Rotigotine

Neupro

Neupro (rotigotine) is a prescription medication available under a brand name. It is a transdermal patch approved by the FDA to treat symptoms of Parkinson’s disease and Restless Legs Syndrome (RLS). It contains the active ingredient rotigotine, a dopamine agonist that helps manage motor symptoms by mimicking dopamine’s effects in the brain. The patch is applied to the skin once daily and is available in various strengths. Common side effects include sleepiness, nausea, headache, and skin reactions at the application site. It’s important to discuss any medical history or other medications with your primary caregiver before starting Neupro to avoid potential interactions or adverse effects.

Product Overview

Neupro is a prescription medication that comes in the form of a transdermal patch that delivers the active ingredient rotigotine through the skin to treat Parkinson’s disease. The Food & Drug Administration (FDA) has approved it for treating Parkinson’s disease in adults. This disease is a condition that affects movement and worsens over time. In addition to treating Parkinson’s disease, Neupro is also approved for treating moderate to severe restless legs syndrome (RLS) in adults. This condition causes uncomfortable sensations and an urge to move the legs, often occurring when lying down or resting. 

Rotigotine is a dopamine agonist, meaning it mimics the action of dopamine, a neurotransmitter involved in controlling movement and coordination. By supplementing dopamine levels, Neupro helps alleviate symptoms like muscle spasms, stiffness, and tremors associated with these conditions. The medication is available in various strengths, allowing for dose adjustments based on individual needs. Patients typically start with a lower dose, which is gradually increased to achieve the desired effect while minimizing side effects. It’s vital to follow the prescribed dosage & application instructions to ensure the medication’s effectiveness. 

Common side effects of Neupro include headaches, nausea, sleepiness, and skin reactions at the application site. More severe side effects, such as increased heart rate, changes in blood pressure, and severe allergic reactions, are less common but require immediate medical attention. Before starting Neupro, patients should discuss their medical history and any other medications they are taking with their doctor to avoid potential interactions. Certain conditions, such as mental health issues, sleep disorders, and heart problems, may require caution when using Neupro. This medicine is a valuable treatment option for managing symptoms of Parkinson’s disease and RLS. Providing continuous rotigotine delivery through a skin patch offers a convenient & effective way to improve a patient’s quality of life. However, like all medications, it’s crucial to use Neupro under the guidance of a healthcare professional to ensure its safe and effective use.

Uses

Targeted Treatment

• Parkinson’s disease (like stiffness, poor muscle control, muscle spasms, and tremors)
• Moderate-to-severe Restless legs syndrome (RLS)

Benefits

• When combined with levodopa therapy, Neupro can start improving PD symptoms as early as one week after beginning treatment.
• The medication comes in the form of a patch that is applied to the skin and changed once daily.
• It is a suitable option for individuals who have difficulty swallowing pills.
• Neupro can be used by people with kidney or liver problems.

[Note: Do not take Escitalopram without consulting your doctor. They will determine whether you need this medication based on your conditions.]

Neupro Dosage

Forms & Strengths

Form: Neupro is available as a transdermal system, which means it comes in the form of a patch that you apply to your skin. This patch gradually releases the medication into your body through your skin over a period of time. 

Strengths: Neupro patches are available in the six following strengths:

• 1 mg/24 hours
• 2 mg/24 hours
• 3 mg/24 hours
• 4 mg/24 hours
• 6 mg/24 hours
• 8 mg/24 hours

Recommended Dosages

For Parkinson’s Disease

• Adults: Initially, use a 2-mg patch every 24 hours if you’re in the early stages of the disease or a 4-mg patch every 24 hours for more advanced stages. Your doctor may increase the dose gradually, depending on how well you tolerate it, but it typically doesn’t exceed 6 to 8 mg every 24 hours.
• Children: The dosage and usage should be determined by a pediatrician.

For Restless Legs Syndrome (RLS)

• Adults: Start with a 1-mg patch applied every 24 hours. If necessary and tolerated, your doctor may gradually increase the dose, but it usually doesn’t exceed 3 mg every 24 hours.
• Children: The dosage and usage should be determined by a pediatrician.

[Note: Remember, these recommendations may vary from person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]

How to Take It?

Here’s how to use the medicine:

This medication comes with instructions for patients. Please read and follow these instructions carefully. If you have any questions, don’t hesitate to ask your doctor.

Using the Skin Patch:

• You can place the patch on your belly, side of your body (between your ribs and pelvis), shoulder, hip, upper arm, or thigh.
• After taking the patch out of its protective pouch, apply it immediately. Do not cut it into smaller pieces. Avoid touching the side of the patch that is sticky.
• Stick the patch on a clean, dry, unbroken, and healthy area of your skin. Choose a spot that is not too oily, has little or no hair, and doesn’t have scars, cuts, burns, or any other skin problems. If you need to put the patch on a hairy area, you have to shave the area at least three days before applying the patch. Try to avoid placing the patch on skin folds, under waistbands, or in areas where tight clothing might rub against it.

Here’s how to apply the patch properly:

• Press the Patch: Hold the patch firmly against your skin using the palm of your hand for about 30 seconds. Ensure it sticks well, especially around the edges.
• Keep It On: The patch should stay on during activities like showering, bathing, or swimming. If it falls off, apply a new one.
• Change the Patch: After 24 hours, remove the old patch and place a new one on a different part of your skin. Avoid using the same spot for at least 14 days. Don’t wear a patch for more than 24 hours, as it may lose effectiveness and irritate your skin.
• Dispose of the Patch: Fold the used patch in half with the sticky sides together, place it in its protective pouch or aluminum foil, and dispose of it safely away from children and pets. Wash the area where the patch was applied with soap and water to remove any residue. You can also use baby or mineral oil to clean the area. Avoid using alcohol or other solvents to prevent skin irritation.
• Apply at the Same Time: Try to change the patch at the same time each day. If you forget, replace the old patch with a new one and resume your regular schedule the next day.
• Prepare the Skin: Do not apply cream, lotion, ointment, oil, or powder on the area where you’ll place the patch.
• Wash Your Hands: Always wash your hands before and after applying the patch.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Neupro Work?

Neupro contains rotigotine, a type of drug known as a dopamine agonist. It’s used to help manage symptoms of Parkinson’s disease, either on its own or alongside another medication called levodopa. Parkinson’s disease symptoms occur because there’s not enough dopamine, a chemical messenger, in the brain. Rotigotine works by helping to balance the levels of dopamine, which can reduce these symptoms. 

In addition to Parkinson’s disease, rotigotine is also used to treat moderate-to-severe restless legs syndrome in adults. The medication is in the form of a patch that you apply to your skin. It takes some time for your body to absorb the drug from the patch. Usually, the drug can be detected in your blood about 3 hours after you apply the patch. It may take just over 24 hours for your body to completely absorb the drug, especially after the first dose.

Important Safety Information

Side Effects

Common side effects of Neupro may include: 

• Headache
• Nausea
• Sleepiness
• Staying asleep or having trouble falling asleep

Mild side effects of Neupro may include (if prescribed for treating Parkinson’s disease):

• Dizziness
• Excessive sweating
• Vision problems
• Swelling in your ankles, hands, or feet
• Nausea
• Vomiting
• Trouble falling or staying asleep
• Sleepiness
• Loss of appetite

Serious side effects of Neupro may include:

• Increased heart rate can include these signs:
  • Lightheadedness
  • Shortness of breath
  • Fast pulse
• Changes in blood pressure may include signs like:
  • Fainting when standing up
  • Feeling nauseous, sweaty, or dizzy when standing up
• Severe fluid retention and weight gain symptoms may include:
  • Sudden increases in weight
  • Swelling (in your legs or ankles)
• Worsening dyskinesia (involuntary movements) in individuals with Parkinson’s disease that can include:
  • Worsening of existing abnormal movements
  • Sudden or uncontrolled movements, which can be new movements
• Augmentation (worsening of symptoms during treatment), in people with RLS or rebound (worsening of symptoms when stopping treatment) symptoms may include:
  • Worsening severity of RLS symptoms
  • Symptoms of RLS manifesting earlier in the day compared to before starting Neupro treatment.
• Confusion and high fever in individuals with Parkinson’s disease who suddenly stop taking Neupro symptoms may include:
  • Rigid muscles
  • Changes in consciousness
  • Elevated body temperature
  • Rhabdomyolysis
• Application site reactions
• Changes in mental health or behaviors
• Sleep problems
• Severe allergic Reactions

[Note: Remember, this list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]

Warnings

Before starting Neupro, discussing your medical history with your doctor is important. Neupro might not be suitable for you if you have certain health conditions or other factors that could affect your well-being. Some of these conditions include:

• Daytime Sleepiness (Due to Unpredictable Periods of Sleep or Sleep Disorder): Neupro can cause sleep problems such as feeling sleepy during the day and sudden “sleep attacks,” where you might fall asleep unexpectedly while doing everyday activities. Before starting Neupro, your doctor will check if you have any risk factors for sleep issues. If you already have problems sleeping, your doctor might suggest trying a different medication for your condition.
• High or Low Blood Pressure: Neupro can affect your blood pressure, causing it to either increase or decrease. Although it’s uncommon, these fluctuations can be severe. If you already have issues with high or low blood pressure, make sure to inform your doctor before starting Neupro. 
• Heart Problems: Although uncommon, this medication can cause a faster heart rate and changes in blood pressure. If you already have heart problems, you might be more likely to experience these side effects. It’s essential to inform your primary healthcare giver about any heart conditions you have before starting Neupro patches.
• Orthostatic Hypotension: Neupro can cause a condition called orthostatic hypotension that causes your blood pressure to drop whenever you stand up. If you already have this condition, taking Neupro might make it worse. It’s important to discuss this with your doctor before starting Neupro if you have orthostatic hypotension. 
• Allergic Reaction: Should you have previously experienced an allergic reaction to Neupro or any of its components, your doctor will probably suggest an alternative medication. Talk to your doctor about other medications that might be a better fit for you. If you have an allergy or sensitivity to sulfites, taking Neupro could make it worse. It is although rare, but a severe allergic reaction is possible. Both mild and severe allergic reactions can occur. They include
  • Trouble breathing
  • Swelling of your mouth, throat, or tongue
  • Swelling under your skin, typically in your feet, eyelids, lips, or hands
  • Skin rash
  • Itchiness
  • Flushing (temporary deepening of skin color, warmth, or redness)
• Conditions Related to Mental Health (Including Schizophrenia or Bipolar Disorder): If you have mental health conditions like bipolar disorder or schizophrenia, Neupro may affect them. The medication can sometimes cause these conditions or make existing ones worse. It’s important to tell your doctor about any mental health issues you have before starting Neupro. This will help them decide if it’s a suitable treatment for you.
• Alcohol: Before you start using Neupro patches, it’s essential to discuss your consumption of alcohol with your doctor. Drinking alcohol while using Neupro patches can increase your chances of experiencing specific side effects, such as feeling drowsy or overly sleepy. Your doctor may advise you on whether it is safe for you to drink alcohol during your treatment with Neupro.

Precautions

When considering whether to take a medication, Weighing the potential risks against the benefits it may offer is crucial. This decision should be made in consultation with your healthcare provider. For this medication, certain factors should be taken into account, including:

• Allergies:  Inform your doctor about any past allergic reactions to this medication or other drugs. It’s also important to mention any other allergies you have, such as to foods, dyes, preservatives, or animals. If you’re using a non-prescription product, make sure to read the label & package ingredients carefully.
• Pediatric: Studies to understand the effects of the rotigotine transdermal patch on children have not been conducted. Therefore, its safety and effectiveness in the pediatric population have not been established.
• Geriatric: Studies conducted so far have not shown any specific problems related to the use of the rotigotine transdermal patch in older adults that would limit its effectiveness. However, it’s important to note that older patients may be more prone to experiencing hallucinations (hearing, seeing, or feeling things that aren’t real) while using this medication. As a result, doctors may need to be cautious when prescribing this medicine to elderly individuals. 
• Pregnancy: The safety of using Neupro during pregnancy is currently unknown, as there have not been studies conducted on its use in pregnant women. However, in animal studies, the drug has been associated with birth defects & pregnancy loss when administered to pregnant animals. It’s important to note that the results from animal studies may not always directly apply to humans. If you’re pregnant and have concerns about managing your condition with Neupro, it’s crucial to discuss your options with your doctor. 
• Birth Control: It’s not clear whether Neupro is safe for use during pregnancy. If you are sexually active and there is a chance of pregnancy for you or your partner, you should discuss your birth control options with your doctor while using Neupro.  
• Breastfeeding: It is currently unclear if Neupro is safe to use while breastfeeding. Specifically, we don’t know if the rotigotine passes into human breast milk or how it might affect a breastfed baby. Rotigotine may reduce prolactin levels, a hormone that aids in milk production, but there isn’t enough data to confirm this. In animal studies, the drug was found in the milk of lactating females, but these results may not apply to humans. If you’re breastfeeding and have questions about managing your condition, it’s important to discuss your options with your doctor.

Contraindications 

Neupro may not be suitable for you if you are having any of the following:

• Breastfeeding
• Mental problems
• Plan to become pregnant.
• High or low blood pressure
• Pregnant
• A sleep disorder
• Heart problems
• Breathing problems
• Plan to breastfeed

Missed Dose

• If you happen to miss a dose of Neupro, apply the patch as soon as you remember. Then, continue with your regular schedule by replacing the patch at the usual time the next day, even if it hasn’t been a full 24 hours since you applied the missed dose.
• To ensure you don’t miss a dose in the future, consider using a medication reminder. This could be setting an alarm or timer on your phone, using a reminder app, or even a simple kitchen timer. 

[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]

Overdose

If you suspect or take an overdose, seek emergency assistance right away if you notice any of the following symptoms:

• Confusion or disorientation
• Dizziness, faintness, or lightheadedness, especially when standing up quickly from a lying or sitting position
• Nausea or feeling sick to your stomach
• Seizures or convulsions
• Sweating more than usual
• Unusual tiredness or weakness that is not normal for you
• Vomiting or throwing up

These signs indicate a serious condition that needs prompt medical attention.

[Note: If you consumed more than recommended dose, get medical help right away, or call the Poison Help line at 1-800-222-1222.]

Storage

• Keep the patches at normal room temperature in a container that is tightly closed away from moisture, heat, and direct light. 
• Store them in a place where children cannot access them. 
• Discard any outdated medicine or medicine that is no longer needed. 
• Consult your primary healthcare provider for advice on how to dispose of any unused medicine properly. 

[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]

Neupro Interactions

Interaction with Medications: When using Neupro, it’s crucial to be aware of its interactions with other medications. While some medicines should not be combined, others can be used together with careful monitoring and dosage adjustments by your healthcare provider.

Medications to Avoid with Neupro:

• Sulpiride: It’s generally not recommended to use Neupro with sulpiride. Your doctor may choose not to prescribe Neupro or may change the other medications you’re taking.

Medications That May Require Caution:

• Haloperidol
• Metoclopramide
• Olanzapine
• Risperidone

In cases where Neupro is prescribed alongside these medications, your doctor may be required to adjust the dosage or frequency of use for one or both of the medicines. It’s essential to inform your healthcare professional about all the medications you are taking to ensure safe and effective treatment.

Other Interactions: Some medications should not be taken with food or certain types of food, as this can lead to interactions. Similarly, consuming alcohol or tobacco while on certain medications can also cause interactions. It’s important to talk to your healthcare provider about how your medication might interact with alcohol, food, or tobacco.

Other Medical Problems: Having other health conditions can impact how this medication works for you. It’s important to inform your doctor about any other health issues you have, particularly:

• Congestive heart failure or
• Dyskinesia (difficulty controlling your muscles) or
• Heart or blood vessel disease or
• Hypertension (high blood pressure) or
• Hypotension (low blood pressure) or
• Severe kidney disease or
• Mental illness (such as hallucinations or psychosis)—These conditions may worsen with the use of this medication.
• Lung or breathing problems (like asthma) or
• Allergy to sulfites—This medication contains sodium metabisulfite, which may cause serious allergic reactions in people with these conditions.
• Sleep disorders or
• History of sleepiness—The side effects of the medication may be more pronounced.

[Note: This isn’t a complete list, and there could be other drugs that interact with Neupro. Make sure to tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]

Neupro Alternatives

• Benztropine
• Pramipexole
• Ropinirole (Ropinirole Hydrochloride)
• Amantadine (Amantadine Hydrochloride)
• Neurontin (gabapentin)
• Sinemet (carbidopa/levodopa)
• Mirapex ER (pramipexole extended release)
• Trihexyphenidyl
• Horizant (gabapentin enacarbil)
• Lyrica (pregabalin)
• Carbidopa/levodopa ER (extended release)
• Azilect (rasagiline)
• Zelapar (selegiline)
• Xadago (safinamide)
• Ropinirole XR (ropinirole extended release)

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.] 

Frequently Asked Questions

How does Neupro make you feel?

People taking Neupro for Restless Legs Syndrome commonly experience side effects like reactions at the site where the patch is applied, nausea, trouble falling and staying asleep, feeling sleepy, and headaches. However, these are not all the possible side effects. For more detailed information, it’s best to consult your doctor or pharmacist.

How long does it take Neupro to start working?

Neupro might take some time to start working because your skin does not immediately absorb it. Usually, the medication won’t show up in blood tests until at least 3 hours after you’ve applied a patch. It can take up to 24 hours or even more for your body to completely absorb the medication, especially after your first dose. 

When is the best time to put the Neupro patch on?

As soon as you take the Neupro patch out of its protective pouch, you should apply it to your skin. Do not cut or alter the patch in any way. Decide on a time that suits you best, either during the day or night, to put on your Neupro patch. Make sure to apply it at the same time every day for consistency.

Can Neupro cause hallucinations?

Yes, Neupro can cause hallucinations. People with Parkinson’s disease who are older, taking Neupro, or taking higher doses of Neupro have a higher risk of experiencing hallucinations or other psychotic-like symptoms. If you notice any hallucinations or similar changes, it’s essential to discuss this with your doctor.

Where is the best place to put a Neupro patch?

The best place to apply a Neupro patch is on a clean, dry, and healthy area of your skin. Suitable locations include your stomach, thigh, hip, flank (the side of your body between the ribs and pelvis), shoulder, or upper arm. Select a spot that isn’t too oily, has minimal or no hair, and is free of scars, cuts, burns, or any skin irritations. 

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