Ropinirole
A non-ergot dopamine agonist for Parkinson's disease and restless legs, broken down in the liver by CYP1A2.
Drug card
- Class
- Dopamine agonist
- How it works
- Activating dopamine D2 and D3 receptors in place of missing dopamine
- Used for
- Parkinson's disease
- Moderate to severe restless legs syndrome
- Known for
- Drowsiness and sudden attacks of sleep
- Compulsive gambling, shopping, eating or sex
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does ropinirole work?
A non-ergoline agonist that stands in for dopamine at D2 and D3 receptors in the caudate-putamen, improving movement in Parkinson's disease; its benefit in restless legs is also thought to come from dopamine receptor stimulation. It is metabolized mainly by the liver enzyme CYP1A2, so drugs and smoking that change CYP1A2 activity change its levels.
Like other dopamine agonists: Dopamine agonists act on dopamine receptors themselves: they bind to and activate receptors of the D2 family (D2 and D3) in the striatum, standing in for the dopamine lost in Parkinson's disease and easing slowness, stiffness and tremor. How they relieve restless legs syndrome is not fully known, but it is thought to be through the same dopamine receptors. Pramipexole and ropinirole are non-ergot agonists.
Uses
What is ropinirole used for?
- Parkinson's disease
- Moderate to severe restless legs syndrome
Side effects
Side effects of ropinirole
- Drowsiness and sudden attacks of sleepKnown forSerious
- Compulsive gambling, shopping, eating or sexKnown forSerious
- Nausea and vomiting
- Fainting, sometimes with a slow heart rateSerious
- Dizziness on standing (orthostatic hypotension)
- Hallucinations and confusionSerious
- Dyskinesia when added to levodopa
- Swollen legs (leg edema)
- Indigestion and heartburn
- Withdrawal: apathy, anxiety, low mood, pain
- Restless legs worsening over time (augmentation)
- Fever and rigidity if stopped suddenlySerious
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- CYP1A2 inhibitors such as ciprofloxacin raise its levels; smoking induces CYP1A2 and lowers them.
- Starting or stopping estrogen, as in hormone replacement therapy, can change the dose needed.
- Antipsychotics and metoclopramide weaken its effect.
- It is tapered off, as stopping suddenly risks withdrawal symptoms and a reaction like NMS.
Good to know: Shares pramipexole's uses and warnings, but the liver (CYP1A2) clears it rather than the kidneys.
Remember it
A way to remember it
Picture a gambler who nods off at the table.
The two warnings dopamine agonists are known for: impulse control disorders such as pathological gambling, and sudden attacks of sleep.
Written for biofideX
Its class
Dopamine agonists
Other dopamine agonists with a card:
Easily mixed up with dopamine precursors and dopamine antagonist antiemetics.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Parkinson's, dementia and migraine
Ropinirole is one of 9 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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