Adults

For Parkinson's disease: Initial dose 0.25 mg three times daily, gradually increased weekly based on response and tolerability, up to a maximum of 24 mg/day. For Restless Legs Syndrome: Initial dose 0.25 mg once daily, 1-3 hours before bedtime, may be increased up to 4 mg/day.

Elderly

Dosage adjustment may be necessary in elderly patients due to potential decreased renal clearance and increased sensitivity.

Renal_impairment

For patients with severe renal impairment (CrCl <30 mL/min), initial dose should be reduced by 50% for Parkinson's disease. For RLS, no adjustment needed for moderate to severe impairment.

Onset

Onset of therapeutic effect is gradual, usually within days to weeks of initiating therapy for Parkinson's disease, and within a few days for RLS.

Excretion

Excreted primarily in the urine as metabolites, with less than 10% excreted as unchanged drug.

Half life

Elimination half-life is approximately 6 hours.

Absorption

Rapidly absorbed after oral administration, peak plasma concentration reached in 1-2 hours. Absolute bioavailability is approximately 55%.

Metabolism

Extensively metabolized in the liver, primarily by the cytochrome P450 enzyme CYP1A2, to inactive metabolites.

Estrogens

May decrease ropinirole clearance, potentially increasing ropinirole levels. Dose adjustment may be necessary.

Fluvoxamine

Potent CYP1A2 inhibitor, significantly increases ropinirole exposure. Co-administration should be avoided or ropinirole dose reduced.

Ciprofloxacin

May increase ropinirole plasma concentrations due to CYP1A2 inhibition, requiring dose adjustment of ropinirole.