Dopamine agonists (pramipexole, ropinirole)

Dopamine agonist drugs trick your brain into thinking they are dopamine. This means they can mimic the way dopamine works which can reduce your symptoms.

Dopamine agonists are typically prescribed in the earlier stages of Parkinson’s but everyone is different and you could be prescribed them at any time if it is right for you.

Treatment with dopamine agonists has to be started carefully. The dose is gradually increased until you and your specialist team are happy that your symptoms are under control.

Delaying levodopa treatment

Dopamine agonists may be an effective treatment for several years when used alone or with levodopa. But this won’t be true for everyone.

Lowers levodopa medication

Taking dopamine agonists may mean you can take lower doses of levodopa as your condition progresses. This can reduce the risk of involuntary movements (dyskinesia) and how much they affect you.

Helping levodopa work better

Dopamine agonists can be taken with levodopa medication to help when levodopa wears off or doesn’t work as well. This is because dopamine agonists work for longer in the body and can reduce the ‘on/off’ effect you may have with levodopa.

Fewer tablets to take 

There are some once-daily preparations that could reduce the number of tablets you take in some cases. But this option may not be suitable for everyone.

Treating restless legs

Dopamine agonist medications can be used for people who have restless legs syndrome, also called Willis-Ekbom disease. Your healthcare professional will decide which specific drug to prescribe.

Restless legs syndrome can be connected to Parkinson’s or it can be a separate condition. You may experience tingling in your legs and you may have an urge to move them.

Check with your healthcare professional for specific advice on when to take dopamine agonist medication you are prescribed for restless legs syndrome.

Find out more about restless legs syndrome.

Heart problems

Some of the older dopamine agonists increase the risk of heart and lung problems. They are known as ‘ergot’ types and include bromocriptine, pergolide and cabergoline. Because of this risk, these Parkinson’s drugs are no longer recommended and we haven’t included them here.

Newer dopamine agonists are known as non-ergot. These are pramipexole, ropinirole, rotigotine and apomorphine. They have not been associated with a risk of heart damage and can be prescribed.

Sleepiness and fainting

Dopamine agonist drugs can make you sleepy, faint or dizzy. This is most likely to happen when you start taking them. Once you reach a stable dose, this effect often wears off.

Some people have experienced a sudden onset of sleep, without any warning. If this happens, it’s important that you tell your specialist or Parkinson’s nurse.

Impulsive and compulsive behaviours

Behaviours may involve gambling, becoming a ‘shopaholic’, binge eating or focusing on sexual feelings and thoughts. This can have a huge impact on people’s lives including family and friends.

Not everyone who takes Parkinson’s medication will experience impulsive and compulsive behaviours, so these side effects should not put you off taking your medication to control your symptoms.

Find out more about impulsive and compulsive behaviours. 

Hallucinations and delusions

Hallucinations and delusions can also have a huge impact on daily life.

A hallucination is when you see, hear or feel things that aren’t there. Delusions are unusual thoughts, beliefs or worries that aren’t based on reality.

They can happen with any Parkinson’s medication but are more common with dopamine agonists. Not everyone will experience this side effect and it is more common in the later stages of Parkinson’s. 

Find out more about hallucinations and delusions.

Other side effects

The patient information leaflet that comes with your medication will tell you the full range of side effects that you may experience.

Some possible side effects include:

• nausea
• constipation
• low blood pressure (hypotension)
• headaches
• anxiety and depression
• movement problems

Find out more about the side effects of Parkinson's drugs

Below we have included the different forms of pramipexole (Mirapexin, Pipexus, Glepark, Oprymea, Zentiva) medication and an overview of how to take them. 

The most recent and complete information on your specific drug will be on your patient information leaflet that comes with your medication packet. Always read it carefully before you start your treatment.

For detailed information you should follow the advice of your specialist or Parkinson’s nurse about how to take pramipexole so that it works well for your Parkinson’s.

Pramipexole drugs are also used to help your symptoms when your levodopa medication causes you to experience wearing off and dyskinesia. This could be motor fluctuations, or wearing off before your next dose of levodopa is due.

Pramipexole tablets (Mirapexin, Pipexus, Glepark, Oprymea or Zentiva)

Swallow the tablets with a drink of water. You can take your doses before or after meals.

Your specialist or Parkinson’s nurse will be able to advise you on the best dose. Usually you will be given these tablets on a low dose at first which will be increased roughly every five to seven days until it is right for you and your symptoms.

You will usually take Mirapexin three times a day but your specialist or Parkinson’s nurse will be best placed to advise you on this.

Pipexus and Mirapexin (prolonged release tablets)

You should take the capsules with a drink of water. Don’t break, crush or chew them. This is because they have been made to release the medicine slowly over the course of the day. You can take them with or without food.
 
Your healthcare professional will be able to advise you on the best dose. But usually you will be given these tablets on a low dose at first which will be increased roughly every five to seven days until it is right for you and your symptoms.
 
You will be prescribed Pipexus or Mirapexin (controlled release tablets) once a day. This can make it easier for you to remember your dose.

Ropinirole is a type of generic (unbranded) dopamine agonist medication.

There are a number of brand names for ropinirole. The brand names are Adartel, Requip, Ralnea, Spiroco, Ipinnia, Raponer and Ropilynz.

Ropinirole medication can be used as a substitute for dopamine because it can have an effect on the same nerve cells where dopamine works. Ropinirole can be used alone or with other medications to treat Parkinson’s.

Taking ropinirole (Requip, Adartel, Requip XL, Ralnea XL, Spiroco XL, Ipinnia XL, Raponer XL or Ropilynz XL)

Below we have included the different forms of ropinirole medication and an overview of how to take them.

The most recent and complete information on your specific drug will be on your patient information leaflet that comes with your medication packet. Always read it carefully before you start your treatment.

For detailed information, you should follow the advice of your doctor about how to take ropinirole so that it works well for your Parkinson’s.

Ropinirole (Requip, Adartel)

Ropinirole (Requip, Adartel) is usually taken 3 times a day, usually just before bedtime or around 3 hours beforehand. Your healthcare professional can then increase your dose during the rest of the first week if you don’t experience side effects.

However, your specialist or Parkinson’s nurse will be best placed to advise you on when to take ropinirole so that it works well for your condition. They can increase your daily dose over time until it is right for you and your symptoms.

Taking ropinirole with your meals will help to reduce any stomach issues that you may experience.

Ropinirole prolonged release tablets (Ralnea XL, Requip XL, Spiroco XL, Ipinnia XL, Raponer XL, Ropilynz XL)

Prolonged-release tablets release your medication slowly throughout the day. This can give you more control of your symptoms. They can be taken alone to try and delay the need for you to take levodopa. This can be helpful because levodopa becomes less effective over time.

You should take these tablets once a day. These tablets can be taken with or without food. 

It is important that you take these tablets whole. They must not be chewed, crushed or divided into pieces.

At first, your specialist will prescribe you a low dose of Ralnea XL, Requip XL, Spiroco XL, Ipinnia XL, Raponer XL or Ropilynz XL. This will usually be once per day for an initial period of 1 week. Your healthcare professional can then increase your daily dose until it is right for you and your symptoms.

In some cases, a high-fat meal may create issues so speak to your specialist if you think that food is creating problems when you take your medication. 

Tell your doctor if you experience side effects from any of these prolonged-release tablets as other forms of ropinirole medication may be more suitable for you.