Ropinirole alternatives: What can I take instead of ropinirole?

Compare ropinirole alternatives | Neurontin | Neupro | Sinemet | Azilect | Trihexyphenidyl | Natural alternatives | How to switch meds

Whether you are using it for the treatment of restless legs syndrome or for treatment of Parkinson disease, ropinirole is likely a crucial component of your therapeutic regimen. You may recognize it by its former brand names, Requip and the extended-release form Requip XL. Ropinirole is a dopamine agonist. Stimulating dopamine receptors in the brain makes perfect sense in combating the dopamine deficiency of Parkinson disease (PD) and its resultant dyskinesia (abnormal movements such as tremor) and general slowing. The mechanism for effectiveness against leg discomfort and the urge to move one’s legs in restless leg syndrome (RLS) is not well established, likely because the underlying basis for RLS itself has not been defined yet. As beneficial as ropinirole may be for these two conditions, it may have significant negative aspects for you as well. Adverse effects are a common reason why one may be searching for an alternative to ropinirole. If so, and you’d like to improve your quality of life, your search can start right here.

What can I take in place of ropinirole?

Ropinirole is often a first or second-line medication for RLS and Parkinson disease. These types of decisions are usually based on effectiveness, safety, and cost, all in comparison to other treatment options. While these comparisons may oftentimes support trying ropinirole, it simply may not work out due to common side effects . If this is the case, your other options for RLS include gabapentinoids, other dopamine agonists, and dopamine precursors. For Parkinson disease, you may want to consider other dopamine agonists, dopamine precursors, monoamine oxidase inhibitors (MAOIs), anticholinergics, and amantadine. We will cover these agents, so you can be well prepared to engage in a discussion with your healthcare provider and get their medical advice on the matter.

Top 5 alternatives

The following are some of the most common alternatives to ropinirole.

1. Neurontin

Neurontin may be better known by its generic name, gabapentin, since it has been available in generic form for a number of years. The drug has Food and Drug Administration (FDA) indications for seizures and nerve pain after shingles, and widespread off-label use is seen for conditions such as restless leg syndrome and fibromyalgia. An evening dose of Neurontin could be recommended by your healthcare provider to treat RLS.

Neurontin is a member of the gabapentinoid class of drugs, a category that also includes Lyrica and the longer-lasting Horizant. Horizant is the only gabapentinoid with an actual FDA indication for RLS, and its long duration of action permits once daily dosing, a desirable feature for those with symptoms throughout the day. Lyrica has also been studied more than Neurontin for RLS treatment. Although the Horizant and Lyrica may seem more appealing, they are usually more expensive. Generic Neurontin, gabapentin, can often be obtained at a reasonable cost, or a SingleCare discount card may help with the pricing of any drug at participating pharmacies. 

Gabapentinoids like Neurontin are first-line medications for RLS. Choosing them over ropinirole is typically a matter of wanting to avoid possible side effects. Notable, potential adverse effects of ropinirole include dizziness, orthostatic hypotension (low blood pressure upon standing up), anxiety, impulse control problems, compulsions, rebound symptoms when the medication wears off, and a withdrawal syndrome that can be severe if the medication is stopped without tapering off. Ropinirole can also be associated with an augmentation syndrome in which RLS symptoms worsen as treatment proceeds. Although Neurontin may avoid some of these issues, it can be associated with other serious side effects like dizziness, sleepiness, respiratory depression (reduced breathing), suicidality, drug dependency, and depression. Thus, Neurontin could be a reasonable alternative to ropinirole, but it may not be recommended by your healthcare provider if you have a history of drowsiness, obesity, depression, or substance abuse. It is also not a treatment for Parkinson disease.

RELATED: Lyrica vs. gabapentin: Differences, similarities, and which is better for you

2. Neupro

All of the dopamine agonists, ropinirole, pramipexole, and Neupro, share many of the same risks, so choosing one over another may not avoid a side effect. Pramipexole is also taken in a manner similar to ropinirole for both RLS and PD, and Mirapex ER and ropinirole XR are both taken once daily for PD. You can surmise that if ropinirole is not working out for you, there is not much of an argument for changing to pramipexole. 

On the other hand, you may be interested in the advantages of Neupro, as it is a patch. The convenience of use and its daylong effectiveness could be enticing for either RLS or PD. Unlike the other once-daily dopamine agonists, Mirapex ER and ropinirole XR, Neupro has an FDA indication for RLS. Before you jump at this option for RLS, you should recognize that most people with RLS only have symptoms in the evenings and do not need medication all day. The RLS indication is limited to those with moderate to severe disease with persistent symptoms. Another reason to potentially keep looking for other alternatives for RLS or PD symptoms is that Neupro is more expensive than ropinirole and other options. 

3. Sinemet

Sinemet has two components, levodopa to work as a dopamine precursor and carbidopa to inhibit peripheral decarboxylase in order for levodopa to not be broken down before it gets to the brain. By enhancing dopamine effects, Sinimet can have similar benefits and risks compared to dopamine receptor agonists like ropinirole. The risk of an augmentation phenomenon with Sinemet is particularly concerning. In these cases, continued worsening of Parkinson or RLS symptoms can be experienced as dosages are increased. Nonetheless, the effectiveness of Sinemet keeps it as a mainstay for Parkinson disease. For RLS treatment, it is used off-label and on an as-needed basis for those suffering symptoms only intermittently rather than daily.

4. Azilect

Azilect could be chosen over ropinirole for mild cases of Parkinson disease. It avoids some of the dopamine agonist side effects and offers the conveniences of once daily dosing. Through inhibition of monoamine oxidase type B, Azilect helps to prevent the breakdown of dopamine. Xadago and Zelapar are also monoamine oxidase inhibitors (MAOIs). Azilect and its fellow type B MAOIs are not potent, so the drugs are typically chosen for individuals with mild PD symptoms. Its dopaminergic effect results in it having some adverse effects that are similar to ropinirole, such as potential depression and compulsive behaviors. Due to a lengthy list of drug interactions, you should also review your list of prescription drugs, over-the-counter medications, and supplements with the prescribing provider before starting and while taking Azilect.

5. Trihexyphenidyl

Another option for those in the early stages of Parkinson disease, trihexyphenidyl may be worth considering if you are younger and troubled predominantly by tremor. Interested individuals would likely include those fearing the possibility of impulse control problems or augmentation phenomenon with ropinirole and Sinemet. An older age could be a reason for hesitation about trihexyphenidyl. It is an anticholinergic drug, meaning it blocks the action of acetylcholine. The effectiveness in PD is based on better balancing acetylcholine and dopamine activity in the brain. Seniors are more susceptible to anticholinergic side effects such as confusion, hallucinations, constipation, and urinary retention.

Natural alternatives to ropinirole

Regarding Parkinson disease, nonpharmacologic interventions are a common area of interest for both the treating providers and patients. Avoiding medication side effects is attractive to all parties. Based on proven benefits in clinical trials, exercise is often used early and throughout the course of treatment if possible. Mindfulness yoga also has evidence to support its use. Adding in a type of Mediterranean-style diet, term the MIND diet, could help slow the progression of PD.

Restless leg syndrome has viable natural alternatives too. If your iron stores are tested and found to be low, iron replacement therapy could help to ameliorate symptoms of restless legs syndrome. Studies also support exercise regimens as an option for RLS. In fact, studies have looked at a number of complementary strategies for RLS treatment, but the volume of evidence is low. Magnesium supplementation has generated interest but remains unproven.

How to switch to a ropinirole alternative

The opportunity to try a new medicine may be enticing if you are not getting the results that you had hoped for out of ropinirole, but changing drugs should not be undertaken brazenly. You should review your reasoning and alternatives with the treating healthcare professional. If you both agree on switching your therapy, ask for directions on how to gradually taper off ropinirole and how to start a new medication, since some require a slow titration due to the possibility of withdrawal symptoms. Fortunately, you now know that alternatives exist and what factors to consider when deciding on a drug change.