Key takeaways

Ropinirole is used to treat Parkinson’s disease and restless legs syndrome by mimicking dopamine, which helps control muscle movements, but it can cause side effects such as dyskinesia and sleep attacks.
Common side effects of ropinirole include nausea, dizziness, drowsiness, involuntary movements, and more serious effects like visual impairment and hallucinations.
Dyskinesia and sleep attacks are notable side effects, with dyskinesia being a long-term consequence of dopamine level increase and sleep attacks occurring unexpectedly during daily activities.
Managing ropinirole side effects involves sharing a complete medical history with the prescriber, following dosage instructions carefully, taking the drug with food, avoiding alcohol and sedatives, and not engaging in risky activities like driving when drowsy.

Ropinirole is a generic prescription drug used to treat the symptoms of Parkinson’s disease and restless legs syndrome (RLS). Both conditions are associated with low levels of dopamine, a chemical used by the brain to control muscle movements. Ropinirole mimics dopamine, so it’s called a dopamine receptor agonist. As a result, people taking ropinirole are better able to control and coordinate their movements. Whether taken as an immediate-release or extended-release tablet, ropinirole has powerful effects on the nervous system, so most people will experience one or more side effects. Unfortunately, a few of these common side effects are serious.

Common side effects of ropinirole

Ropinirole’s most commonly-experienced side effects will depend on the condition being treated. More than 1 in 4 people taking ropinirole for Parkinson’s disease will experience either involuntary jerks and twitches, nausea, or dizziness as adverse effects. For people with restless legs syndrome, the most common side effects are nausea and sleepiness.

The most common side effects of ropinirole are:

Nausea
Dizziness
Drowsiness
Involuntary and sudden movements (dyskinesia)
Low blood pressure when standing up (orthostatic hypotension)
Headache
Low energy
Falls
Back pain
Fainting
Vomiting
Sleep attacks
Confusion
Upper respiratory tract infection
Heartburn
Stomach pain
Hallucinations, delusions, or psychotic behaviors
Sore throat
Joint pain
Sweating
Tremor
Visual impairment
High blood pressure
Constipation
Anxiety
Dry mouth
Pain
Diarrhea
Memory loss
Urinary tract infection

Serious side effects of ropinirole

The most serious side effects of ropinirole include:

Involuntary and sudden movements
Visual impairment
Sleep attacks
Atrial fibrillation
Hallucinations or psychotic behaviors
Loss of impulse control
Compulsive behaviors
Slow heartbeat
Complications involving the lungs and heart
Worsening of restless legs syndrome
Withdrawal symptoms including neuroleptic malignant syndrome symptoms
Severe allergic reactions

Ropinirole and dyskinesia

Dyskinesia describes the involuntary twitches, jerks, and movements many people associate with Parkinson’s disease. They are not, however, a symptom of Parkinson’s. Instead, they are a long-term side effect of years of treatment with levodopa or dopamine agonists like ropinirole. In clinical trials, 34% of people taking immediate-release ropinirole and 21% of those taking extended-release tablets experienced dyskinesia. However, the incidence is closely related to how advanced the condition is and how long people have been taking Parkinson’s drugs. Many people prescribed ropinirole have already been taking drugs that also cause dyskinesia like levodopa for years. Unfortunately, dyskinesia is part of living with Parkinson’s for many people that have Parkinson’s. If twitching or grimacing becomes a problem, talk to the prescribing healthcare provider. Parkinson’s specialists are very well-trained in handling dyskinesia and will probably modify the dose, modify other drugs being given, or prescribe an antidyskinetic medication like amantadine.

Ropinirole and sleep attacks

About 13% of people taking a dopamine agonist like ropinirole may experience sudden sleep attacks, that is, falling asleep while engaged in daily activities. These sleep attacks resemble those experienced by people with narcolepsy and can happen when talking or driving a car. They are not always preceded by drowsiness but have been experienced by people who are wide awake and alert. Sleep attacks are more likely to happen in people with Parkinson’s than with restless leg syndrome, but in both groups, the incidence is unrelated to age, duration of treatment, or the severity of the condition being treated. However, the incidence of sleep attacks is related to the type of drug being taken. Pramipexole, the worst offender, is twice as likely to cause sleep attacks as ropinirole. The highest incidence rate, however, is among people taking a dopamine agonist and levodopa. A sleep attack is a serious side effect and could be life-threatening in some situations. Immediately report a sleep attack to the prescribing healthcare provider. The drug may need to be discontinued.

How soon do ropinirole side effects start?

Some of ropinirole’s side effects begin early in treatment such as nausea, dizziness, headache, fainting, sleep disturbances, elevated blood pressure, and digestive system complaints. Some severe mental problems such as confusion and hallucinations can also happen early. Severe and moderate side effects tend to happen late in treatment.

How long do ropinirole side effects last?

Many mild side effects tend to improve over time as the body adapts to the drug. If they don’t, they are usually reversible if the drug is stopped. Stopping ropinirole, however, is no guarantee that adverse effects will stop, too. Most people taking ropinirole for Parkinson’s will be placed on alternative medications that also increase dopamine in the brain, either a different dopamine agonist, a COMT inhibitor, carbidopa, or levodopa. These drugs have side effects very similar to ropinirole including dizziness, sleepiness, dyskinesia, hallucinations, confusion, and orthostatic hypotension. Side effects may improve by switching drugs, or they may get worse.

What are the long-term side effects of ropinirole?

Dyskinesia is a long-term consequence of taking drugs that significantly raise dopamine levels. All major Parkinson’s disease treatments and most RLS drugs raise dopamine and cause dyskinesia after months or years of treatment. When starting a new Parkinson’s disease medication, how soon dyskinesia occurs will depend on how long a person has had Parkinson’s and how long they’ve been treated.

Ropinirole contraindications

Ropinirole is never prescribed to anyone with a known allergy to the drug.

Pregnancy

The safety of ropinirole during pregnancy has not been studied. Ropinirole can cause defects and developmental problems in animal fetuses. It is up to the woman and her prescriber to weigh the risks and benefits of taking ropinirole when pregnant.

Breastfeeding

The presence of ropinirole in breast milk or its safety in breastfeeding women has not been studied. Theoretically, ropinirole could reduce breast milk production.

Children

Ropinirole is not FDA approved for use in children or teens younger than 18. However, healthcare professionals may prescribe it off-label to treat children and adolescents for restless legs syndrome.

Seniors

Because people older than 65 tend to eliminate ropinirole from the body more slowly than younger adults, healthcare professionals are advised to use lower doses. Seniors on ropinirole are also more likely to experience hallucinations than younger adults.

Ropinirole warnings

Ropinirole is a powerful medicine that has strong effects on the nervous system. As such, there are bound to be problems with particular issues such as pre-existing conditions, overdose, or withdrawal.

Cautions

The effects of ropinirole can worsen some medical conditions. Fortunately, there are only a few:

People with heart problems or low blood pressure may be more vulnerable to orthostatic hypotension and fainting when taking ropinirole
People with severe kidney disease will be given a reduced dose to prevent side effects
People with liver disease may require smaller doses to prevent side effects
People with a history of psychosis are more likely to experience psychiatric side effects when taking ropinirole
People with sleep disorders such as narcolepsy may be more likely to experience sleep attacks during ropinirole treatment

Abuse and dependence

Drug abuse and physical dependence are not considered a risk with ropinirole.

Withdrawal

The abrupt discontinuation of ropinirole, the sudden decrease to a low dose, or a sudden switch to a different drug could cause withdrawal symptoms similar to a condition called neuroleptic malignant syndrome, or NMS, a potentially life-threatening reaction to antipsychotic medications. Symptoms include fever, muscle stiffness, and confusion. Other withdrawal effects are also possible including low energy, depression, apathy, anxiety, and sleeplessness. Because of withdrawal effects, a healthcare provider will gradually reduce the ropinirole dose when the drug needs to be discontinued.

Overdose

Call a poison control center or go to an emergency room if too much ropinirole is taken. The maximum dosage is 18 mg per day. For the most part, the symptoms of an overdose will involve common side effects of ropinirole, but they may be worse. These include:

Nausea
Dizziness
Sweating
Hallucinations
Jerking and twitching
Racing heartbeat
Sleepiness
Digestive system problems
Orthostatic hypotension
Fainting
Chest pain
Confusion

Recalls

Although ropinirole has not been recalled, brand-name Requip and Requip XL have been discontinued. In addition, the FDA has warned consumers that medication errors have occurred when healthcare professionals have mistakenly confused ropinirole for risperidone, an antipsychotic, and given out the wrong medicine. These mix-ups have in some cases led to hospitalization. When filling a ropinirole prescription, patients should always check the prescription label to make sure it’s the right medication.

Ropinirole interactions

Ropinirole has some drug interactions, but no drugs are specifically prohibited. So nearly all prescription drugs, over-the-counter medications, and dietary supplements can be used with ropinirole. However, there still may be problems. In some cases, drugs may be discontinued, doses adjusted, or healthcare providers may need to monitor effects more closely. These problem drugs include:

Antipsychotics and other dopamine blockers: Most antipsychotics do the opposite of ropinirole—they block dopamine. Called dopamine antagonists or dopamine blockers, these drugs will reduce the effectiveness of ropinirole. Other types of drugs are also dopamine blockers, including some antidepressants, nausea treatments, sleeping aids, and GERD treatments such as metoclopramide.
Central nervous system depressants. Drugs that slow down the nervous system can worsen ropinirole side effects such as sleepiness, dizziness, and sleep attacks. Sedatives, benzodiazepines, opioids, anxiety drugs, barbiturates, anticonvulsants, over-the-counter antihistamines, marijuana, and alcohol belong in this category.
Drugs that slow down the body’s metabolism of ropinirole. Some drugs like the antibiotic ciprofloxacin block the ability of the body to break down ropinirole, so the combination raises the risk of side effects. Healthcare providers and pharmacists are familiar with these drugs and will make adjustments.
Drugs that speed up the body’s metabolism of ropinirole. Some substances speed up the body’s breakdown of ropinirole, reducing its effectiveness. Again, healthcare professionals are familiar with these drugs and will adjust doses.
Tobacco. One of the substances that speed up the body’s breakdown of ropinirole is tobacco. Studies indicate that people who smoke have almost 40% less ropinirole in their body than people who don’t when taking the same dose. Healthcare professionals will strongly discourage smoking when prescribing this drug.

How to avoid ropinirole side effects

Unfortunately, side effects are an ever-present hazard when taking drugs like ropinirole. A few tips can help minimize or even prevent many of these side effects.

1. Share a complete medical history with the prescriber

The best way to avoid ropinirole side effects is to make sure the prescriber has a complete medical history. The most important information includes:

Heart problems
Kidney problems
High blood pressure
Low blood pressure
Mental health issues such as bipolar disorder, mania, or psychosis
Sleep disorders such as narcolepsy
Drinking
Smoking
Prescription drugs, over-the-counter medications, and dietary supplements taken
Pregnancy or pregnancy plans
Breastfeeding or breastfeeding plans

2. Follow instructions when taking ropinirole

Take this drug as instructed. Do not take too much, or the side effects could be worse. A missed dose can be taken when remembered, but skip the missed dose if it’s almost time for the next dose. Never take a double dose of ropinirole to make up for a missed dose.

3. Take ropinirole with food

To prevent nausea or feeling sick, try taking the ropinirole tablet with a snack or a meal.

4. Avoid alcohol and other drugs that make you sleepy

Alcohol and other substances, such as over-the-counter antihistamines, will worsen the sleepiness and dizziness caused by ropinirole. They will also make sleep attacks more likely.

5. Avoid driving or other risky activities

Drowsiness and dizziness are possible side effects of ropinirole that can make driving or other risky activities hazardous. Additionally, people taking ropinirole can sometimes fall asleep suddenly and without warning. If this happens when driving, the outcome could be catastrophic. It’s advisable to avoid driving, operating machinery, or engaging in any other potentially hazardous activity that requires full attention for a few days after starting ropinirole. Once its effects are understood, then driving and other activities can be resumed but with heightened caution.

How to treat side effects of ropinirole

Most people will have some side effects when taking ropinirole. Some can be handled at home with a little medical advice. Others, however, will require medical help.

Drowsiness and dizziness

The best thing to do when feeling drowsy, dizzy, or light-headed is to simply sit or lie down. Take it easy. Remember, people taking ropinirole can just fall asleep while they’re talking, working, or driving. Just like that. No warning. So it’s very important when you start to feel sleepy or faint to get yourself into a place where you won’t fall, have an accident, or injure yourself. If you suddenly fall asleep unexpectedly, tell the prescribing healthcare provider.

Nausea and vomiting

Try to drink fluids in small amounts. Antihistamines or nausea medications may not be a good idea because they may worsen other side effects of ropinirole.

Dyskinesia

Talk to the prescriber if any muscle twitching or jerking happens. Doses can be reduced to help with this problem.

Hallucinations

Inform the prescriber about any hallucinations if they occur.

Out-of-control behaviors

Ropinirole can reduce people’s ability to control their urges or behaviors. Inform the prescribing healthcare provider if it’s hard to resist impulses or if certain behaviors run out of control including gambling, sexual urges, eating, or shopping.

Sources

FDA drug safety communication: Medication errors resulting from confusion between risperidone (Risperdal) and ropinirole (Requip), U.S. Food and Drug Administration
Ropinirole, Epocrates
Ropinirole drug summary, Prescriber’s Digital Reference
Ropinirole tablet extended-release prescribing information, U.S. National Library of Medicine
Ropinirole tablet prescribing information, U.S. National Library of Medicine
Sleep attacks in patients with Parkinson’s disease on dopaminergic medications: A systematic review, Movement Disorders Clinical Practice