Non-ergot dopamine D2/D3 receptor agonist
ATC code: N04BC04 (Ropinirole)
Brand names
Ropinirol Cinfa, Requip, Requip Modutab
A selective D2-family dopamine receptor agonist with preferential D3 activity. Compared with pramipexole, longer 6-hour half-life; extended-release allows once-daily dosing. No fibrotic complication risk unlike ergot agonists. CYP1A2-metabolized – significant interactions with smoking (CYP1A2 induction) and ciprofloxacin (inhibition).
First line
First-line in Parkinson's disease in patients under 65 to delay levodopa or in combination with levodopa for motor fluctuations. Starting dose immediate-release 0.25 mg three times daily or extended-release 2 mg once daily. Efficacy comparable to per REAL-PET and CALM-PD. Also raises impulse-control disorder risk ( 2012, 2014 warning).
Second line
Second-line for moderate-to-severe restless legs syndrome per 2024. First-line is iron supplementation in ferritin deficiency and α2δ ligands (gabapentin, pregabalin). Ropinirole 0.25–4 mg 2–3 hours before bed. Long-term use is linked to augmentation – switch the drug when augmentation appears.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Ropinirole is a dopamine receptor agonist. It is prescribed for Parkinson's disease and for moderate-to-severe restless legs syndrome (RLS) ( 2018 guidelines and AEMPS Ficha Técnica). For mild nighttime leg symptoms that do not meet objective RLS criteria, ropinirole is not used. The drug has serious risks: pathological gambling, hypersexuality, compulsive behaviors ( warning, 2014), sudden sleep attacks with risk of falling asleep at the wheel, and augmentation on long-term RLS treatment (paradoxical worsening of symptoms). If ropinirole was prescribed for suspected RLS, check serum ferritin (iron deficiency is a common reversible cause) and reassess the prescription with the clinician. If RLS has not been confirmed by IRLSSG criteria, consider seeking a second opinion.
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Limited data.
Suppresses lactation via prolactin inhibition.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Ropinirole is evaluated for the following indications with varying evidence strength: Restless legs syndrome (evidence tier A), Parkinson's disease (evidence tier A), Insomnia and sleep disorders (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Ropinirole (≥ 1 in 100): Nausea, Drowsiness and sudden sleep attacks, Dizziness, Orthostatic hypotension, Dyskinesias (in Parkinson's with concomitant levodopa), Constipation. See the Safety section for uncommon and serious reactions.
FDA category C. Limited data.
Suppresses lactation via prolactin inhibition.
Ropinirole is contraindicated in: Ropinirole hypersensitivity; Severe renal impairment without dialysis; Severe hepatic impairment; Pregnancy and lactation; Age under 18. Full list in the Safety section.