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Neupro

(rotigotine)

How does this medication work? What will it do for me?

Rotigotine belongs to the class of medications called dopamine agonists. It may be used alone or in combination with levodopa to help control the symptoms of Parkinson's disease. The symptoms of Parkinson's disease are caused by a decrease in the amount of dopamine, a chemical messenger, in the brain. Rotigotine works by correcting the dopamine imbalance in the brain that produces these symptoms.

Rotigotine may also be used to treat moderate to severe restless legs syndrome in adults.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

How should I use this medication?

The recommended starting dose for early-stage Parkinson's disease is a 2 mg/24 hour patch applied daily. Depending on the effectiveness and the side effects that you experience, your doctor may gradually increase the dose.

For advanced-stage Parkinson's disease, the starting dose is a 4 mg/24 hour patch applied daily. The daily dose should not be more than 16 mg/24 hour.

To treat the symptoms of restless legs syndrome, the starting dose is a 1 mg/24 hour patch applied daily. It may be gradually increased to a maximum of 3 mg/24 hours.

Rotigotine transdermal patches are to be changed every day at approximately the same time each day. The patch may be applied to the shoulder, upper arm, lower abdomen (belly), flank (the area of your side between your ribs and hip), thigh or hip. Do not apply heat directly to the patch or to the area of skin close to the patch. This may cause an increased amount of medication to be absorbed into the body, possibly causing an increase in side effects.

To apply the patch:

  1. Choose a clean and dry area of intact skin that is not oily, damaged, irritated, or exposed to the sun. Avoid areas where it may be rubbed by tight clothing and do not apply lotions or creams to the area to which you are applying the patch. This helps prevent the patch from falling off. To avoid irritation, apply the patch to a different area of skin each day. Do not use the same area of skin twice within 14 days.
  2. Peel apart the foil pouch containing the patch. Remove the patch from the pouch.
  3. A protective layer covers the sticky side of the patch. Remove the protective layer by holding the patch in both hands with the sticky side facing you. Bend the patch in half to break the protective layer.
  4. Avoid touching the adhesive. Peel off one side of the release liner. Put the sticky surface of the patch on your skin and press the sticky side of the patch in place.
  5. Fold back the other half of the patch to remove the other side of the liner and press the patch down firmly with the palm of your hand. Hold the patch in place for about 30 seconds and make sure that the patch is affixed to your skin, especially around its edges.
  6. Wash your hands with soap and water.

When changing the patch, remove the old one carefully, fold it in half so that the adhesive sides stick together, and throw it away or bring it to the pharmacy for proper disposal. The patch still contains medication that can harm people who do not need the medication. Keep it out of the reach of children or pets. If adhesive remains on your skin, rub it off gently.

Bathing, showering, swimming, or other contact with water does not affect the patch. However, hot water or steam may cause the patch to loosen. If your patch falls off, apply a new patch.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important that this medication be used exactly as prescribed by your doctor. If this medication is stopped suddenly, there is a risk of developing Neuroleptic Malignant Syndrome which can be fatal. If it becomes necessary to stop the medication, it should be done gradually under your doctor's supervision.

If you forget to apply or change your patch, change it as soon as you remember. If it is close to the time when you normally change your patch, still apply it but change the patch again at your usual time and continue with your regular schedule. Do not wear 2 patches at once. If you are not sure what to do after forgetting to apply or change the patch, contact your doctor or pharmacist for advice.

Store this medication at room temperature in the original pouches until you are ready to apply the patch. Keep this an all other medication out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

What form(s) does this medication come in?

1 mg/24h
Each flexible beige to light brown coloured, square-shaped transdermal system with rounded edges, imprinted with "Neupro 1 mg/24h" contains 2.25 mg rotigotine which provides 1 mg of rotigotine over a 24 hour period. Nonmedicinal ingredients:polyester film, siliconized, aluminized, colour coated with a pigment (titanium dioxide (E171), pigment yellow 95, pigment red 166) layer and imprinted (pigment red 144, pigment yellow 95, pigment black 7), poly(dimethylsiloxane, trimethylsilyl silicate)-copolymerisate, Povidone K90, sodium metabisulphite (E223), ascorbyl palmitate (E304) and DL α tocopherol (E307), transparent fluoropolymer coated polyester film.

2 mg/24h
Each flexible beige to light brown coloured, square-shaped transdermal system with rounded edges, imprinted with "Neupro 2 mg/24h" contains 4.5 mg rotigotine which provides 2 mg of rotigotine over a 24 hour period. Nonmedicinal ingredients: polyester film, siliconized, aluminized, colour coated with a pigment (titanium dioxide (E171), pigment yellow 95, pigment red 166) layer and imprinted (pigment red 144, pigment yellow 95, pigment black 7), poly(dimethylsiloxane, trimethylsilyl silicate)-copolymerisate, Povidone K90, sodium metabisulphite (E223), ascorbyl palmitate (E304) and DL α tocopherol (E307), transparent fluoropolymer coated polyester film.

3 mg/24h
Each flexible beige to light brown coloured, square-shaped transdermal system with rounded edges, imprinted with "Neupro 3 mg/24h" contains 6.75 mg rotigotine which provides 3 mg of rotigotine over a 24 hour period. Nonmedicinal ingredients: polyester film, siliconized, aluminized, colour coated with a pigment (titanium dioxide (E171), pigment yellow 95, pigment red 166) layer and imprinted (pigment red 144, pigment yellow 95, pigment black 7), poly(dimethylsiloxane, trimethylsilyl silicate)-copolymerisate, Povidone K90, sodium metabisulphite (E223), ascorbyl palmitate (E304) and DL α tocopherol (E307), transparent fluoropolymer coated polyester film.

4 mg/24h
Each flexible beige to light brown coloured, square-shaped transdermal system with rounded edges, imprinted with "Neupro 4 mg/24h" contains 9 mg rotigotine which provides 4 mg of rotigotine over a 24 hour period. Nonmedicinal ingredients: polyester film, siliconized, aluminized, colour coated with a pigment (titanium dioxide (E171), pigment yellow 95, pigment red 166) layer and imprinted (pigment red 144, pigment yellow 95, pigment black 7), poly(dimethylsiloxane, trimethylsilyl silicate)-copolymerisate, Povidone K90, sodium metabisulphite (E223), ascorbyl palmitate (E304) and DL α tocopherol (E307), transparent fluoropolymer coated polyester film.

6 mg/24h
Each flexible beige to light brown coloured, square-shaped transdermal system with rounded edges, imprinted with "Neupro 6 mg/24h" contains 13.5 mg rotigotine which provides 6 mg of rotigotine over a 24 hour period. Nonmedicinal ingredients: polyester film, siliconized, aluminized, colour coated with a pigment (titanium dioxide (E171), pigment yellow 95, pigment red 166) layer and imprinted (pigment red 144, pigment yellow 95, pigment black 7), poly(dimethylsiloxane, trimethylsilyl silicate)-copolymerisate, Povidone K90, sodium metabisulphite (E223), ascorbyl palmitate (E304) and DL α tocopherol (E307), transparent fluoropolymer coated polyester film.

8 mg/24h
Each flexible beige to light brown coloured, square-shaped transdermal system with rounded edges, imprinted with "Neupro 8 mg/24h" contains 18 mg rotigotine which provides 8 mg of rotigotine over a 24 hour period. Nonmedicinal ingredients: polyester film, siliconized, aluminized, colour coated with a pigment (titanium dioxide (E171), pigment yellow 95, pigment red 166) layer and imprinted (pigment red 144, pigment yellow 95, pigment black 7), poly(dimethylsiloxane, trimethylsilyl silicate)-copolymerisate, Povidone K90, sodium metabisulphite (E223), ascorbyl palmitate (E304) and DL α tocopherol (E307), transparent fluoropolymer coated polyester film.

Who should NOT take this medication?

Do not use this medication if you are allergic to rotigotine or any ingredients of the medication.

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • difficulty starting movements
  • dizziness
  • headache
  • low blood pressure
  • nausea
  • skin irritation where the patch is applied
  • sleepiness
  • vomiting
  • trouble sleeping
  • vision changes

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • compulsive or uncontrolled behaviour (e.g., gambling, spending)
  • fainting
  • falling asleep while doing normal activities
  • hallucinations (seeing or hearing things that are not real)
  • increased blood pressure
  • low blood pressure making you feel faint, sweaty or have nausea
  • swelling in the legs, ankles or feet
  • symptoms getting worse (restless legs syndrome)
  • weight gain

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • allergic skin reaction (e.g., redness, rash or swelling, blistering skin under the patch)
  • signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Allergy: People who are allergic to sulfites may experience a similar reaction to rotigotine. Before you take rotigotine, inform your doctor about any previous adverse reactions you have had to medications or foods, especially pickled foods, beer and wine. Contact your doctor at once if you experience signs of an allergic reaction, such as skin rash, itching, difficulty breathing or swelling of the face and throat.

Behaviour changes: This medication has been known to cause changes in behaviour. You may notice compulsive behaviour, such as gambling, increased sexual activity or inappropriate spending. If you experience symptoms of depression such as poor concentration, changes in weight, changes in sleep, decreased interest in activities, contact your doctor as soon as possible. If you notice compulsive behaviour or signs of depression in a family member, ensure that they see their doctor.

Drowsiness/reduced alertness: Rotigotine may cause drowsiness, low blood pressure or dizziness and lightheadedness when rising from a lying or sitting position. Avoid driving or operating machinery that requires alertness until you known how this medication affects you.

Heart disease: Rotigotine may cause increases in blood pressure or for your body to retain fluid. If you have a history of high blood pressure or heart disease, this may make the heart problems worse. If you have heart problems or a history of heart problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Melanoma: People with Parkinson's disease may be at increased risk of developing melanoma (a type of skin cancer). It is not known if this increased risk is due to Parkinson's disease or to the medications used to treat Parkinson's disease. Your doctor will monitor you for skin cancer while you are taking this medication. Talk to your doctor if you have any concerns.

MRI and Cardioversion: The backing layer of these patches contains aluminum. If magnetic resonance imaging (MRI) or cardioversion is required, the patch should be removed to avoid skin burns. Inform any medical professional involved in your care that you are using this medication.

Neuroleptic malignant syndrome (NMS): Rarely, rotigotine can cause a potentially fatal syndrome known as neuroleptic malignant syndrome (NMS). If you notice the symptoms of NMS such as high fever, muscle stiffness, confusion or loss of consciousness, sweating, racing or irregular heartbeat, or fainting, get immediate medical attention.

Stopping the medication: If this medication needs to be stopped, it should be done gradually, under the supervision of your doctor. Suddenly stopping rotigotine can cause neuroleptic malignant syndrome, which can be fatal. Discuss with your doctor, the safest way to stop using this medication.

Sudden onset of sleep: There are reports of people who take rotigotine and other medications for Parkinson's disease falling asleep with no warning or drowsiness. If you have a sleep disorder, discuss this with your doctor. If you experience drowsiness while taking this medication, avoid driving or using machinery.

Pregnancy: The effect of rotigotine on a developing baby has not been determined. This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: Rotigotine is likely to reduce the quantity of breast milk produced. In addition, this medication may pass into breast milk. If you are a breast-feeding mother and are taking rotigotine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

What other drugs could interact with this medication?

There may be an interaction between rotigotine and any of the following:

  • alcohol
  • antihistamines (e.g,. cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
  • antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
  • aripiprazole
  • baclofen
  • barbiturates (e.g., butalbital, phenobarbital)
  • benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
  • buspirone
  • carbamazepine
  • chloral hydrate
  • efavirenz
  • gabapentin
  • lamotrigine
  • levetiracetam
  • methylphenidate
  • metoclopramide
  • mirtazapine
  • monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
  • muscle relaxants (e.g., cyclobenzaprine, methocarbamol, orphenadrine)
  • narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone)
  • olopatadine
  • phenytoin
  • prochlorperazine
  • scopolamine
  • tapentadol
  • topiramate
  • tramadol
  • zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2017. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Neupro

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