Ropinirole (patient information)

# Why is this medication prescribed
Ropinirole is used alone or with other medications to treat the symptoms of Parkinson's disease (PD; a disorder of the nervous system that causes difficulties with movement, muscle control, and balance), including shaking of parts of the body, stiffness, slowed movements, and problems with balance. Ropinirole is also used to treat restless legs syndrome (RLS; a condition that causes discomfort in the legs and a strong urge to move the legs, especially at night and when sitting or lying down). Ropinirole is in a class of medications called dopamine agonists. It works by acting in place of dopamine, a natural substance in the brain that is needed to control movement.

# How should this medicine be used
Ropinirole comes as a tablet to take by mouth. When ropinirole is used to treat Parkinson's disease, it is usually taken three times a day. When ropinirole is used to treat restless legs syndrome, it is usually taken once a day, 13 hours before bedtime. Ropinirole may be taken with or without food, but taking ropinirole with food may help to prevent nausea that may be caused by the medication. Follow the directions on your prescription label carefully and ask your doctor or pharmacist to explain any part you do not understand. Take ropinirole exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Your doctor will start you on a low dose of ropinirole and gradually increase your dose. If you are taking ropinirole to treat Parkinson's disease, your doctor will probably not increase your dose more often than once a week. If you are taking ropinirole to treat restless legs syndrome, your doctor will probably increase your dose after 2 days, again at the end of the first week, and then not more often than once a week. It may take several weeks before you reach a dose that works for you. If you are taking ropinirole to treat restless legs syndrome, you may receive a starter kit that contains tablets of increasing strength to be taken during the first 2 weeks of your treatment. The dose of medication you will need depends on how well the medication works for you and may be different than the doses contained in the kit. Your doctor will tell you how to use the kit and whether you should take all the tablets it contains. Follow these directions carefully.
Ropinirole controls the symptoms of Parkinson's disease and restless legs syndrome but does not cure these conditions. Continue to take ropinirole even if you feel well. Do not stop taking ropinirole without talking to your doctor. If you are taking ropinirole to treat Parkinson's disease and you suddenly stop taking the medication, you may experience fever, fast heartbeat, muscle stiffness, sweating, and other symptoms. Your doctor will probably decrease your dose gradually.
If you stop taking ropinirole for any reason, do not start to take the medication again without talking to your doctor. Your doctor will probably want to increase your dose again gradually.

# What special precautions should I follow
Before taking ropinirole:
- tell your doctor and pharmacist if you are allergic to ropinirole, any other medications, or any of the ingredients in ropinirole tablets. Ask your doctor or pharmacist for a list of the inactive ingredients.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements and herbal products you are taking or plan to take. Be sure to mention any of the following: antidepressants ('mood elevators'); antipsychotics (medications for mental illness); cimetidine (Tagamet, Tagamet HB); fluoroquinolone antibiotics such as ciprofloxacin (Cipro), and norfloxacin (Noroxin); fluvoxamine (Luvox); levodopa (in Sinemet, in Stalevo); medications for anxiety and seizures; medications that contain estrogen such as hormone replacement therapy and hormonal contraceptives (birth control pill, patches, rings, or injections); medications that cause drowsiness; metoclopramide (Reglan); mexiletine (Mexitil); sedatives; sleeping pills; and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have ever had an urge to gamble that was difficult to control and if you have or have ever had a sleep disorder other than restless legs syndrome; or heart, liver, or kidney disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking ropinirole, call your doctor.
- you should know that ropinirole may make you drowsy or may cause you to suddenly fall asleep during your regular daily activities. You might not feel drowsy before you suddenly fall asleep. Do not drive a car or operate machinery at the beginning of your treatment until you know how the medication affects you. If you suddenly fall asleep while you are doing something such as watching television or riding in a car, or if you become very drowsy, call your doctor. Do not drive or operate machinery until you talk to your doctor.
- remember that alcohol can add to the drowsiness caused by this medication. Tell your doctor if you regularly drink alcoholic drinks.
- tell your doctor if you use tobacco products. Call your doctor if you start or stop smoking during your treatment with ropinirole. Smoking may decrease the effectiveness of this medication.
- you should know that ropinirole may cause dizziness, lightheadedness, nausea, or sweating when you get up too quickly from a sitting or lying position. This is more common when you first start taking ropinirole. To avoid this problem, get out of the chair or bed slowly, resting your feet on the floor for a few minutes before standing up.

# What special dietary instructions should I follow
Unless your doctor tells you otherwise, continue your normal diet.

# What should I do if I forget a dose
If you are taking ropinirole to treat Parkinson's disease, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
If you are taking ropinirole to treat restless legs syndrome, skip the missed dose. Take your regular dose 13 hours before your next bedtime. Do not double the next dose to make up for the missed dose.

# Side effects

## Mild side effects
Ropinirole may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- nausea
- vomiting
- dizziness
- drowsiness
- weakness
- headache
- heartburn
- stomach pain
- constipation
- sweating
- confusion
- anxiety
- abnormal body movements
- slowed or decreased movements
- numbness, burning, or tingling in the hands, arms, feet, or legs
- frequent or urgent need to urinate
- difficulty urinating or pain when urinating
- runny nose, sore throat, and other cold symptoms
- joint pain
- swelling of the hands, arms, feet, ankles, or lower legs
- dry mouth

## Severe side effects
Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:
- hallucinations (seeing things or hearing voices that do not exist)
- fainting
- slow or irregular heartbeat
- shortness of breath
- double vision or other problems with vision
Some people who took medications such as ropinirole to treat Parkinson's disease developed gambling problems. There is not enough information to tell whether the people developed these problems because they took the medication or for other reasons. Call your doctor if you have an urge to gamble that is difficult to control. Tell your family members about this risk so that they can call the doctor even if you do not realize that your gambling has become a problem.
People who have Parkinson's disease may have a greater risk of developing melanoma (a type of skin cancer) than people who do not have Parkinson's disease. There is not enough information to tell whether medications used to treat Parkinson's disease such as ropinirole increase the risk of developing skin cancer. You should have regular skin examinations to check for melanoma while you are taking ropinirole even if you do not have Parkinson's disease. Talk to your doctor about the risk of taking ropinirole.
Ropinirole may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication.

# What storage conditions are needed for this medicine
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from direct sunlight, excess heat, and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include:
- nausea
- vomiting
- dizziness
- hallucinations
- sweating
- fear when in small or closed space
- body movements that are difficult to control
- pounding heartbeat
- weakness
- nightmares
- coughing
- fainting
- chest pain
- confusion

# What other information should I know
Keep all appointments with your doctor.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Requip