rotigotine

Generic Name: rotigotine (transdermal) (roe TIG oh teen)
Brand Name: Neupro

What is rotigotine?

Rotigotine has some of the same effects as a chemical called dopamine, which occurs naturally in your body. Low levels of dopamine in the brain are associated with Parkinson's disease.

Rotigotine transdermal (skin patch) is used to treat symptoms of Parkinson's disease, such as stiffness, tremors, muscle spasms, and poor muscle control. Rotigotine is also used to treat restless legs syndrome (RLS).

Rotigotine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about rotigotine?

Some people taking rotigotine have fallen asleep during normal daytime activities such as working, talking, eating, or driving. You may fall asleep suddenly, even after feeling alert. Tell your doctor if you have any problems with daytime sleepiness or drowsiness. If you are unsure of how this medicine will affect you, be careful if you drive or do anything that requires you to be awake and alert.

You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking this medication. Talk with your doctor if you believe you have any intense or unusual urges while taking rotigotine.

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If you are taking this medication for rest leg syndrome (RLS), tell your doctor if your symptoms get worse, if they occur in the morning or earlier than usual in the evening, or if you feel restless symptoms in your hands or arms.

Do not stop using rotigotine suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using rotigotine.

Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by rotigotine. Tell your doctor if you regularly use any of these other medicines.

Drinking alcohol can increase certain side effects of rotigotine.

The rotigotine patch may burn your skin if you wear the patch during an MRI (magnetic resonance imaging). Remove the patch before undergoing such a test.

Rotigotine may cause hallucinations (the sensation of hearing or seeing something that is not there), most commonly among elderly people. Call your doctor if you have hallucinations.

What should I discuss with my healthcare provider before using rotigotine?

You should not use rotigotine if you are allergic to it.

Some people using rotigotine have fallen asleep during normal daytime activities such as working, talking, eating, or driving. You may fall asleep suddenly, even after feeling alert. Tell your doctor if you have any problems with daytime sleepiness or drowsiness. If you are unsure of how this medicine will affect you, be careful if you drive or do anything that requires you to be awake and alert.

To make sure you can safely use rotigotine, tell your doctor if you have any of these other conditions:

• asthma or sulfite allergy;

• high or low blood pressure;

• heart disease, congestive heart failure, or heart rhythm disorder;

• kidney disease;

• schizophrenia, bipolar disorder, or other mental illness;

• narcolepsy or other sleep disorder; or

• tremors (dyskinesia) or uncontrolled muscle movements.

You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking rotigotine. It is not known whether the medicine actually causes this effect. Talk with your doctor if you believe you have any intense or unusual urges while taking rotigotine.

Some people taking Parkinson's disease medications have developed skin cancer (melanoma). However, people with Parkinson's disease may have a higher risk of melanoma. Talk to your doctor about this risk and what skin symptoms to watch for. You may need to have regular skin exams.

FDA pregnancy category C. It is not known whether rotigotine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

It is not known whether rotigotine passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Rotigotine may cause hallucinations (the sensation of hearing or seeing something that is not there), most commonly among elderly people. Call your doctor if you have hallucinations.

How should I use rotigotine?

Use exactly as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

To use the patch, open the sealed pouch and remove the protective liner. Apply the patch to clean, dry, hairless, and healthy skin on your stomach, thigh, hip, side, shoulder, or upper arm. Your medication instructions will show you the best places on your body to wear the patch. Avoid placing the patch on a skin area that will be rubbed by a waistband or tight clothing.

Press the patch firmly into place for about 30 seconds to make sure it sticks. You may leave the patch on while bathing, showering, or swimming.

Leave the patch in place and wear it for 24 hours. Remove the skin patch after 24 hours and replace it with a new one. Try to apply a new patch at the same time each day.

Choose a different place on your body to wear the patch each time you put on a new one. Do not use the same skin area twice within 14 days.

If a patch falls off, try sticking back into place. If it does not stick well, put on a new patch.

After removing a patch, fold it in half so it sticks together and throw it away in a place where children or pets cannot get to it.

Use baby oil or mild soap and water to remove any adhesive residue that stays on your skin. Avoid using harsh soaps, alcohol, nail polish remover, or other solvents that could irritate your skin.

Wash your hands with soap and water after applying or removing the patch.

Do not wear more than one rotigotine patch at a time. Using extra skin patches will not make the medication more effective. Never cut a skin patch.

If you are using this medication for RLS, tell your doctor if your symptoms get worse, if they occur in the morning or earlier than usual in the evening, or if you feel restless symptoms in your hands or arms.

The rotigotine patch may burn your skin if you wear the patch during an MRI (magnetic resonance imaging). Remove the patch before undergoing such a test.

Do not stop using rotigotine suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using rotigotine.

Keep the rotigotine transdermal patch in its sealed pouch until you are ready to use it. Store the pouches at room temperature away from heat and moisture.

What happens if I miss a dose?

If you forget to change a patch on your scheduled day, remove and replace the patch as soon as you remember. Wear the new patch until your next regular patch-changing time. Do not change your schedule, even if you wear the new patch for less than 24 hours.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include severe forms of some of the side effects listed in this medication guide.

What should I avoid while using rotigotine?

Avoid applying a patch to skin that is oily or irritated.

Do not expose the skin patch to heat while you are wearing it. This includes a hot tub, heating pad, sauna, or heated water bed. Heat can increase the amount of drug you absorb through your skin and may cause harmful effects.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Rotigotine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop taking rotigotine and call your doctor at once if you have any of these serious side effects:

• severe skin irritation that does not clear up within several hours after removing a skin patch;

• extreme drowsiness, falling asleep suddenly, even after feeling alert;

• feeling like you might pass out;

• chest discomfort, dry cough, feeling short of breath;

• feeling weak or tired, loss of appetite, rapid weight loss;

• hallucinations;

• swelling in your hands or feet, rapid weight gain;

• tremors, twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs; or

• dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, fast or uneven heartbeats, seizure).

Less serious side effects may include:

• nausea, vomiting, loss of appetite;

• headache, dizziness, drowsiness;

• increased sweating;

• sleep problems (insomnia); or

• mild redness where the patch was worn.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: rotigotine side effects (in more detail)

Rotigotine Dosing Information

Usual Adult Dose for Parkinson's Disease:

Early-stage Parkinson's disease:
Initial: 2 mg patch applied topically once a day
Maintenance: Dosage may be increased weekly by 2 mg/24 hours if tolerated and if additional therapeutic effect is needed. The lowest effective dose was 4 mg/24 hours.
Highest recommended dose: 6 mg/24 hours

Advanced-stage Parkinson's disease:
Initial: 4 mg patch applied topically once a day
Maintenance: Dosage may be increased weekly by 2 mg/24 hours based on patient clinical response and tolerability.
Recommended dose: 8 mg/24 hours

Usual Adult Dose for Restless Legs Syndrome:

Initial: 1 mg patch applied topically once a day
Maintenance: Dosage may be increased weekly by 1 mg/24 hours if tolerated and if additional therapeutic effect is needed. The lowest effective dose was 1 mg/24 hours.
Highest recommended dose: 3 mg/24 hours

What other drugs will affect rotigotine?

Cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by rotigotine. Tell your doctor if you regularly use any of these medicines, or any other medicines for Parkinson's disease.

Tell your doctor about all other medicines you use, especially:

• amantadine (Symmetrel);

• medicine to prevent or treat nausea and vomiting, such as metoclopramide (Reglan, Metozolv) or promethazine (Pentazine, Phenergan, Anergan, Antinaus); or

• medicine to treat psychiatric disorders, such as chlorpromazine (Thorazine), fluphenazine (Permitil, Prolixin), haloperidol (Haldol), thiothixene (Navane), thioridazine (Mellaril), and others.

This list is not complete and other drugs may interact with rotigotine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about rotigotine.