Anti-Parkinson Agent, Dopamine Agonist
CSA NA – FDA Approved – REMS (N) – Can Ship
How Does It Work
The precise mechanism of Rotigotine, Neupro is not fully known but it is a nonergot dopamine agonist with a high affinity for D3, D2, and D1 dopamine receptors. It is thought that the stimulation of postsynaptic dopamine D2 autoreceptors within the substantia nigra in the brain leads to improved dopaminergic transmission in the motor areas of the basal ganglia, notably the caudate nucleus/putamen regions.
Indications For Use
Parkinson disease, Restless legs syndrome
Before starting Rotigotine, Neupro makes sure your physician is aware of any allergies or medications you currently take, if you have cardiovascular disease, dyskinesia, are pregnant, or breastfeeding. Rotigotine, Neupro use has been associated with rare but potentially serious adverse events such as application site reactions, fibrosis, fluid retention, hallucinations/psychotic-like behavior, impulse control disorders, melanoma, orthostatic hypotension, and somnolence.
Transdermal Patch: 1-2mg/24 hours patch once daily and titrated up to a maximum of 16mg/24hours.
Pharmacist Tips On Using
How to Take: Apply patch to clean, dry, hairless area of intact healthy skin on the front of the abdomen, thigh, hip, flank, shoulder, or upper arm at approximately the same time daily. Remove from pouch immediately before use and press patch firmly in place on the skin for 30 seconds. Application sites should be rotated on a daily basis. If applied to a hairy area, shave ≥3 days prior to applying the patch. If the patch falls off, immediately apply a new one to a new site.
You Need to Avoid: Do not apply to the same application site more than once every 14 days or apply the patch to skin that is oily, irritated, or damaged, or where it will be rubbed by tight clothing. Avoid exposing the patch to external heat sources (eg, heating pad, electric blanket, heat lamp, hot tub, direct sunlight). Remove patch prior to magnetic resonance imaging or cardioversion to avoid skin burns due to aluminum content. Do not stop abruptly, taper dosage slowly. Other dopaminergic agents have been associated with a syndrome resembling neuroleptic malignant syndrome on withdrawal and/or significant dosage reduction. Decrease by ≤2 mg/24 hours preferably every other day until withdrawal is complete.
Orthostatic hypotension, peripheral edema, systolic hypotension, hyperhidrosis, decreased serum glucose, nausea, vomiting, decreased hematocrit, decreased hemoglobin, application site reaction, dizziness, drowsiness, fatigue, hallucination, headache, malaise, sleep disorder, arthralgia, asthenia, dyskinesia, increased blood urea nitrogen
Note this is not a complete list of side effects, only the most common
Frequently Asked Questions
This medication has a lot of scary side effects, is it safe?
All medications have side effects, but dopamine does a lot of different things in the body therefore supplementing with an agonist has many effects all of which are dosage dependant. Parkinson’s disease results in low dopamine in some areas of the brain but with oral medication, the drug is distributed throughout the body resulting in higher than normal dopamine in some areas while bringing it to normal levels in the area of concern. This is the main treatment for Parkinson’s disease as it replaces what the brain is missing directly and in most cases, side effects are minimal especially when starting out at lower dosages. If you experience side effects of concern, discuss it with your physician as steps can be made to manage them.
Why would my doctor treat my Parkinson’s disease with a drug that causes dyskinesia which is a different movement disorder?
Parkinson’s is a progressive disease that worsens with time resulting in dosages getting higher and higher to manage symptoms. Initially, medications will control the symptoms of it, but as the dosages get higher the risk of side effects increases, and eventually with enough dopaminergic activity dyskinesias will occur. At this point, the condition is generally quite progressed and combination therapies using other medications can be used to lower the total daily dosage of levodopa. As dopamine is important for muscle control in many areas of the nervous system, it is unsurprising that both a deficiency and a surplus will have detrimental effects.