Ropinirole Dosage

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Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Parkinson's Disease

Immediate-release tablets:
Initial:
0.25 mg orally three times daily

Dosage may be titrated upwards with weekly increments to achieve maximum therapeutic effect:

Week 1, give 0.25 mg orally three times daily, not to exceed a daily dose of 0.75 mg
Week 2, give 0.5 mg orally three times daily, not to exceed a daily dose of 1.5 mg
Week 3, give 0.75 mg orally three times daily, not to exceed a daily dose of 2.25 mg
Week 4, give 1 mg orally three times daily, not to exceed a daily dose of 3 mg
Week 5 or greater, see section below: dose adjustments

Maximum dosage studied is 24 mg/day

Extended-release tablets:
Initial:
2 mg orally once daily for 1 to 2 weeks, followed by increases of 2 mg/day at 1-week or longer intervals as appropriate, depending on therapeutic response and tolerability

Maximum dosage studied is 24 mg/day

Switching from ropinirole IR to ropinirole ER:
Patients may be switched directly from ropinirole IR to ropinirole ER tablets. The initial dose of ropinirole ER should most closely match the total daily dose of the ropinirole IR, as shown below:

If total daily dose of ropinirole IR is 0.75 to 2.25 mg, give a total daily dose of 2 mg of ropinirole ER.
If total daily dose of ropinirole IR is 3 to 4.5 mg, give a total daily dose of 4 mg of ropinirole ER.
If total daily dose of ropinirole IR is 6 mg, give a total daily dose of 6 mg of ropinirole ER.
If total daily dose of ropinirole IR is 7.5 to 9 mg, give a total daily dose of 8 mg of ropinirole ER.
If total daily dose of ropinirole IR is 12 mg, give a total daily dose of 12 mg of ropinirole ER.
If total daily dose of ropinirole IR is 15 to 18 mg, give a total daily dose of 16 mg of ropinirole ER.
If total daily dose of ropinirole IR is 21 mg, give a total daily dose of 20 mg of ropinirole ER.
If total daily dose of ropinirole IR is 24 mg, give a total daily dose of 24 mg of ropinirole ER.

Usual Adult Dose for Restless Legs Syndrome

Immediate-release tablets:
Initial:
0.25 mg orally once daily, 1 to 3 hours before bedtime. After 2 days, the dosage can be increased to 0.5 mg once daily and to 1 mg once daily at the end of the first week of dosing, then as indicated below to achieve efficacy.

Days 1 and 2, give 0.25 mg orally once daily
Days 3 to 7, give 0.5 mg orally once daily
Week 2, give 1 mg orally once daily
Week 3, give 1.5 mg orally once daily
Week 4, give 2 mg orally once daily
Week 5, give 2.5 mg orally once daily
Week 6, give 3 mg orally once daily
Week 7, give 4 mg orally once daily

Renal Dose Adjustments

Ropinirole has not been studied in patients with severe renal impairment (CrCl less than 30 mL/min).

Liver Dose Adjustments

The manufacturer recommends to titrate dosage with caution if used in patients with severe hepatic impairment since these patients may have higher plasma levels and lower clearance.

Dose Adjustments

If necessary in Parkinson's disease, after week 4, daily dosage may be increased by 1.5 mg/day on a weekly basis, up to a dose of 9 mg/day, and then by up to 3 mg/day weekly to a total dose of 24 mg/day.

If ropinirole is administered as adjunct therapy to levodopa, the concurrent dose of levodopa may be decreased gradually as tolerated (the average dose reduction of levodopa with ropinirole IR was 31% and 34% with ropinirole ER).

Ropinirole should be discontinued gradually over 7 days. The dosage schedule should be reduced to twice daily for 4 days. Then, for the remaining 3 days, the frequency should be reduced to once daily until complete withdrawal.

Dosage adjustments may be required if a medication known to be a potent inhibitor of CYP450 1A2 is stopped or started during treatment with ropinirole.

Precautions

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

Data not available

Other Comments

Restless legs syndrome patients on doses of ropinirole 4 mg daily were discontinued without a taper.

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