Do not drive, cycle, or operate machinery if you feel dizzy. Try to avoid alcohol as it may make you feel worse.
- feeling tired and weak – make sure you rest and drink plenty of fluids and try to avoid alcohol. Do not drive, cycle or use tools or machinery if you are feeling tired or weak. Try to take ropinirole at a time when you can sit or lie down until you feel better. If you're still having problems after a week, speak to your doctor, as they may need to change your medicine.
- stomach pain – it can help to eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on your stomach may also help. If you are in a lot of pain, speak to a doctor or pharmacist.
- heartburn – it might help to eat smaller and more frequent meals, and to eat and drink slowly. Talk to your doctor if the symptoms get worse.
- feeling or being sick - taking your ropinirole after a meal or a snack can help. If you are being sick, have small, frequent sips of water to avoid dehydration. Sickness should improve with time, but if it becomes a problem your doctor may be able to prescribe an anti-sickness medicine. If you take the combined contraceptive pill or progestogen-only pill and you're being sick, your contraception may not protect you from pregnancy. Check the pill packet for advice.
- feeling anxious or nervous – this should improve as your body gets used to the medicine. If it does not, or the symptoms get worse, speak to your doctor or specialist nurse.
- uncontrollable twitching or twisting movements – let your doctor or specialist nurse know as soon as possible. They may need to adjust your dose or medicine.
7. Pregnancy and breastfeeding
Pregnancy and ropinirole
Ropinirole is not often used in pregnancy. This is because there is little information about how the medicine may affect your baby. However, your doctor may advise you to take it if they think the benefits of taking the medicine outweigh any risks.
If you become pregnant while taking ropinirole, speak to your doctor as soon as possible.
Breastfeeding and ropinirole
Ropinirole is not often used when breastfeeding.
The medicine can make breastfeeding more difficult as it can reduce the amount of milk your body makes.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
- pregnant
- breastfeeding
8. Cautions with other medicines
There are some medicines that do not mix well with ropinirole.
Tell your doctor, specialist nurse or pharmacist if you're taking any of these medicines before starting ropinirole:
- anti-sickness medicines, such as metoclopramide or prochlorperazine
- antidepressants or antipsychotic medicines, such as fluvoxamine, amisulpride, risperidone or haloperiodol
- hormone replacement therapy (HRT) or contraceptives that contain high levels of oestrogen (ethinylestradiol)
- medicines that can lower your blood pressure – blood pressure medicines, tablets that make you pee more (diuretics), or erectile dysfunction medicines such as sildenafil (Viagra) or tadalafil (Cialis)
- ciprofloxacin, an antibiotic
- warfarin, to prevent blood clots (anticoagulant)
Taking painkillers with ropinirole
It's usually OK to take mild painkillers, such as paracetamol or ibuprofen, if you need pain relief.
Check with your doctor before taking any stronger prescription painkillers (including opioids) such as codeine, morphine or tramadol).
Mixing ropinirole with herbal remedies and supplements
There’s very little information about taking herbal remedies and supplements with ropinirole. Not enough research has been done to know whether they can affect your medicine.
Important: Medicine safety
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
9. Common questions about ropinirole
How does ropinirole work?
Ropinirole belongs to a group of medicines called dopamine agonists. Dopamine is an important chemical which sends nerve messages from your brain to your muscles.
With Parkinson's disease, you have less dopamine, so it's harder for your brain to send these messages. This can give you the shakes, as well as making your muscles stiff and your movements slow.
Ropinirole works by copying natural dopamine in the brain. This helps improve movement symptoms related to low dopamine levels in the body, such as in Parkinson's and restless legs syndrome.
How long does it take to work?
You may notice an improvement after taking your first dose. However, it can take up to 1 week for ropinirole to have its full effect.
Talk to your specialist if your symptoms do not improve after taking ropinirole for 2 to 3 weeks.
How long will I take it for?
You can keep taking this medicine as long as it's controlling your symptoms and you're not having any serious side effects. Many people take ropinirole for several months or even years.
Is it safe to take for a long time?
Many people take ropinirole safely for many months or years.
Ropinirole may be an effective treatment for Parkinson’s disease for several years, taken either on its own or with other Parkinson’s medicines such as co-careldopa or co-beneldopa.
However, it may not work for everyone. Speak to your doctor or specialist nurse if you feel your symptoms are getting worse - you may need to have your dose changed.
What will happen if I stop taking it?
If you stop taking ropinirole, your symptoms will return unless you are taking other medicines for Parkinson’s disease or restless legs syndrome.
Do not stop taking ropinirole suddenly. It can lead to serious withdrawal symptoms, such as changes in mood, tiredness, sweating and pain.
If you need to stop taking this medicine, your doctor or specialist nurse will reduce the dose gradually. This will help prevent withdrawal symptoms.
Can I smoke with ropinirole?
Smoking can affect the way ropinirole works.
If you stop or start smoking, or take it up again, while you're on ropinirole, your dose may need to be adjusted. Let your doctor know if you are thinking of stopping or starting smoking.
Can I drink alcohol with it?
Drinking alcohol while taking ropinirole may make you feel sleepy or tired. When you first start taking ropinirole it's best to stop drinking alcohol, until you see how the medicine affects you.
Is there any food or drink I need to avoid?
Apart from being careful about alcohol, you can eat and drink normally while taking ropinirole.
It is best to take ropinirole with food if you can – you'll be less likely to feel or be sick.
Are there similar medicines to ropinirole?
Ropinirole belongs to a group of medicines called dopamine receptor agonists.
Dopamine receptor agonists fall into 2 types of medicine:
- ergot-derived dopamine agonists such as bromocriptine, cabergoline and pergolide – originally made from a type of fungus called ergot
- non ergot-derived dopamine receptor agonists such as ropinirole, pramipexole and rotigotine
Non ergot-derived dopamine receptor agonists are usually preferred, as they have fewer side effects on the heart.
There are also several other medicines that work differently to ropinirole that can be used to treat Parkinson’s disease or restless legs syndrome. So if ropinirole does not work for you, or you are bothered by side effects, speak to your doctor or specialist nurse. They may be able to discuss other options.
Will it affect my contraception?
Ropinirole does not stop contraception working, including the combined pill and emergency contraception.
However, the oestrogen (ethinylestradiol) in some contraceptives may increase the amount of ropinirole in your body, so your dose of ropinirole may need to be reduced.
Speak to your doctor or pharmacist before taking ropinirole if you are taking a contraceptive that contains oestrogen. This includes the combined pill, contraceptive patch and vaginal ring.
If ropinirole is not working for you and you're being sick, your contraceptive pills may not protect you from pregnancy. Check the pill packet to find out what to do.
Find out more:
Will it affect my fertility?
There's no evidence to suggest that taking ropinirole reduces fertility.
However, speak to a pharmacist or your doctor before taking it if you're trying to get pregnant. Ropinirole is not usually recommended during pregnancy.
Can I drive or ride a bike?
Some people find ropinirole can make them feel dizzy or sleepy, or makes them fall asleep suddenly. This is more likely to happen when your dose is being increased. If this happens to you, do not drive, cycle or use tools or machinery.
Speak to your doctor. They will tell you when you can start driving again once these side effects stop.
If you've been diagnosed with Parkinson's disease, you must tell the DVLA and your car insurance company as soon as possible.
What else can help with symptoms of Parkinson's disease?
There's currently no cure, but there are treatments for Parkinson's disease to help relieve the symptoms and maintain your quality of life.
These treatments include:
- supportive therapies, such as physiotherapy or speech therapy
- medicines
- a type of surgery called deep brain stimulation
You may not need any treatment during the early stages of Parkinson's disease, as symptoms are usually mild. But you may need regular appointments with your specialist so your condition can be monitored.
A care plan will usually be agreed with your healthcare team and you and your family or carers. This will outline the treatments and help you need now and what you're likely to need in the future. This will need to be reviewed regularly.
Regular exercise is particularly important because it helps relieve muscle stiffness, improves mood and relieves stress. Find out more about living with Parkinson’s disease, including advice on staying active.
What else can help with restless legs syndrome?
The symptoms of restless legs syndrome will usually improve by treating the underlying cause, such as iron deficiency anaemia or cardiovascular disease.
But if the cause is unknown, the symptoms can get worse with time and severely affect your life. In this case there are other treatments for restless legs syndrome that can help.
These include:
- relaxation exercises, leg massage, or taking a hot bath in the evening
- lifestyle changes such as stopping smoking, getting more sleep, and exercise. If you want to give up smoking, talk to your doctor about the different ways to stop.