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Generic Name: Ropinirole Hydrochloride
Class: Nonergot-derivative Dopamine Receptor Agonists
VA Class: CN500
Chemical Name: 4-[2-(Dipropylamino)ethyl]-1,3-dihydro-2(H)-indol-2-one monohydrochloride
Molecular Formula: C16H24N2O•ClH
CAS Number: 91374-20-8

Introduction

Nonergot-derivative dopamine receptor agonist.1 2 3 4 5 7 14 15 16

Uses for Requip

Parkinsonian Syndrome

Symptomatic management of idiopathic parkinsonian syndrome.1 2 3 4 5 7 8 11 13 14 15

Slideshow: 10 Common Sleep Disorders: Treatments and Truths

Used as an adjunct to levodopa for the symptomatic management of parkinsonian syndrome in patients with advanced disease.18 19

Also used as monotherapy for the initial symptomatic management of parkinsonian syndrome.18 Most clinicians would use levodopa for initial therapy in individuals >70 years of age (less likely than younger individuals to develop levodopa-related motor complications and because of concerns about cognitive dysfunction), in patients with cognitive impairment, and in those with severe disease.18 A dopamine receptor agonist may be preferred for initial therapy in patients ≤70 years of age.18

Restless Legs Syndrome

Symptomatic management of moderate-to-severe primary restless legs syndrome (Ekbom syndrome).1 21 22 23 24 25 26 27

Requip Dosage and Administration

Administration

Oral Administration

Parkinsonian syndrome: Administer orally, usually in 3 equally divided doses daily.1 13

Restless legs syndrome: Administer orally once daily, 1–3 hours before bedtime.1

May be administered without regard to meals;1 however, taking the drug with food may reduce the occurrence of nausea.1

If a dose is skipped, do not administer a double dose to make up for the missed dose.1

Dosage

Available as ropinirole hydrochloride; dosage expressed in terms of ropinirole.1 17

Adults

Parkinsonian Syndrome
Oral

Initiate at a low dosage and increase slowly until the maximum therapeutic response is achieved.1

Table 1. Usual Initial Dosage of Ropinirole for the Treatment of Parkinsonian Syndrome1

Week of Therapy

Daily Dosage Schedule

Total Daily Dose

1

0.25 mg 3 times daily

0.75 mg daily

2

0.5 mg 3 times daily

1.5 mg daily

3

0.75 mg 3 times daily

2.25 mg daily

4

1 mg 3 times daily

3 mg daily

After week 4

 

Daily dosage may be increased by 1.5 mg daily each week up to 9 mg daily, and then by up to 3 mg daily each week to a total daily dosage of 24 mg1 13

Continually reevaluate and adjust the dosage according to the needs of the patient in an effort to find a dosage schedule that provides maximum relief of symptoms with minimum adverse effects.17

When ropinirole is used as an adjunct to levodopa, the levodopa dosage may be decreased gradually as tolerated.1

Discontinue ropinirole therapy gradually over a period of 1 week.1 Reduce the frequency of administration from 3 times daily to twice daily for 4 days and then to once daily for 3 days before complete discontinuance of the drug.1 (See Nervous System and Muscular Effects under Cautions.)

If therapy is interrupted for a substantial period of time, reinitiation at initial recommended dosage (see Table 1) may be warranted.1

Restless Legs Syndrome
Oral

Initiate at a low dosage and increase slowly based on clinical response and tolerability.1

Table 2. Usual Initial Dosage of Ropinirole for the Treatment of Restless Legs Syndrome1

Day/Week of Therapy

Daily Dosage

Days 1 and 2

0.25 mg once daily

Days 3–7

0.5 mg once daily

Week 2

1 mg once daily

Week 3

1.5 mg once daily

Week 4

2 mg once daily

Week 5

2.5 mg once daily

Week 6

3 mg once daily

Week 7

4 mg once daily

Has been discontinued without gradually reducing the dosage in patients receiving up to 4 mg once daily.1

If therapy is interrupted for a substantial period of time, reinitiation at initial recommended dosage (see Table 2) may be warranted.1

Prescribing Limits

Adults

Parkinsonian Syndrome
Oral

Dosages >24 mg daily have not been evaluated in clinical trials.1

Restless Legs Syndrome
Oral

Safety and efficacy not established for dosages >4 mg once daily.1

Special Populations

Hepatic Impairment

Titrate dosage carefully.1 Manufacturers make no specific recommendations for dosage adjustment.1 29

Renal Impairment

No dosage adjustments necessary in patients with Clcr of 30–50 mL/minute.1 Manufacturers make no specific recommendations for dosage adjustment in patients with severe renal impairment.1 29

Geriatric Patients

No dosage adjustments necessary in patients >65 years of age, since therapy is initiated at a low dosage and titrated according to clinical response.1

Cautions for Requip

Contraindications

  • Known hypersensitivity to ropinirole hydrochloride or any ingredient in the formulation.1

Warnings/Precautions

Warnings

Somnolence

Episodes of falling asleep while engaged in activities of daily living (e.g., business meetings, telephone calls, driving), which occasionally resulted in accidents, have been reported,1 18 20 in some cases as late as 1 year after initiation of ropinirole therapy.1 Some patients perceived no warning signs (e.g., excessive drowsiness) and believed that they were alert immediately prior to the event;1 18 20 many experts believe that falling asleep while engaged in such activities always occurs in a setting of preexisting somnolence, although patients may not give such a history.1 18

Somnolence reported more frequently in patients with parkinsonian syndrome than in those with restless legs syndrome.1

Concurrent use of other CNS depressants may cause additive sedative effects.1

Patients should not drive or operate other machinery until effects on the individual are known.1

Continually reassess patients for drowsiness or sleepiness.1 Patients may not acknowledge drowsiness or sleepiness until directly questioned about such adverse effects during specific activities.1 Ask patients about any factors that may increase the risk of somnolence (e.g., concomitant sedating drugs, the presence of sleep disorders [other than restless legs syndrome], concomitant drugs that increase plasma ropinirole concentrations).1

Ropinirole generally should be discontinued if a patient develops clinically important daytime sleepiness or episodes of falling asleep during activities that require active participation (e.g., conversations, eating).1 If the drug is continued, the patient should be advised not to drive and to avoid other potentially dangerous activities.1 Insufficient information to establish that dosage reduction will eliminate episodes of falling asleep while engaged in activities of daily living.1

Orthostatic Hypotension and Syncope

Ropinirole and other dopamine agonists appear to impair systemic regulation of BP, resulting in postural hypotension.1

Syncope, sometimes associated with bradycardia, has been reported in patients with parkinsonian syndrome or restless legs syndrome.8 9 10 11 13 15 1 Episodes reported in those with parkinsonian syndrome generally occurred >4 weeks after initiation of therapy and in association with a recent increase in ropinirole dosage.1 8 9 10 11 13 15

Because patients with parkinsonian syndrome generally have a reduced capacity to respond to orthostatic challenge, carefully monitor these patients for manifestations of orthostatic hypotension, especially during dosage escalation.1 Caution patients about rising rapidly after sitting or lying down, especially if they have been in a seated or recumbent position for prolonged periods and/or if they are just beginning ropinirole therapy.1

Use with caution in patients with severe cardiovascular disease.1

Hallucinations

Potential for hallucinations,1 13 14 particularly in geriatric patients with parkinsonian syndrome, those receiving concomitant levodopa, and those receiving higher dosages of ropinirole.1

General Precautions

Nervous System and Muscular Effects

Although not reported in clinical trials with ropinirole, a symptom complex resembling neuroleptic malignant syndrome (NMS; e.g., elevated temperature, muscular rigidity, altered consciousness, autonomic instability) has been reported in association with rapid dosage reduction of, withdrawal of, or changes in antiparkinsonian therapy.1

If ropinirole therapy is discontinued in patients receiving the drug for parkinsonian syndrome, gradual dosage reduction over a period of 1 week is recommended.1 (See Dosage under Dosage and Administration.)

Fibrotic Effects

Retroperitoneal fibrosis, pulmonary infiltrates, pleural effusion, thickening of pleura, pericarditis, and cardiac valvulopathy reported in patients receiving ergot-derivative dopamine receptor agonists (e.g., bromocriptine, pergolide);1 presumably related to the ergoline structure of these agents.1 Not known whether non-ergot-derived drugs that increase dopaminergic activity (e.g., ropinirole) may induce similar changes.1

Pleural effusion, pleural fibrosis, interstitial lung disease, and cardiac valvulopathy reported in preliminary studies and during postmarketing surveillance of ropinirole.1 Causal relationship not established; however, the possibility that ropinirole may have a contributory role cannot be excluded.1

Melanoma

Melanoma observed more frequently in patients with parkinsonian syndrome than in the general population.1 Ropinirole has not been specifically associated with an increased risk; however, the possible association between ropinirole and melanoma has not been systematically evaluated.1 Periodic dermatologic screening is recommended in patients receiving ropinirole, regardless of the indication for use.1

Other Considerations in Patients with Parkinsonian Syndrome

May potentiate adverse dopaminergic effects of levodopa and may cause or exacerbate preexisting dyskinesias.1 Reduction of levodopa dosage may ameliorate these adverse effects.1

Other Considerations in Patients with Restless Legs Syndrome

Worsening of symptoms in the early morning hours (rebound) or earlier onset of symptoms in the evening or afternoon, increase in symptoms, or spread of symptoms to involve other extremities (augmentation) reported in patients receiving dopaminergic drugs for restless legs syndrome.1 Frequency of these events in patients receiving ropinirole not evaluated.1 Management of these events not evaluated.1

Ocular Effects

A 2-year study in patients with parkinsonian syndrome did not reveal clinically important differences in retinal function (evaluated by ocular electroretinogram assessments) in those receiving ropinirole compared with those receiving levodopa.1

Retinal degeneration reported in albino rats receiving ropinirole for 2 years at dosages 0.6–20 times the maximum recommended human dosage on a mg/m2 basis; similar changes not observed in albino mice or in rats or monkeys treated for 1 year.1 Clinical importance in humans not established.1

Ropinirole binds to melanin-rich tissues (e.g., eye) in pigmented rats; not known whether accumulation of the drug in these tissues occurs over time.1

Possible Prescribing and Dispensing Errors

Ensure accuracy of prescription; similarities in both the trade (brand) and generic (nonproprietary) names, similarities in container labels and carton packaging, illegible handwriting on prescriptions, and overlapping product characteristics (e.g., drug strengths, dosage forms, dosage intervals) between risperidone (Risperdal, an antipsychotic agent) and ropinirole hydrochloride (Requip) may result in medication errors.28 These errors have required hospitalization in some cases.28

Specific Populations

Pregnancy

Category C.1

Lactation

Ropinirole and/or its metabolites are distributed into milk in rats.1 Not known whether ropinirole is distributed into human milk.1 Ropinirole inhibits prolactin secretion and could potentially inhibit lactation.1 Discontinue nursing or the drug.1

Pediatric Use

Safety and efficacy not established in children.1

Geriatric Use

Geriatric patients are at increased risk for hallucinations.1

Hepatic Impairment

Use with caution.1 Clearance may be reduced.1

Renal Impairment

Use has not been evaluated in patients with severe renal impairment or in those undergoing hemodialysis.1 Use with caution in these patients.1

Common Adverse Effects

Patients with early parkinsonian syndrome (without levodopa): Nausea, dizziness, somnolence, syncope, vomiting, fatigue, viral infection, dyspepsia, pain, leg edema, increased sweating, asthenia, dependent edema, orthostatic symptoms, abdominal pain, pharyngitis, abnormal vision, dry mouth, hypertension, confusion, hallucinations, urinary tract infection.1

Patients with advanced parkinsonian syndrome (with concomitant levodopa): Dyskinesia, nausea, dizziness, somnolence, headache, hallucinations, falls, abdominal pain, confusion, upper respiratory tract infection, increased sweating, vomiting, arthralgia, tremor, anxiety, urinary tract infection, constipation, pain, hypokinesia, paresthesia, diarrhea, amnesia, nervousness.1

Patients with restless legs syndrome: Nausea, somnolence, vomiting, dizziness, fatigue.1

Interactions for Requip

Metabolized principally by CYP1A2.1

Drugs Affecting Hepatic Microsomal Enzymes

Potential for pharmacokinetic interactions with drugs that are inhibitors or inducers of CYP1A2, with possible alteration in metabolism of ropinirole.1 If a potent CYP1A2 inhibitor is initiated or discontinued during treatment with ropinirole, adjustment of the ropinirole dosage may be required.1

Dopamine Antagonists

Possible pharmacodynamic interaction, resulting in diminished effectiveness of ropinirole.1

Specific Drugs

Drug

Interaction

Comments

Amantadine

Alteration of oral clearance of ropinirole is unlikely1

 

Anticholinergic agents

Alteration of oral clearance of ropinirole is unlikely1

 

Antidepressants, tricyclics

Alteration of oral clearance of ropinirole is unlikely1

 

Antihistamines

Alteration of oral clearance of ropinirole is unlikely1

 

Antipsychotic agents (e.g., phenothiazines, butyrophenones, thioxanthenes)

Dopamine antagonist activity of the antipsychotic agent may diminish effectiveness of ropinirole1

Use concomitantly in patients with major psychotic disorders only if the potential benefits outweigh the risks1

Benzodiazepines

Alteration of oral clearance of ropinirole is unlikely1

 

Ciprofloxacin

Increased peak plasma concentration and AUC of ropinirole1

Use with caution1

CNS depressants (e.g., alcohol, antidepressants, antipsychotics, benzodiazepines)

Possible additive sedative effects1

Use with caution1

Digoxin

Pharmacokinetic interaction unlikely1

 

Diuretics, thiazides

Alteration of oral clearance of ropinirole is unlikely1

 

Estrogens (e.g., ethinyl estradiol)

Reduced oral clearance of ropinirole1

If estrogen therapy is initiated or discontinued during treatment with ropinirole, adjustment of the ropinirole dosage may be required1

Ibuprofen

Alteration of oral clearance of ropinirole is unlikely1

 

Levodopa

Parkinsonian syndrome: Additive therapeutic and/or adverse (e.g., dyskinesia) effects1 17

Parkinsonian syndrome: Consider a reduction in levodopa dosage when ropinirole is added to levodopa therapy1 17

Metoclopramide

Dopamine antagonist activity of metoclopramide may diminish effectiveness of ropinirole1

 

Selegiline

Alteration of oral clearance of ropinirole is unlikely1

 

Smoking

Smoking is expected to increase the clearance of ropinirole, since CYP1A2 is induced by smoking1

 

Theophylline

Pharmacokinetic interaction unlikely1

 

Requip Pharmacokinetics

Absorption

Bioavailability

Rapidly absorbed after oral administration, with peak plasma concentration attained in approximately 1–2 hours.1

Appears to undergo first-pass metabolism; absolute bioavailability is about 55%.1

Food

Food decreases the rate but not the extent of absorption; time to peak plasma concentration is delayed by about 2.5 hours and peak plasma concentration is reduced.1

Distribution

Extent

Widely distributed throughout the body.1

Plasma Protein Binding

Up to 40%.1

Elimination

Metabolism

Extensively metabolized in the liver by N-despropylation and hydroxylation to form inactive metabolites.1 Metabolism is mediated principally by CYP1A2.1

Elimination Route

Excreted in urine principally as metabolites; <10% of an administered dose is excreted in urine as unchanged drug.1

Half-life

Approximately 6 hours.1

Special Populations

In patients >65 years of age, oral clearance of ropinirole is reduced by 30%.1

Pharmacokinetics not evaluated to date in patients with hepatic impairment; however, clearance may be reduced and plasma concentrations increased.1

Pharmacokinetics not altered in patients with Clcr of 30–50 mL/minute.1 Not evaluated to date in patients with severe renal impairment or in those undergoing hemodialysis;1 however, removal of substantial amounts of the drug by hemodialysis is unlikely because of the drug’s large apparent volume of distribution.17

Stability

Storage

Oral

Tablets

Tightly closed container at 20–25°C.1 Protect from light and moisture.1

Actions

  • Exhibits high binding specificity for and intrinsic activity at dopamine D2 receptors in vitro9 10 11 13 14 15 compared with other dopamine receptor agonists (e.g., bromocriptine, pergolide); has a higher affinity for the D3 subtype than for the D2 or D4 subtypes.1 7

  • Parkinsonian syndrome: Appears to act by directly stimulating postsynaptic dopamine receptors in the corpus striatum.8 10 17

  • Restless legs syndrome: Mechanism of action of ropinirole is unknown.1 The dopaminergic system appears to be involved in the pathogenesis of this syndrome.1

Advice to Patients

  • Importance of reading patient information leaflet before initiating therapy and each time the drug is dispensed.1

  • Importance of taking as prescribed; if a dose is missed, advise not to double next dose.1

  • Risk of somnolence;1 14 15 possibility of falling asleep while engaged in activities of daily living.1 18 20 Avoid driving or operating machinery until effects on the individual are known.1

  • Potential for orthostatic hypotension (e.g., dizziness, nausea, syncope, sweating), especially during dosage escalation.1 Patients should avoid rising rapidly after sitting or lying down, especially if they have been in a seated or recumbent position for prolonged periods and/or if they are just beginning ropinirole therapy.1

  • Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs (especially CNS depressants or alcohol), as well as any concomitant illnesses.1

  • Risk of hallucinations, particularly in geriatric patients with parkinsonian syndrome, those receiving concomitant levodopa, and those receiving higher dosages of ropinirole.1

  • Ropinirole may be taken with or without food; however, taking the drug with food may reduce the occurrence of nausea.1

  • Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed.1

  • Importance of informing patients of other important precautionary information.1 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Ropinirole Hydrochloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets, film-coated

0.25 mg (of ropinirole)*

Requip Tiltab

GlaxoSmithKline

Ropinirole Hydrochloride Tablets

0.5 mg (of ropinirole)*

Requip Tiltab

GlaxoSmithKline

Ropinirole Hydrochloride Tablets

1 mg (of ropinirole)*

Requip Tiltab

GlaxoSmithKline

Ropinirole Hydrochloride Tablets

2 mg (of ropinirole)*

Requip Tiltab

GlaxoSmithKline

Ropinirole Hydrochloride Tablets

3 mg (of ropinirole)*

Requip Tiltab

GlaxoSmithKline

Ropinirole Hydrochloride Tablets

4 mg (of ropinirole)*

Requip Tiltab

GlaxoSmithKline

Ropinirole Hydrochloride Tablets

5 mg (of ropinirole)*

Requip Tiltab

GlaxoSmithKline

Ropinirole Hydrochloride Tablets

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Requip 0.25MG Tablets (GLAXO SMITH KLINE): 90/$291.99 or 270/$849.95

Requip 0.5MG Tablets (GLAXO SMITH KLINE): 90/$305.98 or 270/$891.01

Requip 1MG Tablets (GLAXO SMITH KLINE): 90/$299.99 or 270/$860.00

Requip 2MG Tablets (GLAXO SMITH KLINE): 90/$291.99 or 270/$849.95

Requip 3MG Tablets (GLAXO SMITH KLINE): 90/$302.00 or 270/$870.98

Requip 4MG Tablets (GLAXO SMITH KLINE): 90/$306.98 or 270/$887.92

Requip 5MG Tablets (GLAXO SMITH KLINE): 90/$302.00 or 270/$870.98

Requip XL 12MG 24-hr Tablets (GLAXO SMITH KLINE): 30/$390.01 or 90/$1,119.91

Requip XL 4MG 24-hr Tablets (GLAXO SMITH KLINE): 90/$460.01 or 270/$1,339.94

Requip XL 6MG 24-hr Tablets (GLAXO SMITH KLINE): 30/$259.99 or 90/$749.99

Requip XL 8MG 24-hr Tablets (GLAXO SMITH KLINE): 30/$249.99 or 90/$695.93

Ropinirole HCl 0.25MG Tablets (MYLAN): 100/$59.99 or 300/$159.97

ROPINIRole HCl 0.5MG Tablets (ROXANE): 100/$54.99 or 300/$164.97

ROPINIRole HCl 1MG Tablets (GLENMARK PHARMACEUTICALS): 100/$109.98 or 300/$311.97

ROPINIRole HCl 2MG Tablets (GLENMARK PHARMACEUTICALS): 100/$82.00 or 300/$227.95

Ropinirole HCl 3MG Tablets (MYLAN): 100/$79.99 or 300/$223.78

Ropinirole HCl 4MG Tablets (MYLAN): 100/$79.99 or 300/$225.96

Ropinirole HCl 5MG Tablets (MYLAN): 100/$65.98 or 300/$169.97

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions January 12, 2012. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

References

1. GlaxoSmithKline. Requip (ropinirole hydrochloride) tablets prescribing information. Research Triangle Park, NC; 2005 Jul.

2. Adler CH, Sethi KD, Hauser RA et al. Ropinirole for the treatment of early Parkinson’s disease. Neurology. 1997; 49:393-9. [IDIS 390050] [PubMed 9270567]

3. Eden RJ, Costall B, Domeney AM et al. Preclinical pharmacology of ropinirole (SK&F 101468-A) a novel dopamine D2 agonist. Pharmacol Biochem Behav. 1991; 38:147-54. [PubMed 1673248]

4. Kreider MS, Knox S, Gardiner D et al. The efficacy of ropinirole, a non-ergoline D2 agonist, as an adjunct to L-dopa (DCI) in patients with Parkinson’s disease. Mov Disord. 1996; 11(Suppl 1):156.

5. Bowen WP, Coldwell MC, Hicks FR et al. Ropinirole, a novel dopaminergic agent for the treatment of Parkinson’s disease, with selectivity for cloned dopamine D3 receptors. Br J Pharmacol. 1993; 110:93P.

6. Goetz CG. New strategies with dopaminergic drugs: modified formulations of levodopa and novel agonists. Exp Neurol. 1997; 144:17-20. [PubMed 9126145]

7. Tulloch IF. Pharmacologic profile of ropinirole: a nonergoline dopamine agonist. Neurology. 1997; 49(Suppl 1):S58-62. [IDIS 390126] [PubMed 9222275]

8. Gottwald MD, Bainbridge JL, Dowling GA et al. New pharmacotherapy for Parkinson’s disease. Ann Pharmacother. 1997; 31:1205-17. [IDIS 392974] [PubMed 9337447]

9. Kapoor R, Pirtosek Z, Frankel JP et al. Treatment of Parkinson’s disease with novel dopamine D2 agonist SK&F 101468. Lancet. 1989; 1:1445-6. [PubMed 2567448]

10. Vidailhet MJ, Bonnet AM, Belal S et al. Ropinirole without levodopa in Parkinson’s disease. Lancet. 1990; 336:316-7. [IDIS 269938] [PubMed 1974005]

11. Rascol O, Lees AJ, Senard JM et al. Ropinirole in the treatment of levodopa-induced motor fluctuations in patients with Parkinson’s disease. Clin Neuropharmacol. 1996; 19:234-45. [PubMed 8726542]

12. Rabey JM. Second generation of dopamine agonists: pros and cons. J Neural Transm. 1995; 45:213-24.

13. Anon. Pramipexole and ropinirole for Parkinson’s disease. Med Lett Drugs Ther. 1997; 39:109-10. [PubMed 9398824]

14. Brooks DJ, Torjanski N, Burn DJ. Ropinirole in the symptomatic treatment of Parkinson’s disease. J Neural Transm. 1995; 45:231-8.

15. Rascol O, Lees AJ, Senard JM et al. A placebo-controlled study of ropinirole, a new D2 agonist, in the treatment of motor fluctuations ofl-dopa-treated parkinsonian patients. Adv Neurol. 1996; 69:531-4. [PubMed 8615176]

16. Larsen JP, Brunt E, Korczyn AD et al et al. Ropinirole is effective in long-term treatment of patients with early Parkinson’s disease. Neurology. 1998; 50:A277-8.

17. SmithKline Beecham, King of Prussia, PA: Personal communication.

18. Olanow CW, Watts RL, Koller WC. An algorithm (decision tree) for the management of Parkinson’s disease (2001): treatment guidelines. Neurology. 2001; 56:S1-S88.

19. Anon. Initial treatment of Parkinson’ disease: wait just a minute. Med Lett Drugs Ther. 2001; 43:59-60. [PubMed 11445778]

20. Frucht S, Rogers JD, Greene PE et al. Falling asleep at the wheel: motor vehicle mishaps in persons taking pramipexole and ropinirole. Neurology. 1999; 10:1908-10.

21. Anon. Ropinirole (Requip) for restless legs syndrome. Med Lett Drugs Ther. 2005; 47:62-4.

22. Trenkwalder C, Garcia-Borreguero D, Montagna P et al. Ropinirole in the treatment of restless legs syndrome: results from the TREAT RLS 1 study, a 12 week, randomised, placebo controlled study in 10 European countries. J Neurol Neurosurg Psychiatry. 2004; 75:92-7. [PubMed 14707315]

23. Bogan R, Connolly MG Jr, Rederich G. Ropinirole is an effective, well-tolerated treatment for moderate-to-severe restless legs syndrome: results of a US study. 9th International Congress of Parkinson’s Disease and Movement Disorders. New Orleans, LA 2005 March. Abstract 204.

24. Walters AS, Ondo WG, Dreykluft T et al. Ropinirole is effective in the treatment of restless legs syndrome-TREAT RLS 2: a 12-week, double-blind, randomized, parallel-group, placebo-controlled study. Mov Disord. 2004; 19:1414-23. [PubMed 15390050]

25. Karrasch J, Haan J, Kruger AJ et al. Maintained efficacy with ropinirole: results of a multinational 36-week study in patients with RLS. Sleep. 2004; 27:A294. Abstract 658.

26. Earley CJ. Restless legs syndrome. N Engl J Med. 2003; 348:2103-9. [IDIS 497583] [PubMed 12761367]

27. Littner MR, Kushida C, Anderson WM et al. Practice parameters for the dopaminergic treatment of restless legs syndrome and periodic limb movement disorder-An American Academy of Sleep Medicine Report. Sleep. 2004; 27:557-9. [PubMed 15164914]

28. US Food and Drug Administration. FDA drug safety communication: medication errors resulting from confusion between risperidone (Risperdal) and ropinirole (Requip). Rockville, MD; 2011 Jun 13. From the FDA website.

29. Mylan Pharmaceuticals Inc. Ropinirole hydrochloride tablets prescribing information. Morgantown, WV; 2011 Jun.

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