Side Effects of Requip (ropinorole)

Requip (ropinorole) is an anti-Parkinson’s medication. Requip works by binding to dopamine receptors in the brain. Requip stimulates the dopamine receptors and improves symptoms of Parkinson's disease. It is also a treatment for restless legs syndrome (RLS).

Common side effects of Requip include

• nausea,
• gas (flatulence),
• dizziness,
• sleepiness,
• fatigue,
• flushing,
• hallucinations,
• confusion,
• irregular heart rate and rhythm, and
• confusion.

Serious side effects of Requip include

• falling asleep during activities of daily living, including driving. 

Drug interactions of Requip include the following because these drugs block dopamine receptors and lead to decreased effectiveness of Requip

• phenothiazine,
• atypical antipsychotics, and
• metoclopramide.

Requip should be used with caution with ciprofloxacin because ciprofloxacin slows down the breakdown of Requip, which leads to increased Requip levels in the body.

There are no adequate studies of Requip to determine safe and effective use in pregnant women. It is unknown if Requip enters breast milk. Requip should be avoided while breastfeeding to avoid potential risks to newborn infants.

The most common side effects of Requip include:

• fainting
• sleepiness or drowsiness
• hallucinations (seeing or hearing things that are not real)
• dizziness
• nausea or vomiting
• uncontrolled sudden movements
• leg swelling
• fatigue, tiredness, or weakness
• confusion
• headache
• upset stomach, abdominal pain or discomfort
• increased sweating

Tell your healthcare provider if you have any side effect that bothers you or does not go away.

This is not a complete list of side effects and should not take the place of talking with your healthcare provider. Your healthcare provider or pharmacist can give you a more complete list of possible side effects.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Requip can cause serious side effects, including:

• Hypersensitivity/allergic reactions. You may experience a hypersensitivity/allergic reaction characterized by hives, rash, itching, and/or swelling of the face, lips, mouth, tongue, or throat, which may cause problems in swallowing or breathing. If you experience any of these reactions after starting Requip, you should not take Requip again until you talk to a healthcare provider and seek their advice.
• Falling asleep during normal activities. You may fall asleep while doing normal activities such as driving a car, doing physical tasks, or using hazardous machinery while taking Requip. You may suddenly fall asleep without being drowsy or without warning. This may result in having accidents. Your chances of falling asleep while doing normal activities while taking Requip are greater if you take other medicines that cause drowsiness. Tell your healthcare provider right away if this happens. Before starting Requip, be sure to tell your healthcare provider if you take any medicines that make you drowsy.
• Fainting. Fainting can occur, and sometimes your heart rate may be decreased. This can happen especially when you start taking Requip or your dose is increased. Tell your healthcare provider if you faint or feel dizzy or light-headed.
• Decrease in blood pressure. Requip can decrease your blood pressure(hypotension), especially when you start taking Requip or when your dose is changed. If you feel faint or feel dizzy, nauseated, or sweaty when you stand upfrom sitting or lying down (orthostatic hypotension), this may mean that your blood pressure is decreased. When you change position from lying down or sitting to standing up, you should do it carefully and slowly. Call your healthcare provider if you have any of the symptoms of decreased blood pressure listed above.
• Changes in heart rate (decrease or increase). Requip can decrease or increase your heart rate.
• Unusual urges. Some patients taking Requip get urges to behave in a way unusual for them. Examples of this are an unusual urge to gamble, increased sexual urges and behaviors, or an uncontrollable urge to shop, spend money, or eat. If you notice or your family notices that you are developing any unusual behaviors, talk to your healthcare provider.
• Increased chance of skin cancer (melanoma). It is not known if Requip increases your chance of getting melanoma. You and your healthcare provider should check your skin on a regular basis. Tell your healthcare provider right away if you notice any changes in your skin such as a change in the size, shape, or color of moles on your skin.
• Changes in Restless Legs Syndrome symptoms. Requip may cause Restless Legs symptoms to come back in the morning (rebound), happen earlier in the evening, or even happen in the afternoon.

CYP1A2 Inhibitors And Inducers

In vitro metabolism studies showed that CYP1A2 is the major enzyme responsible for the metabolism of ropinirole. There is thus the potential for inducers or inhibitors of this enzyme to alter the clearance of ropinirole.

Therefore, if therapy with a drug known to be a potent inducer or inhibitor of CYP1A2 is stopped or started during treatment with Requip, adjustment of the dose of Requip may be required.

Coadministration of ciprofloxacin, an inhibitor of CYP1A2, increases the AUC and Cmax of ropinirole. 

Cigarette smoking is expected to increase the clearance of ropinirole since CYP1A2 is known to be induced by smoking.

Estrogens

Population pharmacokinetic analysis revealed that higher doses of estrogens (usually associated with hormone replacement therapy [HRT]) reduced the clearance of ropinirole. Starting or stopping HRT may require adjustment of dosage of Requip.

Dopamine Antagonists

Because ropinirole is a dopamine agonist, it is possible that dopamine antagonists such as neuroleptics (e.g., phenothiazines, butyrophenones, thioxanthenes) or metoclopramide may reduce the efficacy of Requip.