Adartrel

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Adartrel on Prescriptsy

Adartrel is described on Prescriptsy as independent product information.

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Important medical information

The information on this page does not replace a diagnosis or personalised advice from a doctor. Adartrel is a prescription-only medicine (POM) that affects dopamine signalling in the brain and requires careful medical supervision.

• Treatment with Adartrel must be prescribed, initiated and monitored by a doctor experienced in the management of restless legs syndrome.
• If you develop hallucinations, compulsive behaviours (such as gambling, unusual spending or increased sexual urges), severe drowsiness, or episodes of suddenly falling asleep, contact your doctor immediately.
• This page provides general information only. Always follow the instructions given by your prescriber and read the Patient Information Leaflet supplied with your medicine.

What is Adartrel and how does it work?

Adartrel is the brand name for a medicine containing the active substance ropinirole .

Ropinirole is a dopamine agonist, meaning it works by stimulating dopamine receptors in the brain, mimicking the action of the natural chemical dopamine.

Adartrel is specifically licensed for the treatment of moderate to severe restless legs syndrome (RLS) in adults.

Restless legs syndrome is a neurological condition characterised by an irresistible urge to move the legs, usually accompanied by uncomfortable or distressing sensations such as crawling, tingling, pulling, throbbing or aching.

Symptoms typically worsen during periods of rest or inactivity and are most troublesome in the evening and at night, often disrupting sleep.

The exact cause of RLS is not fully understood, but dysfunction in the brain's dopaminergic pathways is believed to play a central role.

By stimulating dopamine D2 and D3 receptors, ropinirole helps to restore more normal signalling in the areas of the brain involved in movement control and sensory processing.

This reduces the uncomfortable sensations and the urge to move, allowing patients to rest more comfortably and sleep more effectively.

Understanding restless legs syndrome

How common is RLS?

Restless legs syndrome is more common than many people realise.

Studies suggest that it affects approximately 5 to 10 per cent of the adult population in the UK to some degree, although only a proportion of those affected have symptoms severe enough to require medical treatment.

It can begin at any age but is more prevalent in middle-aged and older adults, and it affects women more commonly than men.

Primary and secondary RLS

RLS can be primary (idiopathic), where there is no identifiable underlying cause, or secondary, where it is associated with another condition or factor.

Common secondary causes include iron deficiency, chronic kidney disease, pregnancy (usually in the third trimester), peripheral neuropathy and certain medications.

Before starting treatment with Adartrel, your doctor will investigate potential secondary causes, as addressing these may improve or resolve your symptoms without the need for a dopamine agonist.

Impact on quality of life

Moderate to severe RLS can have a profound effect on quality of life.

Sleep disruption is the most immediate consequence, leading to daytime fatigue, difficulty concentrating and reduced productivity.

Over time, chronic sleep deprivation can contribute to mood disturbances, anxiety and depression.

The condition can also affect partners who share a bed, as the involuntary leg movements can be disruptive.

Effective treatment with medicines such as Adartrel, combined with good sleep hygiene and lifestyle adjustments, can significantly improve symptoms and overall wellbeing.

Who may be prescribed Adartrel?

Patients who may benefit

Your doctor may consider prescribing Adartrel if you have moderate to severe restless legs syndrome that is causing significant distress, sleep disruption or impaired daytime functioning, and if non-pharmacological measures have not provided adequate relief.

Before prescribing, your doctor will typically assess your iron stores (serum ferritin), kidney function and other potential contributing factors.

Iron supplementation is recommended as a first-line treatment if ferritin levels are low.

Patients who may not be suitable

Adartrel may not be appropriate if you have severe liver disease, a known allergy to ropinirole or any of the tablet's inactive ingredients, or if you are pregnant or breastfeeding.

Your doctor will also exercise caution if you have significant cardiovascular disease, a history of psychotic illness, or are taking medicines that interact with ropinirole.

Because of the risk of impulse control disorders, particular care is needed in patients with a personal or family history of gambling, compulsive behaviours or addictive tendencies.

How to take Adartrel

Adartrel is taken once daily, one to three hours before bedtime, as this is when RLS symptoms are typically at their worst.

The tablets can be taken with or without food, although taking them with a light snack may help reduce nausea. Swallow the tablet whole with water.

Treatment begins at a very low dose of 0.25 mg and is gradually increased over several weeks.

This slow titration minimises the risk of side effects such as nausea, dizziness and drowsiness.

Your doctor will provide a specific titration schedule and will assess your response at each step.

The maximum recommended dose for restless legs syndrome is 4 mg per day, but many patients achieve adequate symptom control at lower doses.

It is important to attend follow-up appointments so your doctor can monitor your response, check for side effects and screen for impulse control disorders. Do not adjust your dose without medical advice, and do not stop the medicine abruptly.

Key safety concerns with dopamine agonists

Impulse control disorders

One of the most significant safety concerns with dopamine agonist medicines, including ropinirole, is the risk of impulse control disorders (ICDs).

These are behavioural changes that can develop during treatment and may include pathological gambling, compulsive shopping or spending, binge eating or food cravings, and hypersexuality or unusually increased sexual behaviour.

These behaviours can have serious personal, financial and relational consequences.

The challenge is that patients experiencing these behaviours may not recognise them as abnormal or may feel embarrassed to discuss them.

It is therefore important that family members, partners and carers are aware of this risk and know to report concerns to the prescribing doctor.

Your doctor should ask about impulse control at each review.

If an ICD develops, dose reduction or discontinuation of the dopamine agonist usually resolves the behaviour, although this should be done gradually to avoid withdrawal symptoms.

Excessive sleepiness and sudden sleep

Ropinirole can cause significant drowsiness and, in some cases, episodes of suddenly falling asleep without warning. This is a safety concern for anyone who drives or operates machinery.

Under DVLA guidance, drivers who experience excessive sleepiness must inform the DVLA and stop driving until the problem is controlled.

If you experience daytime drowsiness or sudden sleep episodes while taking Adartrel, discuss this with your doctor promptly.

Side effects of Adartrel

The most common side effect is nausea, which affects a significant proportion of patients, especially during the early weeks of treatment.

Other common side effects include dizziness, drowsiness, fatigue, vomiting, abdominal pain and swelling of the ankles or legs.

These effects often improve as the body adjusts to the medicine.

Less common but important side effects include low blood pressure on standing (orthostatic hypotension), confusion, and hallucinations.

Hallucinations are more frequently reported at higher doses and in elderly patients. Rare but serious effects include impulse control disorders, psychotic reactions and severe allergic reactions.

Augmentation, in which RLS symptoms paradoxically worsen, is an important long-term concern described in more detail below.

Augmentation, when symptoms worsen on treatment

Augmentation is a phenomenon specific to the dopaminergic treatment of restless legs syndrome.

It occurs when, despite ongoing treatment, RLS symptoms begin to appear earlier in the day, spread to involve the arms or trunk, or increase in overall intensity.

Augmentation is the most common long-term complication of dopamine agonist therapy for RLS.

If augmentation is suspected, the instinctive response might be to increase the dose, but this typically makes the problem worse.

The correct approach is to consult your doctor, who may reduce the dose gradually, switch to a different class of medicine, or use an alternative management strategy.

Recognising augmentation early is important for effective management.

Non-pharmacological management of RLS

Medicines are not the only approach to managing restless legs syndrome. Many patients find that lifestyle modifications and good sleep practices help to reduce symptom severity, either alone or alongside medication.

• Maintain a regular sleep schedule, going to bed and waking at the same times each day.
• Avoid caffeine, particularly in the afternoon and evening, as it can worsen RLS symptoms.
• Limit alcohol consumption, especially close to bedtime.
• Take moderate exercise regularly, but avoid vigorous activity late in the evening.
• Try leg stretches, massage, warm baths or cool compresses before bed.
• Keep the bedroom cool, dark and quiet to promote better sleep.
• Avoid prolonged periods of sitting or lying still in the evening; gentle activity such as walking can provide temporary relief.

Your doctor may also review your current medicines, as some drugs, including certain antidepressants, antihistamines and anti-nausea medications, can worsen RLS symptoms.

Adartrel, generic ropinirole and other RLS treatments

Adartrel is the original brand name for ropinirole in the RLS indication. Generic ropinirole tablets are also available in the UK and contain the same active substance.

Your pharmacist may dispense a generic version, which is clinically equivalent.

Ropinirole is also available under the brand name Requip for Parkinson's disease, but the dosing and licensed indications differ.

Other pharmacological treatments for RLS include pramipexole (another dopamine agonist), gabapentin and pregabalin (alpha-2-delta ligands), and in refractory cases, low-dose opioids under specialist supervision.

The choice of treatment depends on symptom severity, coexisting conditions, previous treatment response and individual risk factors. Your doctor will advise on the most appropriate option for you.

Availability and prescribing in the UK

Adartrel and generic ropinirole are available on NHS prescription in the United Kingdom.

The standard prescription charge in England is nine pounds and ninety pence per item, with exemptions for eligible patients.

There are no prescription charges in Scotland, Wales or Northern Ireland. If you are on long-term treatment, a prescription pre-payment certificate may reduce your costs.

Ropinirole for restless legs syndrome is listed in the BNF and is a recognised treatment within NICE clinical guidance.

Your GP can prescribe it, although referral to a specialist (neurologist or sleep medicine physician) may be considered for complex or refractory cases.

When to seek medical advice

Contact your GP or call NHS 111 if your RLS symptoms are not improving despite treatment, if you develop new or worsening side effects, or if you or your family notice any unusual behavioural changes.

Seek emergency help by calling 999 if you experience a severe allergic reaction (swelling of the face, lips or throat, difficulty breathing), collapse, or seizures.

Sources and further reading

• Summary of Product Characteristics, Adartrel, EMC (medicines.org.uk)
• British National Formulary, Ropinirole, bnf.nice.org.uk
• NICE Clinical Knowledge Summaries, Restless legs syndrome, cks.nice.org.uk
• NHS, Restless legs syndrome, nhs.uk
• RLS-UK (patient support organisation), rls-uk.org
• MHRA Yellow Card Scheme, yellowcard.mhra.gov.uk