Medication: Requip

Requip is a medication for restless legs syndrome that can work for some, but has side effects in others.

About Requip and RLS

The FDA has approved Requip to treat “moderate-to-severe primary Restless Legs Syndrome (RLS)” for adults with the condition. The medication is made by GlaxoSmithKline. RLS is “a chronic and disruptive neurological condition” where patients feel an urge to move their legs and experience some sensations that may be painful, such as tingling, pulling, tightening, and “creeping-crawling”. The RLS symptoms are pronounced when the patient is at rest, generally when they are sleeping, lying down, or sitting. Movement only provides temporary relief, and patients with this condition have trouble sleeping, leading to disruption in daily activities. Lack of sleep leaves patients less alert during the day. The way that Requip works is that it is a “dopamine agonist”, which means that it “stimulates the dopamine receptors in the brain”. Researchers have an idea that RLS may have an underlying cause related to dopamine, which is a chemical in the brain that is in charge of carrying signals between the nerve cells responsible for body movement. When dopamine doesn’t work as it should, these nerve signals’ communication is upset. During Requip’s clinical trials, patients who had RLS due to other underlying conditions (e.g., renal failure, pregnancy, iron deficiency) were excluded. A significant number of patients in the clinical trial showed improvement in their symptoms and a lower relapse rate compared to placebo. Two-thirds of patients with RLS are women, and the condition is chronic, increasing with age. There may be a genetic component to the disorder. Sometimes RLS is underdiagnosed, and patients may receive a diagnosis of neuropathy, insomnia, arthritis, nocturnal cramps, depression, and back pain instead.¹

Dosage and Side Effects

Requip and Requip XL are also known as ropinirole. Ropinirole is also used to treat Parkinson’s disease (PD) symptoms. The extended-release version is not used for RLS, as it would be for PD. For RLS, ropinirole is taken, as a regular tablet, once a day, at the same time every day (about 1-3 hours before bedtime). RLS patients receive an increased dose after a couple of days, then again at the end of the first week. Each dosage increase occurs about once a week after that, until a dosage level is reached in several weeks. Requip comes with a special starter pack to help patients adjust to their initial dosages. Requip does not cure RLS, but it can help to manage the symptoms. Patients who decide to stop taking the medication should lower their dose gradually, under a doctor’s supervision. Serious side effects may occur if patients stop the medication abruptly.² An allergic reaction to ropinirole would present as swelling of the face, mouth, or throat, hives, and difficulty breathing. Serious side effects of ropinirole include tremors, hallucinations, tightness in the chest, fever, confusion, sweating, fast or uneven heartbeats, stiff muscles, or a feeling of wanting to pass out.³ During the daytime, “sudden sleep attacks may occur”. Unusual effects from ropinirole include compulsive gambling and hypersexuality.⁴ Other less serious side effects include nausea, stomach pain, vomiting, loss of appetite, constipation, diarrhea, headache, anxiety, agitation, and dry mouth.⁵ Requip does not work for all RLS patients, and side effects may lead some to seek other treatments or even alternative care options, such as chiropractic.