Ropinirole

Ropinirole, sold under the brand name Requip among others, is a medication used to treat Parkinson's disease (PD) and restless legs syndrome (RLS).[3] In PD the dose needs to be adjusted to the effect and treatment should not be suddenly stopped.[3] It is taken by mouth.[4]

Ropinirole
Clinical data
Trade namesRequip, Repreve, Ronirol, others
AHFS/Drugs.comMonograph
MedlinePlusa698013
Routes of
administration		By mouth
ATC code
Legal status
Legal status
  • BR: Class C1 (Other controlled substances)[1]
  • In general: ℞ (Prescription only)
Pharmacokinetic data
Bioavailability50%[2]
MetabolismLiver (CYP1A2)[2]
Elimination half-life5-6 hours[2]
Identifiers
  • 4-[2-(Dipropylamino)ethyl]-1,3-dihydro-2H-indol-2-one
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.110.353
Chemical and physical data
FormulaC16H24N2O
Molar mass260.381 g·mol−1
3D model (JSmol)
  • O=C2Nc1cccc(c1C2)CCN(CCC)CCC
  • InChI=1S/C16H24N2O/c1-3-9-18(10-4-2)11-8-13-6-5-7-15-14(13)12-16(19)17-15/h5-7H,3-4,8-12H2,1-2H3,(H,17,19) checkY
  • Key:UHSKFQJFRQCDBE-UHFFFAOYSA-N checkY
  (verify)

Common side effects include sleepiness, vomiting, and dizziness.[4] Serious side effects may include pathological gambling, low blood pressure with standing and hallucinations.[3][4] Use in pregnancy and breastfeeding is of unclear safety.[5] It is a dopamine agonist and works by triggering dopamine D2 receptors.[4]

It was approved for medical use in the United States in 1997.[4] It is available as a generic medication.[3] In 2020, it was the 156th most commonly prescribed medication in the United States, with more than 3 million prescriptions.[6][7]

Medical uses

Ropinirole is prescribed for mainly Parkinson's disease, RLS and extrapyramidal symptoms. It can also reduce the side effects caused by selective serotonin reuptake inhibitors, including Parkinsonism syndrome as well as sexual dysfunction and erectile dysfunction caused by either SSRIs[8] or antipsychotics.

Dosage

Ropinirole is available in various preparations, ranging from a 0.25 mg tablet to a 5 mg tablet. The primary reason is dose titration. Prolonged-release tablets are available in 2–8 mg doses.

For Parkinson's disease, the maximum recommended dose is 24 mg per day, taken in three separate doses spread throughout the day for the immediate-release formulation. The maximum dose recommendations of ropinirole for subjects with end stage renal disease (ESRD) should be reduced by 25% compared with those recommended for subjects with normal renal function. A 25% dose reduction represents a more straightforward dosage regimen in terms of available tablet strength, compared with a 30% dose reduction.[9]

For RLS, the maximum recommended dose is 4 mg per day, taken 1 to 3 hours before bedtime. A 52-week open label study had a mean dosage of 1.90 mg, once daily 1 to 3 hours before bedtime.[10]

Side effects

Ropinirole can cause nausea, dizziness, hallucinations, orthostatic hypotension, and sudden sleep attacks during the daytime. Unusual side effects specific to D3 agonists such as ropinirole and pramipexole can include hypersexuality, punding and compulsive gambling, even in patients without a history of these behaviours.[11]

Ropinirole is also known to cause an effect known as "augmentation" when used to treat restless legs syndrome, where over time treatment with dopamine agonists will cause RLS symptoms to become more severe. This usually leads to constant dosage increases in an attempt to offset the symptom progression. Symptoms will return to the level of severity they were experienced at before treatment was initiated if the drug is stopped; however, both ropinirole and pramipexole are known to cause painful withdrawal effects when treatment is stopped and the process of taking a patient who has been using the medication long-term off of these drugs is often very difficult and generally should be supervised by a medical professional.[12]

Pharmacology

Ropinirole acts as a D2, D3, and D4 dopamine receptor agonist with highest affinity for D3, which are mostly found in the limbic areas.[13] It is weakly active at the 5-HT2, and α2 receptors and is said to have virtually no affinity for the 5-HT1, GABA, mAChRs, α1, and β-adrenoreceptors.[14]

Ropinirole is metabolized primarily by cytochrome P450 CYP1A2 to form two metabolites; SK&F-104557 and SK&F-89124, both of which are renally excreted,[9] and at doses higher than clinical, is also metabolized by CYP3A4. At doses greater than 24 mg, CYP2D6 may be inhibited, although this has been tested only in vitro.[2]

Society and culture

It is manufactured by GlaxoSmithKline (GSK), Mylan Pharmaceuticals, Cipla, Dr. Reddy's Laboratories and Sun Pharmaceutical. The discovery of the drug's utility in RLS has been used as an example of successful drug repurposing.[15]

Lawsuits

In November 2012, GlaxoSmithKline was ordered by a Rennes appeals court to pay Frenchman Didier Jambart 197,000 euros ($255,824); Jambart had taken ropinirole from 2003 to 2010 and exhibited risky hypersexual behavior and gambled excessively until stopping the medication.[16]

References
  1. Anvisa (31 March 2023). "RDC Nº 784 - Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial" [Collegiate Board Resolution No. 784 - Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control] (in Brazilian Portuguese). Diário Oficial da União (published 4 April 2023). Archived from the original on 3 August 2023. Retrieved 16 August 2023.
  2. Tompson DJ, Vearer D (December 2007). "Steady-state pharmacokinetic properties of a 24-hour prolonged-release formulation of ropinirole: results of two randomized studies in patients with Parkinson's disease". Clinical Therapeutics. 29 (12): 2654–2666. doi:10.1016/j.clinthera.2007.12.010. PMID 18201581.
  3. British National Formulary (76th ed.). Pharmaceutical Press. 2018. pp. 419–420. ISBN 978-0-85711-338-2.
  4. "Ropinirole Hydrochloride Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 3 March 2019.
  5. "Ropinirole Pregnancy and Breastfeeding Warnings". Drugs.com. Retrieved 3 March 2019.
  6. "The Top 300 of 2020". ClinCalc. Retrieved 7 October 2022.
  7. "Ropinirole - Drug Usage Statistics". ClinCalc. Retrieved 7 October 2022.
  8. Clinical trial number NCT00334048 at ClinicalTrials.gov - "Treating Sexual Dysfunction From SSRI Medication: a Study Comparing Requip CR to Placebo"
  9. Tompson D, Hewens D, Earl N, Oliveira D, Taubel J, Swan S, Giorgi L (7–11 June 2009). An open-label, parallel-group, repeat-dose study to investigate the effects of end-stage renal disease and haemodialysis on the pharmacokinetics of ropinirole] (PDF). 13th International Congress of Parkinson’s Disease and Movement Disorders. Paris, France. Archived from the original (PDF) on 17 March 2012.
  10. Garcia-Borreguero D, Grunstein R, Sridhar G, Dreykluft T, Montagna P, Dom R, et al. (November 2007). "A 52-week open-label study of the long-term safety of ropinirole in patients with restless legs syndrome". Sleep Medicine. 8 (7–8): 742–752. doi:10.1016/j.sleep.2006.09.009. PMID 17512789.
  11. Bostwick JM, Hecksel KA, Stevens SR, Bower JH, Ahlskog JE (April 2009). "Frequency of new-onset pathologic compulsive gambling or hypersexuality after drug treatment of idiopathic Parkinson disease". Mayo Clinic Proceedings. 84 (4): 310–316. doi:10.4065/84.4.310. PMC 2665974. PMID 19339647.
  12. "What is Augmentation?" (PDF). Austin, Texas: Restless Legs Syndrome (RLS) Foundation. Archived from the original (PDF) on 9 May 2018. Retrieved 8 May 2018.
  13. Shill HA, Stacy M (2009). "Update on ropinirole in the treatment of Parkinson's disease". Neuropsychiatric Disease and Treatment. 5: 33–36. PMC 2695212. PMID 19557097.
  14. Eden RJ, Costall B, Domeney AM, Gerrard PA, Harvey CA, Kelly ME, et al. (January 1991). "Preclinical pharmacology of ropinirole (SK&F 101468-A) a novel dopamine D2 agonist". Pharmacology, Biochemistry, and Behavior. 38 (1): 147–154. doi:10.1016/0091-3057(91)90603-Y. PMID 1673248. S2CID 26842270.
  15. Lipp E (1 August 2008). "Novel Approaches to Lead Optimization". Genetic Engineering & Biotechnology News. Drug Discovery. Vol. 28, no. 14. Mary Ann Liebert. p. 20. ISSN 1935-472X. Retrieved 28 September 2008. Note: The opinion that ropinirole's use in RLS was a successful example of drug repurposes was reported as being that of Josef Scheiber, a post-doctoral fellow at the Novartis Institutes for BioMedical Research.
  16. Wong C (29 November 2012). "Court Rules Parkinson's Drug Turned Straight Patient Into A Gay Sex Addict". Huffington Post.
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