Ropinirole: Parkinson's and restless legs medicine

Ropinirole is prescribed for two movement-related conditions. In Parkinson's disease it helps with symptoms such as tremor, slowness and stiffness. In restless legs syndrome it eases the uncomfortable urge to move the legs. It is prescription-only, and the NHS says it is for adults aged 18 or over.

It comes as standard tablets and slow-release tablets. UK brand names on the NHS page are Requip, Ipinnia and Repinex. The NHS page does not explain the mechanism, so this guide leaves it at what the medicine is used for.

The NHS gives typical dosing as an illustration, with a build-up over time. Your own plan comes from your prescriber and may differ.

Take it at the same time or times each day. For restless legs, the NHS says to take it at night just before bed. Tablets are swallowed whole with water, and slow-release tablets should not be crushed or chewed.

Food changes things slightly. Standard tablets taken with food reduce the chance of nausea, but slow-release tablets should not be taken with a high-fat meal because that may increase the amount of ropinirole absorbed.

If you miss a dose, skip it and take the next at the usual time. The NHS says to speak to the doctor if doses have been missed for a day or more in Parkinson's, or two days or more in restless legs.

Common effects, in more than 1 in 100 people, are dizziness, tiredness and weakness, stomach pain, heartburn, nausea and vomiting, anxiety or nervousness, and involuntary movements, which are likelier when levodopa-containing medicines are also used. The NHS suggests rising slowly if dizzy, and eating smaller, more frequent meals for stomach upset.

Speak to a doctor about swelling of the legs, feet or hands, or if restless legs get worse.

The NHS says to call 111 or a doctor straight away for excessive daytime sleepiness or sudden sleep attacks during activities, uncontrolled binge eating, gambling, shopping or increased sex drive (an impulse control disorder), hallucinations or confusion, and delusional thinking or paranoia. Family members are often the first to notice these changes, so it helps to tell them what to look for.

Call 999 for swelling of the face or throat, breathing difficulty or wheezing, or other signs of a serious allergic reaction. Report suspected side effects through Yellow Card.

Most adults 18 and over can take ropinirole. The NHS asks people to tell their doctor beforehand if they have had an allergic reaction to it, have kidney or liver disease, have a serious heart condition or blood pressure problems, or have a serious mental health condition such as psychosis.

The NHS names a wide set of interacting medicines: anti-sickness medicines (metoclopramide, prochlorperazine), fluvoxamine, several antipsychotics (sulpiride, amisulpride, risperidone, haloperidol), HRT or contraceptives with high oestrogen (ethinylestradiol), blood pressure medicines, diuretics, sildenafil and tadalafil, ciprofloxacin and warfarin.

Paracetamol or ibuprofen are generally acceptable for mild pain, while stronger painkillers such as codeine, morphine or tramadol need the doctor's approval. The NHS says there is not enough information to say herbal remedies are safe with ropinirole. Alcohol may increase drowsiness, so avoid it initially when starting.

Ropinirole is rarely prescribed in pregnancy because of limited safety information, though a doctor may recommend it if benefits outweigh risks. It is not commonly used while breastfeeding; the NHS notes it may reduce the amount of milk you make. There is no evidence that it affects fertility.

Do not stop it suddenly. Withdrawal symptoms can occur, along with a rare serious reaction called neuroleptic malignant syndrome, so the doctor reduces the dose gradually. For overdose, urgent help is through 111, or 999 for chest pain or an irregular heartbeat.