Ropinirole

Ropinirole is prescribed for mainly Parkinson's disease, restless legs syndrome, and extrapyramidal symptoms. It can also reduce the side effects caused by selective serotonin reuptake inhibitors, including Parkinsonism syndrome as well as sexual dysfunction and erectile dysfunction caused by either SSRIs or antipsychotics. A 2008 meta-analysis found that ropinirole was less effective than pramipexole in the treatment of restless legs syndrome. == Side effects ==

Ropinirole can cause nausea, dizziness, hallucinations, orthostatic hypotension, and sudden sleep attacks during the daytime. Unusual side effects specific to D3 agonists such as ropinirole and pramipexole can include hypersexuality, punding and compulsive gambling, even in patients without a history of these behaviours. Ropinirole is also known to cause an effect known as "augmentation" when used to treat restless legs syndrome, where over time treatment with dopamine agonists will cause restless legs syndrome symptoms to become more severe. This usually leads to constant dosage increases in an attempt to offset the symptom progression. Symptoms will return to the level of severity they were experienced at before treatment was initiated if the drug is stopped; however, both ropinirole and pramipexole are known to cause painful withdrawal effects when treatment is stopped and the process of taking a patient who has been using the medication long-term off these drugs is often very difficult and should be supervised by a medical professional. ==Pharmacology==

Pharmacodynamics File:ROPINRIOLE D2 DOCKING.png|thumb|left|class=bg-transparent|https://doi.org/10.1093/nar/gkae300 https://pubs.acs.org/doi/10.1021/acs.jcim.3c00054 [PDB ID: 8IRS] [Rendered with SwissDrugDesign Software] Ropinirole acts as a D2, D3, and D4 dopamine receptor agonist with highest affinity for D3, which are mostly found in the limbic areas. It is weakly active at the 5-HT2, and α2 receptors and is said to have virtually no affinity for the 5-HT1, GABA, mAChRs, α1-, and β-adrenoreceptors. It is a potent agonist of the 5-HT2B receptor, but shows biased agonism at this receptor and does not appear to pose a risk of cardiac valvulopathy. The comprehensive receptor interactions of ropinirole have been described. Ropinirole produces marked hypolocomotion at lower doses (1–50mg/kg i.p.) and causes hyperlocomotion at higher doses (100mg/kg i.p.) in rodents. The former effect is thought to be mediated by activation of inhibitory presynaptic dopamine autoreceptors and reduced dopamine release, while the latter action is thought to be due to stimulation of postsynaptic dopamine receptors. and at doses higher than clinical, is also metabolized by CYP3A4. At doses greater than 24 mg, CYP2D6 may be inhibited, although this has been tested only in vitro. It has been reported to be 30-fold more potent than ropinirole as a dopamine D2 receptor agonist in vitro. However, ropinirole and 7-hydroxyropinirole were equipotent in terms of antiparkinsonian activity in rodents in vivo. ==Chemistry==

Ropinirole is a partial ergoline. The chemical structure of the LSD metabolite 2-oxo-LSD is slightly related, and a notable analogue is DPAI (2-desoxo-2-ene-ropinirole). ==History==

Ropinirole was first described in the scientific literature by 1985. ==Society and culture==

It is manufactured by GlaxoSmithKline (GSK), Mylan Pharmaceuticals, Cipla, Dr. Reddy's Laboratories and Sun Pharmaceutical. The discovery of the drug's utility in restless legs syndrome has been used as an example of successful drug repurposing. Lawsuit In November 2012, GlaxoSmithKline was ordered by a Rennes appeals court to pay Frenchman Didier Jambart 197,000 euros ($255,824); Jambart had taken ropinirole from 2003 to 2010 and exhibited risky hypersexual behavior and gambled excessively until stopping the medication. This behavior displayed is characteristic of Dopamine Dysregulation Syndrome. ==See also==