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ropinirole

Class: Dopamine agonists. First FDA approval 09/19/1997: 29 years on the US market.

This grade answers one narrow question: how strong is the public evidence and safety record behind this drug, and how clean is its money trail and court record? It is not a verdict on whether the drug is right for you.

B

Score breakdown (81/100)

Safety ×35%
A
Evidence ×25%
F
Regulatory ×15%
B
Money & lawsuits ×15%
A
Options ×10%
A

Safety: 92

Evidence: 46

Regulatory history: 85

Money & lawsuits: 100

Options: 100

Independent reviews and post-approval warnings

FDA Drug Safety Communications

Warnings the FDA chose to announce publicly after approval, as opposed to quiet label edits. Class-wide items name the drug's class, not this drug specifically.

What the FDA label says

Approved uses

Ropinirole tablets are a non-ergoline dopamine agonist indicated for the treatment of Parkinson’s disease (PD) and moderate-to-severe primary Restless Legs Syndrome (RLS). ( 1.1, 1.2 ) 1.1 Parkinson’s Disease Ropinirole tablets are indicated for the treatment of Parkinson’s disease. 1.2 Restless Legs Syndrome Ropinirole tablets are indicated for the treatment of moderate-to-severe primary Restless Legs Syndrome (RLS).

Contraindications

Ropinirole tablets are contraindicated in patients known to have a hypersensitivity/allergic reaction (including urticaria, angioedema, rash, pruritus) to ropinirole or to any of the excipients. History of hypersensitivity/allergic reaction (including urticaria, angioedema, rash, pruritus) to ropinirole or to any of the excipients. (4)

Warnings and precautions

Sudden onset of sleep and somnolence may occur (5.1) Syncope may occur (5.2) Hypotension, including orthostatic hypotension may occur (5.3) May cause hallucinations and psychotic-like behaviors (5.4) May cause or exacerbate dyskinesia (5.5) May cause problems with impulse control or compulsive behaviors (5.6) 5.1 Falling Asleep during Activities of Daily Living and Somnolence Patients treated with ropinirole hydrochloride have reported falling asleep while engaged in activities of daily living, including driving or operating machinery, which sometimes resulted in accidents. Although many of these patients reported somnolence while on ropinirole hydrochloride, some perceived that they had no warning signs, such as excessive drowsiness, and believed that they were alert immediately prior to the event. Some have reported these events more than 1 year after initiation of treatment. In controlled clinical trials, somnolence was commonly reported in patients receiving ropinirole hydrochloride and was more frequent in Parkinson's disease (up to 40% ropinirole hydrochloride, 6% placebo) than in RLS (12% ropinirole hydrochloride, 6% placebo) [see Adverse Reactions (6.1) ] . It has been repo...

Adverse reactions (label)

The following adverse reactions are described in more detail in other sections of the label: Hypersensitivity [see Contraindications (4) ] Falling asleep during activities of daily living and somnolence [see Warnings and Precautions (5.1) ] Syncope [see Warnings and Precautions (5.2) ] Hypotension/orthostatic hypotension [see Warnings and Precautions (5.3) ] Hallucinations/psychotic-like behavior [see Warnings and Precautions (5.4) ] Dyskinesia [see Warnings and Precautions (5.5) ] Impulse control/compulsive behaviors [see Warnings and Precautions (5.6) ] Withdrawal-emergent hyperpyrexia and confusion [see Warnings and Precautions (5.7) ] Withdrawal Symptoms [see Warnings and Precautions (5.8) ] Augmentation and early-morning rebound in RLS [see Warnings and Precautions (5.9) ] Fibrotic complications [see Warnings and Precautions (5.10) ] Retinal pathology [see Warnings and Precautions (5.11) ] Most common adverse reactions (incidence with ropinirole hydrochloride at least 5% greater than placebo) in the respective indications were: Early PD: Nausea, somnolence, dizziness, syncope, asthenic condition, viral infection, leg edema, vomiting, and dyspepsia. (6.1) Advanced PD: Dyskinesi...

Recent major label changes

Warnings and Precautions, Withdrawal Symptoms ( 5.8 ) 7/2021 Melanoma-removal ( 5.9 ) 7/2021

Source: FDA SPL label for ropinirole (Accord Healthcare Inc.), effective 20241003. Full label on DailyMed.

Side-effect reports sent to the FDA

These are counts of reports people filed, not rates of harm. Anyone can file one, and nobody checks whether the drug was the cause. Millions of doses are taken for every report sent, so the useful part is how this drug compares with the average across all drugs.

25,971reports that mention this drug
25,936of those blame this drug, not another one the person was taking
63%of reports describe a serious outcome, such as a hospital stay (average for all drugs: 57%)
8.4%of reports include a death, from any cause (average for all drugs: 9.1%)

Problems reported most often

Drug Ineffective · 1,869Fall · 1,811Fatigue · 1,651Nausea · 1,600Dizziness · 1,216Pain · 1,105Hallucination · 1,098Dyspnoea · 1,072Death · 1,035Diarrhoea · 1,020Headache · 986Asthenia · 948Off Label Use · 938Gait Disturbance · 870Insomnia · 865

Reports per year

20192020202120222023202420252026
2,5952,4912,0051,8131,4391,6791,790848

1,237 reports blaming this drug for every million Medicare prescriptions filled, which is 0.4× the typical drug on this site. (4,306 reports in 2024–2026, against 3,480,847 Medicare fills in one year. This is the one number here that accounts for how many people take the drug.)

Source: the FDA's Adverse Event Reporting System (FAERS). Reports are voluntary and unverified. Drugs that are prescribed a lot, in the news, or in lawsuits attract more reports, so the percentages are compared with the whole database to correct for that partly, not fully.

Recalls and regulatory record

7recall actions on file
2 / 21brand / generic applications
3label changes since 2021
NoREMS program
DateClassFirmReason
02/2023Class IIAccord Healthcare, Inc.CGMP Deviations: recalling drug products following an FDA inspection.
02/2023Class IIAccord Healthcare, Inc.CGMP Deviations: recalling drug products following an FDA inspection.
02/2023Class IIAccord Healthcare, Inc.CGMP Deviations: recalling drug products following an FDA inspection.
02/2023Class IIAccord Healthcare, Inc.CGMP Deviations: recalling drug products following an FDA inspection.
02/2023Class IIAccord Healthcare, Inc.CGMP Deviations: recalling drug products following an FDA inspection.
02/2023Class IIAccord Healthcare, Inc.CGMP Deviations: recalling drug products following an FDA inspection.
02/2023Class IIAccord Healthcare, Inc.CGMP Deviations: recalling drug products following an FDA inspection.

Class I = reasonable probability of serious harm. Class II = temporary or reversible harm. Class III = unlikely to harm. Most generic recalls are manufacturing or labeling defects for one lot, not a verdict on the molecule.

Evidence base

73randomized trials (PubMed)
11systematic reviews
80registered trials
49%of completed trials posted results
8%terminated or withdrawn
79%industry-funded

Independent Cochrane reviews

Counts measure how much evidence exists and how transparent it is, not how big the benefit is. For that, ask your prescriber: if 100 people like me took this, how many would get better because of it, and how many would be harmed? (Doctors call these the "number needed to treat" and "number needed to harm.") It differs by condition and is the number drug ads leave out. Sources: PubMed, ClinicalTrials.gov.

Money and lawsuits

In 2024, drug companies reported $0 in payments to US physicians and hospitals tied to this drug across 0 transactions.

No pending federal MDL names this drug or its brands.

Not named in any federal pharmaceutical settlement of $100M or more on record.

Sources: CMS Open Payments (Sunshine Act); Judicial Panel on Multidistrict Litigation pending docket list; DOJ settlements as tabulated on Wikipedia with links to the primary record. State-court and individual suits are not included.

Who takes it and what it costs

704,591Medicare Part D patients (2024)
3,480,847prescriptions filled
$19average cost per fill
$65Mtotal Medicare spend
ProductFills$/fill
Ropinirole HCl3,405,431$16
Ropinirole ER75,416$131

Same-class alternatives

apomorphinebromocriptinecabergolinedihydroergocryptine mesylatepergolidepiribedilrotigotine

Same ATC pharmacological class, graded ones first, best grade at the top. Being in the same class does not make them interchangeable for your condition; it makes them worth asking about.

Questions to ask your prescriber

  1. In 2011 the FDA issued a safety communication about this drug (Risperdal and Requip - Medication errors resulting from confusion between risperidone (Risperdal) and ropiniro). Does that risk apply to me?
  2. The most-reported problems in FDA's adverse event data are fall, fatigue, nausea. How would we recognize and handle those?
  3. Why this one over apomorphine, bromocriptine, cabergoline? What would make you pick one of those instead?
  4. What result are we expecting, by when, and what is the plan if it does not happen?
  5. If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)