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

What is Neupro?

Neupro (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.

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

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

Important information

Some people using Neupro 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 Neupro 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 using Neupro.

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Do not stop using Neupro suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using Neupro. Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by Neupro. Tell your doctor if you regularly use any of these other medicines. Drinking alcohol can increase certain side effects of rotigotine. The Neupro patch may burn your skin if you wear the patch during an MRI (magnetic resonance imaging). Remove the patch before undergoing such a test. Neupro 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.

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Before using Neupro

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

To make sure Neupro is safe for you, tell your doctor if you have:

  • asthma or sulfite allergy;

  • high or low blood pressure;

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

  • kidney disease;

  • a history of mental illness or psychosis;

  • narcolepsy or other sleep disorder; or

  • tremors (dyskinesia) or uncontrolled muscle movements.

People with Parkinson's disease may have a higher risk of skin cancer (melanoma). Talk to your doctor about this risk and what skin symptoms to watch for.

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

See also: Pregnancy and breastfeeding warnings (in more detail)

It is not known whether rotigotine passes into breast milk or if it could harm a nursing baby. Neupro may also slow breast milk production. Tell your doctor if you are breast-feeding a baby.

How should I use Neupro?

se Neupro skin patches exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Neupro skin patches come 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 Neupro 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 Neupro skin patch firmly into place for at least 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 Neupro 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, put a new patch on a different place on your body and wear it the rest of the day. Then replace the patch the next day at your regular time.

After removing a Neupro 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 Neupro 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, call 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 Neupro 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 Neupro suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using Neupro.

Keep the Neupro 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.

Neupro dosing information

Usual Adult Dose of Neupro 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 of Neupro 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 should I avoid?

Avoid applying a patch to skin that is oily or irritated. Avoid using any lotion, oil, cream, ointment, or powder on the skin where you will apply a Neupro skin patch, or the patch may not stick well to your skin.

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. 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.

Neupro side effects

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

Stop taking Neupro and call your doctor at once if you have:

  • 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;

  • a light-headed feeling, like you might pass out;

  • increased sexual urges, unusual urges to gamble, or other intense urges;

  • hallucinations (hearing or seeing something that is not real; most commonly in elderly people);

  • unusual thoughts or behavior;

  • 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).

Some people using Neupro have fallen asleep during normal daytime activities such as working, talking, eating, or driving. Tell your doctor if you have any problems with daytime sleepiness or drowsiness.

Common Neupro side effects may include:

  • nausea, vomiting, loss of appetite;

  • dizziness, drowsiness;

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

  • 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: Side effects (in more detail)

What other drugs will affect Neupro?

Taking this medicine with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking Neupro with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Other drugs may interact with Neupro, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your pharmacist can provide more information about Neupro.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Neupro only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2014 Cerner Multum, Inc. Version: 3.01. Revision Date: 2014-01-14, 10:36:37 PM.

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