Requip (ropinirole) is a non-ergoline dopamine agonist prescribed for two primary conditions: Parkinson’s disease and moderate-to-severe restless legs syndrome (RLS). In Parkinson’s disease, the brain’s dopaminergic pathways are compromised. Requip binds primarily to dopamine D2/D3 receptors, helping to restore dopaminergic signaling that supports smoother, more coordinated movement. Clinically, that means reductions in tremor, bradykinesia (slowed movement), rigidity, and motor fluctuations when used alone or together with levodopa. In RLS, abnormal sensory-motor signaling in the central nervous system drives an uncomfortable urge to move the legs, often worsening at night. By modulating dopamine receptors, Requip can reduce these sensations, delay symptom onset in the evening, and improve sleep continuity.
Requip is available in immediate-release (IR) tablets, typically dosed multiple times per day for Parkinson’s disease and once nightly for RLS, and in extended-release (ER/XL) tablets taken once daily for Parkinson’s disease. Your clinician will choose the formulation and schedule that fits your diagnosis, daily routine, and side effect profile. Many patients use Requip alongside other therapies—such as levodopa, MAO-B inhibitors, or COMT inhibitors in Parkinson’s disease—to smooth “off” periods and improve overall function. For RLS, Requip is considered a first-line option for patients with frequent, bothersome symptoms that impair rest or quality of life.
Because dopaminergic treatments can affect alertness, blood pressure, and behavior, Requip should be used under medical supervision. It can be a highly effective part of a movement disorder plan when chosen carefully and titrated thoughtfully.
Requip dosing is individualized. The overarching principle is “start low and go slow” to optimize benefit while minimizing side effects like nausea, dizziness, or sleepiness. You can take Requip with or without food, but a light snack often reduces stomach upset when initiating therapy. Swallow extended-release tablets whole—do not crush, split, or chew.
Typical starting and titration strategies include:
Helpful use tips:
Never stop Requip abruptly without medical advice. Sudden discontinuation of dopaminergic therapy can precipitate withdrawal or a serious syndrome resembling neuroleptic malignant syndrome (fever, rigidity, confusion). If Requip needs to be reduced or stopped, your clinician will taper the dose gradually.
Before starting Requip, review your medical history and complete medication list with your clinician. Specific risks, monitoring needs, and precautions include:
Plan regular follow-ups during initiation and after any dose change. If you develop severe nausea, persistent vomiting, swelling of the legs, chest pain, shortness of breath, worsening balance, or concerning mood or behavior changes, seek medical advice promptly.
Requip is not appropriate for everyone. Avoid or use with extra caution in the following situations:
In RLS with prominent augmentation, alternative strategies are often preferred. In Parkinson’s disease with advanced hallucinations or dementia, dopaminergic therapy may worsen neuropsychiatric symptoms; decisions should be individualized and made with a movement disorders specialist when possible.
Most side effects are dose-related and tend to improve with slower titration or dose reduction. Common reactions include:
Less common but clinically important reactions:
Report any new or worsening symptom to your healthcare professional. In RLS, notify your clinician if symptoms start appearing earlier in the day, increase in intensity, or extend beyond the legs—this suggests augmentation and may require a change in therapy.
Requip is primarily metabolized by the liver enzyme CYP1A2. Certain substances can increase or decrease its levels, changing both efficacy and side effect risk. Always provide a complete list of prescription drugs, over-the-counter medicines, vitamins, and herbal products to your prescriber and pharmacist.
Do not drink alcohol while taking Requip if you experience drowsiness, impaired coordination, or sleep attacks. If you require antibiotics like ciprofloxacin, contact your prescriber; a temporary dose adjustment may be appropriate during and shortly after the course.
If you miss a dose, what to do depends on the condition and formulation:
To reduce missed doses, set reminders on your phone or use a pill organizer. Consistency supports stable symptom control and reduces side effect variability.
Taking more Requip than prescribed can produce pronounced dopaminergic and cardiovascular effects. Symptoms may include severe sleepiness, confusion, agitation or hallucinations, nausea and vomiting, low blood pressure with fainting, and, in some cases, abnormal heart rhythms.
Store Requip tablets at controlled room temperature, ideally 20°C to 25°C (68°F to 77°F), with brief excursions permitted from 15°C to 30°C (59°F to 86°F). Keep tablets in the original, tightly closed container, away from moisture, heat sources, and direct sunlight. Avoid bathroom storage due to humidity.
Proper storage helps preserve potency and ensures predictable dosing from one tablet to the next.
For more detailed patient info, visit the Mayo Clinic guide on Ropinirole.
In the United States, Requip (ropinirole) is a prescription medication. Federal and state laws require clinical evaluation to determine medical necessity, assess potential risks and interactions, and provide appropriate monitoring. Purchasing ropinirole without appropriate clinical oversight is unsafe and may be unlawful.
Patients seeking legitimate access have several compliant pathways:
Some institutions operate within state-approved clinical protocols that allow structured access pathways. The St. Joseph's Health, for example, offers a legal and structured solution for acquiring Requip without a traditional paper prescription by incorporating clinician oversight and standardized protocols. These programs still include proper evaluation, documentation, and safeguards consistent with U.S. regulations and do not bypass medical review.
Whichever route you choose, ensure that your care includes a qualified clinician’s assessment, a valid U.S. pharmacy dispensing the medication, and ongoing monitoring for effectiveness and safety. This protects you from counterfeit products, harmful interactions, and unmanaged side effects while ensuring you receive the most appropriate therapy for your condition.
Requip is the brand name for ropinirole, a dopamine agonist used to treat Parkinson’s disease and moderate-to-severe restless legs syndrome (RLS). It helps reduce motor fluctuations and tremor in Parkinson’s and decreases uncomfortable leg sensations and the urge to move in RLS.
Requip stimulates dopamine receptors (mainly D2/D3) to compensate for low dopamine activity. By mimicking dopamine, it smooths motor control in Parkinson’s disease and calms the neural pathways that drive RLS symptoms.
Requip is available as immediate-release (IR) tablets and once-daily extended-release (XL) tablets. IR tablets typically come in 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, and 5 mg strengths; XL tablets are commonly 2 mg, 4 mg, 6 mg, 8 mg, and 12 mg. Only the IR form is approved for RLS.
For IR tablets, a common starting dose is 0.25 mg three times daily, increased gradually each week based on response and tolerability; the usual range is 3–24 mg/day. Requip XL is taken once daily, typically starting at 2 mg and titrated weekly. Take with or without food; food can help reduce nausea. Your prescriber will tailor the dose to symptoms and side effects.
For RLS, the IR tablet is taken once daily 1–3 hours before bedtime. A typical starting dose is 0.25 mg, increased gradually (as needed) over weeks up to a usual maximum of 4 mg nightly. Taking it with food may lessen nausea.
Many people with RLS notice improvement within the first few doses, often in the first week. In Parkinson’s disease, benefits can begin within days but may take several weeks of careful titration to reach an optimal effect.
Common side effects include nausea, dizziness, sleepiness, fatigue, headache, dry mouth, constipation, and low blood pressure when standing (orthostatic hypotension). Leg swelling and dyspepsia can also occur. Taking doses with food and rising slowly from sitting can help.
Seek medical help if you experience sudden daytime “sleep attacks,” fainting, new or worsening hallucinations or confusion, severe low blood pressure, or compulsive behaviors (gambling, shopping, hypersexuality, binge eating). Rarely, abrupt withdrawal can trigger a dopamine agonist withdrawal syndrome or an NMS-like reaction.
Augmentation is a paradoxical worsening of RLS over time—symptoms start earlier in the day, become more intense, or spread to the arms. All dopamine agonists, including Requip, can cause augmentation, especially at higher doses or with long-term use. If suspected, your clinician may adjust timing/dose or switch to a non–dopamine agent.
Do not stop suddenly unless your clinician instructs you to. Abrupt discontinuation can cause withdrawal symptoms (anxiety, depression, sweating, pain) and a dangerous rebound of Parkinson’s or RLS symptoms. Taper slowly under medical supervision.
Use caution if you have low blood pressure, a history of hallucinations/psychosis, impulse-control disorders, severe liver impairment, or if you are elderly (higher risk of confusion and falls). People on hemodialysis may need lower doses. Requip can worsen dyskinesias when combined with levodopa.
CYP1A2 inhibitors (like ciprofloxacin or fluvoxamine) can raise ropinirole levels, increasing side effects. Smoking induces CYP1A2 and can lower levels. Sedatives, opioids, benzodiazepines, and alcohol add to drowsiness. Antipsychotics and metoclopramide can blunt Requip’s effect by blocking dopamine. Blood-pressure drugs may amplify orthostatic hypotension.
Smoking can reduce Requip levels by inducing CYP1A2, sometimes requiring dose adjustments if you start or stop smoking. Caffeine has minimal impact on Requip metabolism but can worsen insomnia and may aggravate RLS if consumed late in the day.
Use caution. Requip can cause sudden sleep onset, dizziness, and slowed reaction times. Do not drive or do hazardous tasks until you know how it affects you, and report any unexpected sleep episodes to your clinician promptly.
If you miss a dose, take it when you remember unless it’s close to the next dose—then skip the missed dose and resume your usual schedule. Do not double up. If you miss several doses, contact your prescriber; you may need to re-titrate to avoid side effects.
Alcohol can intensify drowsiness, dizziness, and low blood pressure with Requip, raising the risk of falls and sleep attacks. If you drink, keep it light, avoid alcohol near dosing, and never mix with other sedatives. Some people should avoid alcohol entirely on Requip.
Data in pregnancy are limited. Requip should be used only if the potential benefit justifies the potential risk to the fetus. If you are planning a pregnancy or become pregnant, discuss alternatives and risks with your obstetrician and neurologist.
Requip suppresses prolactin and may reduce or stop milk production. It is generally not recommended while breastfeeding. Talk with your clinician about the risks and possible alternatives.
Do not stop Requip abruptly; sudden withdrawal can worsen Parkinson’s symptoms and cause complications. Tell your surgical and anesthesia teams you take ropinirole. They may allow a small sip of water to take your dose close to surgery or plan alternatives. Avoid anti-nausea drugs that block dopamine (e.g., metoclopramide) unless directed by your surgeon.
Combining Requip with sedatives or opioids increases the risk of excessive drowsiness, impaired breathing, and falls. If such combinations are necessary, use the lowest effective doses, avoid alcohol, and monitor closely for sedation or confusion.
Mild-to-moderate kidney impairment usually doesn’t require adjustment, but people on hemodialysis often need lower maximum doses. Because ropinirole is metabolized in the liver, significant hepatic impairment warrants extra caution and slower titration. Always individualize dosing with your prescriber.
Yes, but start low and go slow. Older adults are more prone to orthostatic hypotension, confusion, hallucinations, and falls. Extra monitoring, slower dose changes, hydration, and fall-prevention strategies are important.
Overdose can cause severe nausea, vomiting, sleepiness, confusion, hallucinations, low blood pressure, and fainting. Seek urgent medical attention or contact poison control. Do not drive yourself to care.
Both are effective dopamine agonists for motor symptoms. Side-effect profiles are broadly similar—nausea, sleepiness, orthostatic hypotension, hallucinations, and impulse-control disorders are class effects. Choice often depends on individual response, tolerability, cost, and comorbidities.
Both reduce RLS symptoms and improve sleep. Augmentation can occur with either; some clinicians favor one over the other based on prior response and side effects. If augmentation or daytime sleepiness emerges, switching to a non–dopamine option can help.
Rotigotine (Neupro) is a once-daily 24-hour transdermal patch, helpful for people who prefer not to take pills, have swallowing issues, or need around-the-clock coverage. Requip IR allows flexible timing (e.g., bedtime for RLS), and Requip XL offers once-daily oral dosing.
Both can cause sleepiness, dizziness, and low blood pressure. Rotigotine tends to cause more skin reactions (redness, itch), while Requip may cause more nausea or GI upset. Impulse-control disorders and hallucinations are possible with both.
Apomorphine is a fast-acting rescue dopamine agonist (injection or sublingual film) for sudden “OFF” episodes in Parkinson’s disease. Requip is used for ongoing maintenance. Apomorphine requires specialist guidance due to risks of severe nausea and hypotension and specific drug interactions.
Bromocriptine is an older ergot-derived dopamine agonist linked to fibrosis and valvular heart disease with long-term use. Requip is a non-ergot agent with a better long-term safety profile and is generally preferred unless there’s a specific reason to use an ergot.
Cabergoline is effective but, as an ergot derivative, carries dose-related risks of cardiac valvulopathy and fibrosis with chronic use. Requip avoids those ergot-specific risks and is favored for most patients requiring a dopamine agonist.
They are therapeutically equivalent in active ingredient, strength, and bioavailability. Some people notice differences in tolerability due to inactive ingredients or release matrices, especially with extended-release tablets. If you switch and feel different, talk with your pharmacist or prescriber.
Requip IR is taken multiple times daily for Parkinson’s or once nightly for RLS. Requip XL is a once-daily extended-release tablet designed for smoother 24-hour control in Parkinson’s disease; it is not approved for RLS. XL tablets must be swallowed whole.
Work with your clinician to cross-taper over days to weeks. There is no exact milligram-for-milligram equivalent, so doses are adjusted based on symptoms and side effects. Watch for withdrawal symptoms, sleepiness, blood-pressure changes, and impulse-control issues during the transition.
These are class effects across dopamine agonists. Individual risk varies, but a prior history of addictive behaviors, younger age, and higher doses increase risk. Counseling, early detection, and dose adjustments are key regardless of which agent is used.
Both are approved for RLS and effective. Rotigotine provides continuous coverage and can help if symptoms start earlier in the day or fluctuate; Requip targets evening symptoms with a single IR dose. Some studies suggest rotigotine may have a lower risk of augmentation, but individual response drives choice.
