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Requip (Ropinirole) Side Effects & Adverse Reactions (List)

Requip (Ropinirole) is a drug initially approved in 1997 by the United States FDA for the treatment of [early or advanced-stage] idiopathic Parkinson’s disease.  In the management of Parkinson’s disease, Requip can be utilized either as: a standalone agent or as an adjunct to L-DOPA.  After its initial approval for the attenuation of Parkinson’s symptoms, Requip would receive FDA approval for the treatment of restless leg syndrome (RLS), another neurological disorder.

Pharmacologically, it’s classified as a non-ergoline dopamine agonist and is manufactured by the pharmaceutical company GlaxoSmithKline (GSK).  Requip functions principally by agonizing dopamine receptors, exhibiting highest affinity for D2, D3, and D4 receptor sites (in that order).  To a negligible extent, it also acts upon 5-HT2 and Alpha-2 adrenergic receptors.

As a result of its pharmacodynamic profile as a dopaminergic agonist, many psychiatrists prescribe Requip as an off-label intervention for patients with extrapyramidal symptoms (e.g. dystonia, akathisia, dyskinesia, etc.) caused by antipsychotics and SSRI-induced sexual dysfunction.  Although the drug is clinically effective for indicated neurological conditions such as Parkinson’s disease and RLS, it is not devoid of side effects.  Many individuals experience unwanted side effects and adverse reactions as a result of treatment with Requip.

Requip (Ropinirole) Side Effects & Adverse Reactions (List)

Included below is a comprehensive list of side effects that you may experience while taking Requip.  Realize that the specific side effects, their respective severities, and the total number of side effects you experience will be subject to significant individual variation.  In other words, you may have an entirely different set of side effects while taking Requip compared to another user.

That said, some side effects are reported more frequently than others among Requip users.  Some of the most common Requip side effects include: dizziness, dyskinesia, nausea, orthostatic hypotension, and somnolence.  If you have any questions or concerns about any side effects you’re currently experiencing, be sure to discuss them with a medical professional.

Appetite changes: You may notice a change in your appetite while taking Requip.  Most users report a reduction in overall appetite, which may lead to a modest amount of weight loss.  If you feel less hungry than usual or find yourself feeling satiated sooner than usual, it’s likely a result of the dopaminergic stimulation provided by Requip.

In some cases, a reduction in appetite among Requip users may be a direct result of other side effects including: nausea, vomiting, and/or gastrointestinal irritation – all of which could interfere with appetite.  That said, a small percentage of users may experience a noticeable increase in appetite, leading to weight gain.  If you find yourself consuming more food than usual while taking Requip, it may be related to poorer impulse control (another side effect).

Blood pressure changes: Some individuals experience changes in blood pressure while taking Requip.  Certain doses may increase blood pressure, leading to hypertension, while others may decrease blood pressure, leading to hypotension.  In fact, a common side effect of Requip is orthostatic hypotension or a sudden decrease in blood pressure upon transition from a seated to a standing position.

If you have any prior history of blood pressure abnormalities, it is important to report any drug-induced changes in blood pressure to your doctor.  Sometimes Requip may decrease blood pressure to such an extent that some users are prone to bouts of fainting.  Tracking your blood pressure while taking Requip may be necessary to avoid significant spikes or drops.

Confusion: A common side effect of Requip is confusion, or feeling cognitively amiss.  You may notice a decline in cognitive performance or feel as if you’re stuck in a state of “brain fog.”  This confusion can be common during the initial few weeks of starting Requip because your neurophysiology will not have adapted to the changes in neurochemistry and connectivity induced by the drug.

However, if the confusion is severe, persistent, and interferes with your occupational and/or academic performance – make your doctor aware of this side effect.  In some cases, another medication may be a better fit for your particular neurophysiology.  That said, in most cases the confusion is mild and diminishes as a user adapts to the drug.

Constipation: Gastrointestinal changes are common among Requip users, with many reporting constipation as a side effect.  The drug may slow the movement of food throughout the digestive tract, making you more prone to constipation.  If you notice fewer total bowel movements and/or notable changes in your stool, you may want to discuss this with your doctor.

Some individuals taking Requip may notice that the constipation subsides as they continue treatment and/or adjust the dose.  Others may need to utilize a concurrent treatment for constipation (e.g. with laxatives) and/or make dietary modifications (e.g. ramp up the fiber) to cope with this side effect.  That said, constipation may be uncomfortable and lead to indigestion and stomach aches.

Dizziness: Users of Requip may notice that the drug tends to make them feel extremely dizzy.  The dizziness associated with Requip usage is often a transient side effect that diminishes with continued usage and/or dosage adjustments.  However, if the dizziness is accompanied by lightheadedness and/or bouts of fainting, it may be a sign that the drug is decreasing a user’s blood pressure or increasing orthostatic hypotension susceptibility.

Mild dizziness is a common side effect that many users can cope with throughout treatment.  However, if you feel as if you just got off a rollercoaster and/or as if your equilibrium is out of sorts after several weeks of treatment, talk to your doctor.  Excessive and/or severe dizziness is considered an adverse reaction if incessant.

Drowsiness: Requip may make you feel drowsier than usual, possibly prone to sleeping more than usual throughout the day.  Drowsiness is important to recognize as a potential side effect due to the fact that it may interfere with your ability to operate a motor vehicle or heavy machinery.  If you commute with a motor vehicle and are experiencing drug-induced drowsiness, you may be putting your own life at risk, as well as passengers, and/or other motorists.

Furthermore, if you operate heavy machinery at work, you may endanger yourself, others, and possibly cause equipment damage.  Until you know whether the drug makes you drowsy, you should avoid driving and/or heavy machinery.  If Requip makes you excessively drowsy, talk to your doctor about a dosage adjustment, alternative options, and/or an adjunct to boost psychomotor vigilance.

Dry mouth: Dopamine receptor agonists such as Requip are understood to cause dry mouth in many users.  Don’t be surprised if your mouth feels completely parched and as if your salivary glands have ceased manufacturing salivary fluid.  Although dry mouth is a bit uncomfortable, it usually isn’t considered a serious side effect and most users can find ways to cope.

Unfortunately, if the dry mouth is extreme, it may increase proliferation of unwanted bacteria in oral cavities – possibly contributing to halitosis.  Although you can chew gum, excessive dry mouth may compromise your dental health.  You may want to discuss this side effect with your doctor and a dentist if it becomes problematic.

Dyskinesia: Among the most common adverse effects resulting from Requip is dyskinesia.  Although Requip was engineered to correct motor dysfunction among individuals with Parkinson’s disease, ironically, it may actually cause dyskinesia in certain users.  If you notice that your voluntary movements appear abnormal or are impaired, it may be a result of this treatment.

Other related symptoms include uncontrollable twisting, twitching, spasms, or unusual movements.  Fortunately, most individuals will notice a significant reduction in dyskinesia while taking Requip alone or with L-DOPA.  Contact your doctor immediately if the medication increases dyskinesia – you may need to alter your dose and/or opt for an alternative treatment.

Edema: Requip increases propensity of edema or excessive build-up of watery fluid within cavities and tissues of the body.  Most common among Requip users is edema of the legs, particularly the feet.  During treatment, you may notice that your legs appear swollen, larger than usual, or as if they’re retaining more fluid – this is edema.

In some cases, users may notice that only their feet or ankles appear to swell as a result of collected watery fluid.  Sometimes the edema associated with treatment can lead to minor or moderate joint pain.  Since many other medical conditions can cause edema, it is necessary to report this side effect to your doctor as soon as you notice it to rule out other causes (e.g. heart failure).

Fainting: Some individuals taking Requip will end up fainting during treatment.  Prior to fainting, users may experience lightheadedness and/or dizziness.  In most cases, the actual cause of the fainting is the side effect “orthostatic hypotension” or a sudden drop in blood pressure upon standing from a seated position or lying down.

If you faint during treatment, this will side effect may warrant immediate consultation with your doctor.  There may be some strategies that you can implement to minimize likelihood of orthostatic hypotension in the future, thereby decreasing risk of fainting.  In other cases, something as simple as a dosage adjustment may reduce odds of fainting.

Fatigue: A subset of users may notice that Requip makes them more fatigued than usual.  This fatigue may be prominent during the daytime and could interfere with productivity and/or the ability to accomplish various tasks.  If you feel extremely fatigued as a result of Requip, talk to your doctor about what can be done.

Sometimes the fatigue may improve as you continue treatment and/or after a dosing adjustment.  If the drug seems to be working well, but makes you extremely lethargic, your doctor may recommend a safe adjunct to help increase alertness and/or energy levels throughout the day.  Mild fatigue is generally recognized as a common side effect of Ropinirole.

Hallucinations: Don’t be surprised if you end up hallucinating while taking Requip.  Although the drug modulates dopaminergic receptors to improve psychomotor symptoms of Parkinson’s and RLS, excessive agonism of these receptors can lead some individuals to experience auditory hallucinations (e.g. hearing voices).  Though auditory hallucinations may be most common, others may experience visual, tactile, or olfactory hallucinations.

Essentially a hallucination is perceiving something (a stimuli) through the senses that has no basis in reality.  Understand that hallucinations are actually a fairly common reaction to Requip, but may cause anxiety and/or panic.  Talk to your doctor about dosage adjustments and/or a medication change if Ropinirole causes you to regularly hallucinate.

Headaches: Another of the most common side effects associated with Requip is headache.  Headaches throughout treatment may range from mild to severe intensity, but are typically intermittent in that they are not present 24/7.  If you have a moderate or severe (e.g. migraine) headache that doesn’t subside or diminish with continued Requip usage, be sure to contact your doctor and inform him/her that you’re experiencing this side effect.

Some users may need to simply learn to cope with mild headaches and/or use some sort of adjunct intervention to reduce headaches.  Often times a dosage adjustment and/or over-the-counter headache relief medication may prove helpful.  In other cases, headaches experienced when first starting Requip may decrease over time.

Impulse control disorder (ICD): A side effect that occurs in approximately 10% of Requip users (as well as other dopamine agonists) is impulse control disorder (ICD).  Impulse control disorder is characterized by inability to control impulses, leading to excessive: gambling, shopping, and/or sex.  The reason Ropinirole may cause impulse control disorders is related to its modulation of dopamine and neural signaling.

  • Compulsive gambling
  • Hypersexuality
  • Shopping in excess

Particularly, Ropinirole may cause an impulse control disorder by decreasing signaling sent from the prefrontal cortex to the nucleus accumbens, while increasing signaling from the nucleus accumbens to the anterior insula.  This essentially decreases logical oversight and control of urges (normally facilitated by the PFC) while increases pleasure associated with reward (via the anterior insula).  As a result, you may find yourself compulsively gambling, spending your entire savings, or having too much risky sex.

Caregivers, friends, and/or family of Requip users should be informed of this possible side effect to monitor changes in behavior.  Lawsuits against makers of Requip (GSK) have been filed and won for over $250,000 in damages for gambling and hypersexuality.  If you notice yourself behaving impulsively while taking this drug, report it to your doctor immediately; you may need a dosage adjustment or entirely different medication.

Insomnia: Even among those who feel fatigued during the day while taking Requip, insomnia is a common side effect.  You may find yourself unable to fall asleep at night, especially in the early stages of treatment.  Insomnia may result from changes in dopaminergic signaling, brain waves, and/or other neurophysiological processes associated with regulating the circadian rhythm.

In addition to being unable to fall asleep at a normal, healthy time – you may notice that you wake up in the middle of the night and are unable to fall back asleep.  Some insomnia is expected as a side effect, but if it interferes with your wellbeing, it should be reported to your doctor.  Adjunctive treatment with a safe hypnotic (sleeping medication) may prove helpful in certain cases.

Irregular heartbeat: A side effect that can occur among some users of Requip, particularly those on too high of a dosage is irregular heartbeat.  You may notice that your heart rhythm is abnormally slow or fast or feel as if it is skipping beats.  Some individuals may report heart palpitations or sensations that the heart is fluttering, beating loudly, or rapidly pounding.

To ensure that heart rate irregularities while taking Requip aren’t the sign of a serious, life-threatening cardiac reaction, you’ll want to seek medical evaluation if you notice changes in heart function during treatment.  Those with preexisting cardiovascular risk or disease should be especially aware of this side effect of Requip.  Adjustments in dosing and/or medication may be necessary if heart rhythms are deemed abnormal.

Lightheadedness: Certain users may feel lightheaded while taking Requip – this is a common side effect.  Lightheadedness may be most noticeable during the first few weeks as your neurophysiology learns to accommodate the Requip.  With continued treatment, lightheaded feelings may subside altogether or considerably diminish.

On the other hand, you may feel intermittent bursts of lightheadedness and/or dizziness when standing up from lying down or a seated position.  Orthostatic hypotension (sudden decrease in blood pressure) is a well-documented side effect of Requip, and can certainly cause lightheadedness.  The lightheadedness associated with orthostatic hypotension may cause fainting in a subset of individuals.

Memory loss: Your ability to store and/or retrieve short and long-term memories may be compromised while taking Requip.  While memory loss isn’t usually severe, it can occur and may be bothersome, especially if you had an exceptional memory prior to Ropinirole administration.  A slight blunting of memory faculties may be a disconcerting side effect that persists throughout treatment.

In some cases, optimization of Requip dosing can ameliorate the side effect of memory dysfunction.  If memory loss is severe and impairing your ability to hold down a job or function in society, alternative medications may warrant consideration.  Fortunately, memory may also improve for a subset of users, and any impairment experienced during treatment should subside upon Requip discontinuation.

Mood swings: A small percentage of individuals taking Requip may report significant mood swings.  If you feel relatively good one day, followed by cycling through feelings of agitation, anxiety, and/or depression – it could be the medication.  Whenever neurotransmission is significantly tweaked, there’s no predicting how everyone’s mood will be affected.

  • Agitation
  • Anxiety
  • Depression
  • Irritability

It should be noted that Requip doesn’t cause negative moods in most users.  In fact, it often enhances mood among those with various forms of depression.  That said, don’t be surprised if you notice some sort of mood swings and/or unpredictable changes in emotion during treatment.

Muscle or joint pain: A less common side effect from Requip is muscle pain, joint aches, cramps, or overall physical weakness.  In some cases, muscle and joint pain are caused by edema or heightened retention of watery fluid in cavities or tissues of the body.  This fluid can lead to swelling and put increased pressure on joints, leading some users to perceive pain in the afflicted region.

Feeling physically weak and/or experiencing joint pain may also be common among individuals taking higher doses of Requip.  If the pain becomes severe and/or unbearable, you may want to discuss alternative treatments with your doctor.  Fortunately, this is a relatively rare side effect compared to others, meaning you’re relatively unlikely to experience it.

Nausea: One of the most reported Requip side effects is nausea or an internal feeling of sickness that may lead to vomiting.  While nausea may be mild for some users, for others it may be extreme enough to reduce appetite and/or provoke vomiting.  Many users are likely to feel nauseous at some point while using Requip.

Sometimes the nausea is only extreme in the early weeks of treatment, and may subside with continued Requip usage.  If you find yourself feeling constantly nauseous while taking Requip, talk to your doctor about possible solutions.  Dosing adjustments, adjunctive treatments, and/or altering the time of Requip administration (e.g. after a meal) may decrease nausea.

Orthostatic hypotension: A commonly reported side effect of Requip is orthostatic hypotension, or an abrupt decrease in (systolic or diastolic) blood pressure while transitioning from a seated to a standing (upright) position.  Individuals unaware of orthostatic hypotension may end up fainting or blacking out regularly during treatment.  If you experience orthostatic hypotension, it could be accompanied by other signs such as dizziness or lightheadedness.

Those prone to bouts of treatment-induced orthostatic hypotension may want to beware of some preventative strategies.  Prevention of orthostatic hypotension is sometimes possible by instructing patients to transition from seated (or lying down) positions to standing at a slower pace.  In other cases, abdominal compression, hydration (with water), specific counter-maneuvers (bodily contractions), and vasopressor agents may be helpful.

Sexual dysfunction: Although a subset of individuals taking Requip can become hypersexual or find it difficult to resist sexual impulses, others may notice that their libido plummets.  If your sex drive and/or ability to orgasm decreases during treatment, it could be a result of other side effects such as drowsiness and/or fatigue.  Some users have reported inability to maintain an erection and/or anorgasmia (inability to orgasm) during treatment.

That said, sexual dysfunction among users of Ropinirole isn’t regarded as a very common side effect.  When considering the fact that Requip is often prescribed to offset preexisting sexual dysfunction resulting from treatment with serotonergic antidepressants, individuals are more likely to notice an improvement in sexual performance.

Sleep attacks: A fairly common side effect of Requip that occurs in some users is sudden, unpredictable “sleep attacks.”  In other words, you may take Requip, not feel the slightest bit tired or drowsy, and seemingly with no predictable signs, fall asleep.  Sleep attacks are considered highly-problematic in that they could compromise your safety or the safety of others while operating a motor vehicle or heavy machinery (such as in a workplace setting).

Unless you’ve been taking Requip for awhile, you should be cautious of these sleep attacks as a side effect.  If you experience sleep attacks (as occur with Requip and other dopamine agonists), you may need to adjust your dosing and/or augment the drug with another wakefulness-promoting agent (eugeroic).  Discuss what can be done to prevent Requip-induced sleep attacks with your doctor.

Sleep disturbances: In addition to experiencing insomnia (inability to fall asleep), you may find that you cannot stay asleep throughout the night while taking Requip.  It is possible that the medication alters sleep architecture and various REM parameters (e.g. latency, density, duration) that disrupt your sleep.  Disrupted sleep should be expected during the first few weeks of treatment as your brain adjusts to the Requip-induced changes in neurochemistry.

However, as you continue treatment and optimize your dosage, expect sleep disturbances to decrease.  If sleep disturbances to not cease with ongoing treatment, severity should be assessed and discussed with your doctor.  A change of medication may prove beneficial or an adjunctive hypnotic may be necessary to ensure adequate sleep quantity and quality.

Somnolence: Some individuals feel extremely sleepy during treatment with Requip to the extent that they cannot function during the daytime.  It may be difficult to perform basic tasks such as: preparing meals, showering, cleaning up around the house – and especially difficult to hold down a steady, cognitively/physically-demanding job if you’re constantly feeling sleepy.  For the fortunate, sleepiness experienced when starting Requip may subside with continued treatment.

For the less fortunate, sleepiness may persist throughout treatment.  If the somnolence is unremitting, a doctor may consider prescribing an adjuvant agent such as a psychostimulant or wakefulness-promoting agent to help users cope.  All users should beware that somnolence could be a sign of an imminent sleep attack; do not operate a motor vehicle or machinery if you experience this side effect.

Stomach aches: There’s evidence that Requip can cause stomach aches, likely as a result of its effect on the gastrointestinal tract.  Some individuals may experience drug-induced constipation, characterized by infrequent bowel movements and hardening of feces.  Assuming food is moving at a slower rate through your digestive tract and/or accumulating, you may experience indigestion – leading your stomach to ache and/or burn.

As you continue taking Requip, you may find that stomach aches are bearable or subside altogether.  Stomach aches may also result from accumulation of watery fluid (e.g. bloating) or taking Requip on an empty stomach.  If stomach aches become extreme, consider taking Requip along with food or only after a meal.

Sweating: A side effect that many Requip users report is an increase in the production of sweat.  You may sweat throughout the day (while at work) and/or notice that you’ve completely soaked your bedding from night sweats.  The sweating may be so profuse that you feel as if you just walked out of a steam room or sauna.

The excessive sweating may be accompanied by hot flashes (sudden bursts of feverish heat) or cold flashes (brief sensations of feeling chilled).  Fortunately for most users, sweating is not usually an extreme side effect due to the fact that it is usually mild.  That said, if the hyperhidrosis is deemed unbearable, it necessitates discussion with a doctor.

Tremors: Despite the fact that Requip often normalizes unwanted psychomotor irregularities associated with Parkinson’s disease, it can actually cause tremors (shakes) in a subset of users.  Tremors may be more likely among those who are improperly dosed or who haven’t fully adjusted to the medication.  If you experience tremors or notice an increase in shaking during treatment, realize that this is a reported side effect; it can cause worsening of Parkinson’s symptoms.

Those that experience tremors while taking Requip should have them assessed by a medical professional (e.g. neurologist) as these could signify a worsening of underlying Parkinson’s.  However, if tremors appear to decrease upon transition to another medication, you can likely assume that they were a side effect of Requip.  Sometimes a slight modification of the dosing may eliminate tremors resulting from Ropinirole.

Vision changes: A small percentage of users report visual abnormalities such as blurred vision while taking the drug.  Since many individuals with Parkinson’s experience visual changes as a result of the disease and/or old-age, it is often difficult to distinguish whether they were caused by a treatment, disease progression, and/or aging.  In any regard, it is smart to regularly assess your vision and/or consult an ophthalmologist if you are concerned about worsening of eyesight.

There is no evidence to suggest that administration of Requip inflicts damage upon eyesight.  If you had 20/20 vision prior to taking the drug, there’s a good chance that this will be maintained throughout treatment.  The blurred vision experienced in some users is most likely related to changes in neural activation of the visual cortex and/or turnover of neurotransmitters – not the eyes themselves.

Vomiting: If you’re taking a dopamine agonist such as Requip, there’s a good chance you may have vomited at some point throughout treatment.  Albeit highly unappealing, vomiting is reportedly very common side effect experienced by Requip users.  Don’t be surprised if at some point throughout treatment, especially in the early stages, you end up feeling highly nauseous and it prompts you to vomit.

Thankfully, vomiting doesn’t usually persist as you continue to use Requip and your neurophysiology adjusts to its presence.  Some believe that likelihood of vomiting can be reduced by taking Requip with food (or on a full stomach), as well as by starting with a low dose.  Frequent vomiting, even after weeks of treatment, should be considered an adverse effect and a sign that you’re unable to tolerate Requip.

Weight loss: Some individuals notice that while taking Requip, they end up losing weight.  Any weight loss experienced during treatment may be a result of dopaminergic modulation.  The ability of Requip to agonize dopamine receptors may increase feelings of satiety in some users and possibly even speed up their metabolic rates.

If the drug is working properly to manage symptoms of Parkinson’s, and isn’t overly sedating, some individuals may be more inclined to workout on a regular basis and/or be more cognizant of their food choices.  That said, weight loss is commonly observed as a general symptom of Parkinson’s disease – making it difficult to know whether a patient is experiencing weight loss as a side effect or from his/her Parkinson’s.

Weird dreams: Any drug that modifies neurochemistry and neural activation has potential to alter sleep architecture and cause the side effect of weird dreams.  You may notice that while taking Requip, your dreams become especially vivid, bizarre, and/or that you experience nightmares.  Sometimes the dream alterations are most noticeable in the early stages of treatment (e.g. first few weeks of taking Requip) and subside with ongoing usage.

On the other hand, dream oddities may be maintained throughout treatment.  In most cases, dream changes are not considered serious enough to warrant discontinuation of Requip.  However, you may want to brace yourself for some entertaining dreams as a side effect of this medication.

Variables that influence Requip (Ropinirole) side effects

It is important to understand that not everyone taking Requip will experience the exact same side effects.  Some individuals taking Requip may report no significant side effects throughout their entire course of treatment, while others may be plagued by a multitude of side effects such as: insomnia, nausea, sleep attacks, vomiting, etc. The number and severity of side effects that you’re likely to experience are likely based upon influential variables such as: Requip dosage, duration of treatment, co-administered agents, and other individual factors (e.g. genetics).

  1. Requip Dosage (High vs. Low)

There is evidence that dopamine agonists tend to yield dose-dependent side effects.  Meaning, the greater the dosage of Requip you administer on a daily basis, the more likely you are to experience side effects.  This is common sense and is generally observed with most neuropsychiatric drugs – the greater the extent of a dosage increase, the more severe and/or numerous side effects become.

There is one chief reason that high-dose users will be more likely than low-dose users to experience side effects.  Firstly, high-dose users will be ingesting a greater overall amount of Requip, meaning this larger dose will exert a greater neurophysiological effect, but also place a greater burden on hepatic enzymes and renal pathways for metabolism and clearance.  At the higher dose, neurochemistry is altered more substantially (specifically via dopamine agonism) than at lower doses.

Hence, high-dose users will be more prone to effects resulting from heightened dopamine receptor agonism such as impulse control disorders.  The body may have a tougher time breaking down (via metabolism) and eliminating the higher-dose of Requip from circulation after ingestion, possibly making side effects such as: constipation, nausea, and vomiting more likely.  Those taking lower doses won’t experience the same extent of neural modification and should have an easier time metabolizing Requip, making side effects less likely or less significant.

Requip (generic “Ropinirole”) is manufactured in tablets ranging from 0.25 mg to 5 mg.  The maximum recommended daily dose for Parkinson’s patients is 24 mg/day (taken in three separate 8 mg doses).  Those taking the drug for RLS may only take up to 4 mg per day, making them less susceptible to dose-related side effects than the higher-dosed Parkinson’s patients.

  1. Duration of treatment

The total duration over which you’ve been taking Requip may influence the number and severity of side effects that you’re experiencing.  Particularly, individuals who are in early stages of treatment such as those who’ve only taken Requip for a few days (or a few weeks) will be more likely to report side effects than long-term users.  If you’re currently experiencing side effects, consider how long you’ve been using Requip.

  • Short-term: A short-term user, or someone who’s recently started using Requip, is very likely to experience side effects. Since the human body didn’t evolve to accommodate daily administration of Ropinirole (and other dopamine receptor agonists), its introduction may generate an initial neurophysiological reaction; leading to side effects.  Furthermore, short-term users are unlikely to be taking an optimal dosage, making side effects more likely.
  • Moderate-term: After months of treatment (a moderate term), you’re likely to tolerate Requip better than during the initial few days or weeks of administration.  At this point, your neurophysiology will have learned to accommodate the drug and perhaps the dosing will have been tweaked slightly to decrease likelihood of a few side effects.  Certain side effects experienced over the short-term may begin to diminish after a moderate-term.
  • Long-term: If you’ve managed to take Requip for years, your body will have fully adapted to the presence of the drug. Side effects experienced during the initial adaptation phase will have completely subsided or significantly diminished.  At this point you will likely have fully optimized your dosing and worked with your doctor to come up with strategies or adjunctive options to mitigate side effects.  That said, you may have noticed dwindling efficacy of your dosage (after several years), and thus may have required an increase in dosing – possibly increasing susceptibility to certain unwanted side effects.
  1. Co-administered agents

If you’re taking Requip as a standalone agent, you can disregard the influence of co-administered agents on side effects.  On the other hand, if you’re taking Requip along with a laundry list of drugs and/or supplements, it is necessary to consider that side effects may have resulted from an interaction (via pharmacokinetics or pharmacodynamics) with another substance (or multiple substances).

Since Requip is metabolized predominantly by CYP1A2 isoenzymes within the liver, any agent that affects CYP1A2 metabolism may affect side effects and efficacy of Requip.  Examples of agents that are known to inhibit CYP1A2 metabolism include: Ciprofloxacin, Luvox, and Verapamil.  If you are taking any of these inhibitors along with Requip, expect impaired metabolism and ultimately more side effects at lower doses.

On the other hand, if you’re using tobacco products (CYP1A2 inducers) along with Requip, expect it to be metabolized faster – possibly decreasing side effects and efficacy in certain users.  Even if you aren’t using any drugs or supplements that affect CYP1A2 metabolism, you should consider whether they may interact or increase side effects via neurochemical modulation.  For example, if you’re on a cocktail of other drugs that affect dopamine – there could be some sort of interaction effect.

You’ll also want to consider whether the side effects that you’ve attributed to Requip aren’t from another agent.  Some individuals may take Requip along with L-DOPA or an SSRI and automatically assume that any side effects are from the Requip, when in reality, they may actually be caused by the other agent.  Review the side effect profiles of all agents that you’re taking before assuming Requip is the problem.

Also understand that certain substances that you’re taking may actually decrease side effects of Requip.  For example, if you’re taking sleeping pills at night and a stimulatory agent during the day (e.g. caffeine), you may not experience insomnia nor drowsiness during your treatment with Requip.  Therefore, you may want to reflect upon whether certain co-administered substances may have attenuated Requip-induced side effects.

  1. Individual factors

In addition to Requip dosing, duration of treatment, and whether you’re taking other substances along with it – consider that individual factors may influence side effects.  Two users that have been taking Requip as a standalone agent for the same duration and at the same dose – may report significantly different side effects.  In this case, differences in side effects may be best explained by individual factors including: CYP450 metabolism, genetics, medical conditions, sleep hygiene, diet, stress, and physical activity.

  • Administration specifics: The time of day at which you take Requip, number of daily doses, and whether you take it along with food can affect whether you experience side effects. Someone who takes a single dose at night on an empty stomach may experience an entirely different set of side effects than someone who takes it twice per day after large meals.  It may require some experimentation to determine the optimal specifics of administration for your needs.
  • CYP450 metabolism: Requip is understood to be metabolized by CYP1A2 to form multiple metabolites (SK&F-104557 and SK&F-89124). At higher doses, it is also metabolized by CYP3A4 and possibly even CYP2D6.  Since CYP1A2, CYP3A4, and CYP2D6 are polymorphic, expression of alleles may vary among users.  Variation in expression of alleles can alter (expedite or prolong) metabolism of Requip – thereby increasing or decreasing side effects.
  • Dietary intake: Your diet can affect metabolism, energy levels, mood, and neurological function. Additionally, intake of certain foods such as broccoli affect CYP1A2 isoenzymes by acting as inducers.  Consider that quality, nutrient-dense foods may mitigate various side effects resulting from Requip, but suboptimal food choices may lead to exacerbation of certain side effects.
  • Genetics/epigenetics: Though genes certainly influence CYP450 isoenzyme expression for metabolism, our reaction to certain substances is not solely determined by the efficiency by which we metabolize Requip. Various other genes influencing our neurophysiology may dictate whether we’re likely to experience certain side effects from treatment.  Additionally, epigenetics or genetic expression as influenced by environmental factors may predict how we respond to Requip’s pharmacological profile.
  • Medical conditions: The medical conditions for which a person is taking Requip may influence likelihood of certain side effects based on the underlying neurochemistry associated with the condition. Additionally, comorbid neuropsychiatric conditions or medical problems may also increase susceptibility to certain side effects associated with Requip.  Reflect upon whether you have any other medical diagnoses and how they may relate to side effects of Requip.
  • Sleep hygiene: Some individuals may legitimately experience sleep disturbances as a result of Requip. Others may experience sleep disturbances due to poor sleep hygiene, as well as Requip.  Ensuring that you’re practicing good sleep hygiene may attenuate side effects stemming from sleep abnormalities including: daytime sleepiness/drowsiness, sleep attacks, headaches, and mood swings.  Those with poor sleep hygiene may experience an exacerbation of side effects during treatment.
  • Stress: An individual who is highly stressed will likely experience more side effects than someone with low stress. Stress can cause a host of unwanted physical sensations including: headache, dizziness, nausea, etc. – and many of these may be synergistically exacerbated by Requip.  Whether you effectively manage stress may determine whether you experience greater or fewer unwanted Requip side effects.

Requip (Ropinirole): Do the benefits outweigh the side effects?

If you’ve been taking Requip for awhile, you may want to do a self-audit on the perceived efficacy of treatment in comparison to side effects that you’ve experienced.  Assuming you’ve been taking Requip for several months and have experienced minimal (or possibly zero) side effects, yet symptoms of Parkinson’s or RLS have significantly improved – it’s likely a great fit for your neurophysiology.  In this example in which the benefits substantially outweigh any unwanted side effects – it’s a “no-brainer” to continue usage.

On the other hand, some users may take Requip and experience minimal side effects, but also no significant benefits.  It makes minimal sense to continue a treatment if you’re not deriving any sort of therapeutic benefit – the purpose is to treat your medical condition (e.g. Parkinson’s).  Therefore, even if side effects are few and far between, but the drug clearly isn’t helping your neurological disorder – discuss alternative medications with your doctor.

A majority of Requip users will experience a blending of therapeutic benefits and side effects.  For example, Requip may significantly improve psychomotor symptoms and mood of a patient with Parkinson’s, but he/she may also experience dizziness, headaches, and nausea on a daily basis as a result of treatment.  In this case, assuming symptomatic improvement is significant, the aforestated side effects (dizziness, headaches, and nausea) may be accepted by the user as an inevitable “trade off.”

The worse case scenarios include: when users experience only side effects (and no benefits), when certain side effects are intolerable or a “deal-breaker” (e.g. compulsive gambling), and/or when side effects significantly outweigh benefits.  For example, an individual who takes Requip and gets slight relief from symptoms of Parkinson’s, but experiences daily vomiting along with frequent sleep attacks – may prefer another intervention.  You may find it helpful to track side effects of Requip in a daily journal and discuss whether the drug is worth continuing with your doctor.

Possible ways to reduce Requip (Ropinirole) side effects

If you’re currently taking Requip, there may be some ways in which you can reduce the occurrence and/or intensity of certain side effects.  Possible ways to decrease likelihood of Requip side effects include: dosage adjustments, attenuators, tweaking administration, eliminating problematic agents, and/or continuing usage.  Prior to implementing any of these mitigation strategies, discuss safety and efficacy with a medical professional.

  1. Dosage reduction: Side effects are understood to be more prominent and likely to occur at a higher dose. Your doctor may slightly reduce your dosage and this reduction may eliminate or reduce the severity of a particular side effect. To minimize likelihood of side effects, all Requip users should strive to take a minimal effective dose or lowest amount of the drug to alleviate symptoms.
  2. Attenuators: Sometimes administration of an agent (drug or supplement) aimed to strategically attenuate a particular side effect of Requip may provide benefit. For example, someone who struggles with sleep disturbances (e.g. insomnia, frequent awakenings, etc.) may derive benefit from a sleeping medication or hypnotic supplement. In another case, someone with drowsiness may benefit from simply increasing intake of caffeine or prescription of a concurrent stimulatory agent.
  3. Tweaking administration: Modifying the specifics of Requip administration may be an effective way to reduce side effects for some users. For example, individuals that are taking Requip in divided doses may benefit from altering the number of total doses taken throughout the day. Others may benefit from transitioning from an immediate-release version to the XL (extended-release) format.  Altering the time of day at which the drug is taken and/or whether it is taken with food may also influence side effects.
  4. Eliminate agents: Some individuals may be taking a host of dietary supplements and/or medications along with Requip that aren’t totally necessary. A medical professional should be able to pinpoint which substances are legitimately helpful and others that can be safely discontinued. By discontinuing unnecessary agents, likelihood of interaction-related and/or overall side effects should decrease.
  5. Continue using: If you’ve only taken Requip for a short-term, understand that it can take up to a month or two for your neurophysiology to adapt to the drug. Until your neurophysiology has adapted to accommodate regular administration of Requip, you are likely to experience side effects. As you continue using it for a several more weeks, you may find that side effects fade or completely subside.

Have you experienced Requip (Ropinirole) side effects?

If you’re a current Requip (Ropinirole) user and/or used it in the past, share any side effects that you experienced in the comments section below.  Mention the specific side effects and their respective severities (on a scale of 1 to 10).  Which side effect did you find most problematic and/or extreme while taking Requip?

To help others get a better understanding of your situation, share some specifics such as: your daily Requip dosage, total duration of usage, whether you take any other drugs/supplements along with it, and the medical condition that you’re treating.  If you’ve discovered ways to cope with or reduce certain side effects of Requip, include them in your comment.  Have you found that the benefits associated with treatment outweigh the unwanted side effects?

Are there any side effects that you’re willing to put up with as long as the medication continues to reduce symptoms of Parkinson’s or RLS?  Understand that a majority of individuals taking Requip will experience side effects – no pharmaceutical drug is tolerable for every user.  During treatment, always pay attention to how your body reacts – if you cannot tolerate Requip, there are plenty of other available interventions.

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