Neupro patches (Rotigotine)
What is it used for?
- Parkinson's disease.
- Moderate to severe restless legs syndrome with no known cause in adults.
How does it work?
Neupro patches contain the active ingredient rotigotine, which is a type of medicine called a dopamine agonist. Rotigotine works by mimicking the activity of a substance in the brain called dopamine.
Dopamine is a substance known as a neurotransmitter. Neurotransmitters are found in the brain and nervous system and are involved in transmitting messages between nerves. These messages allow the normal functioning of the body. The neurotransmitter dopamine is known to be reduced or absent in the brains of people with Parkinson's disease, and this is thought to be the cause of the disease symptoms.
Dopamine normally transmits messages by stimulating specific receptor sites in the brain. Rotigotine works by stimulating these same receptor sites. This produces the same effects as dopamine, and acts as a dopamine substitute. In this way rotigotine helps to restore the dopamine activity in the brain, which helps reduce the symptoms of Parkinson's disease.
Rotigotine can be used by itself or in conjunction with levodopa to treat Parkinson's disease, and is particularly useful in people for whom levodopa alone is no longer providing adequate control of symptoms.
Rotigotine is also used to treat restless legs syndrome, which is characterised by severe discomfort in the legs and difficulty in sleeping. It is not fully understood exactly how rotigotine helps to relieve this condition.
Rotigotine can cause a drop in blood pressure when you first start treatment, and this may cause dizziness or fainting. To minimise the chance of this and other side effects, the dose of rotigotine is increased slowly when treatment is started. Follow the instructions given by your doctor or pharmacist.
Neupro patches are designed to be changed every 24 hours. The rotigotine is absorbed through the skin from the patch and into the bloodstream at a continuous rate and this provides a steady level of the medicine throughout the day.
How do I use the patches?
- When using your patches, follow the instructions in the leaflet provided with your patches carefully. One patch should be applied daily at about the same time each day. The patch should be applied to clean, dry, hairless, healthy skin on the lower back, abdomen, hip, shoulder, upper arm or thighs. Do not apply it to skin that is red, irritated or damaged. Don’t apply lotions, creams or powders to the skin before applying the patch, as they will prevent it sticking properly. It is important the sticky side of the patch is not touched and that the patch is pressed down firmly with the palm of the hand for about one minute to make sure it stays in place.
- When changing the patch, the old patch should be removed and disposed of safely; the new patch should be applied to a different area of the skin. It is recommended that the site of application is rotated and that the same site is not used within 14 days of the last application. If you experience any skin irritation at the site of application that lasts for more than a few days, is not healing, or seems to be spreading, it is important to inform your doctor.
- If you forget to change your patch, then change it as soon as you remember and then continue with your regular routine. This may mean you have to remove a patch after having worn it for less than 24 hours.
- The Neupro patch has been designed to remain in place during showering, bathing and exercising. If for any reason a patch does come off, it should be replaced with a new one for the rest of the day.
- The patch must not be exposed to heat while it is on the skin, for example excessive sunlight, heat pads, or heat from a sauna or hot bath. The patch should be covered by clothing if it is exposed to direct sunlight.
- If you get a rash or irritation on the skin exposed to the patches you should protect it from direct sunlight until the skin heals. Exposure to sunlight can lead to skin discolouration.
- Do not cut the patches.
- Neupro patches should be stored in a refrigerator at 2°C to 8°C (not in the freezer compartment). Make sure they are kept out of the reach of children. You may want to let the patch reach room temperature before you apply it, though this is not necessary for the patch to work.
- This medicine can occasionally cause your blood pressure to drop when you move from a lying down or sitting position to sitting or standing, especially when you first start using the patches. This may make you feel dizzy or unsteady. To avoid this try getting up slowly. If you do feel dizzy, sit or lie down until the symptoms pass. Drinking alcohol may increase the chance of feeling dizzy. People using Neupro patches should have their blood pressure monitored regularly.
- This medicine can cause drowsiness and sleepiness and some people have suddenly fallen asleep during their daily activities. In some cases this occurred without any warning signs. Although this is uncommon, you should exercise caution when driving or performing other potentially hazardous activities. People who have experienced sleepiness or have ever suddenly fallen asleep while taking this medicine should not drive or operate machinery. You should take care when drinking alcohol or taking other medicines that cause drowsiness, as this may increase the risk of drowsiness.
- Changes in behaviour, including unusual urges to gamble, increased sex drive and hallucinations have been reported in people using dopamine agonists such as this one for Parkinson's disease. If you think this medicine is affecting you in this way, you should consult your doctor.
- Dopamine agonists such as this one can sometimes make the symptoms of restless legs syndrome worse, or spread to other areas, or may cause the symptoms to start ealier in the evening or afternoon. If you think that this medicine is affecting you in this way, you should consult your doctor.
- It is recommended that people using Neupro patches have regular eye tests. Tell your doctor if you experience any disturbances to your vision while using the patches, so that your eyes can be tested.
- The Neupro patches have an aluminium backing film which can cause the skin to burn if they are left on during magnetic resonance imaging (MRI scan), or treatment of an abnormal heart rhythm (cardioversion) using a defibrillator. It is therefore necessary that the patch is removed if you are having one of these procedures.
- You should not suddenly stop using these patches unless your doctor tells you otherwise. If it is necessary to stop using your Neupro patches, you must do so gradually, following the instructions given by your doctor.
Use with caution in
- Severely decreased liver function.
Not to be used in
- The safety and efficacy of this medicine have not been established in children and adolescents under 18 years of age. It is not recommended for this age group.
- People having cardioversion therapy (treatment for abnormal heart rhythm using a defibrillator). The patch should be removed before the therapy.
- People having magnetic resonance imaging (MRI scan). The patch should be removed before the scan.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- The safety of this medicine for use during pregnancy has not been established. It should not be used during pregnancy. Seek further medical advice from your doctor.
- This medicine should not be used by breastfeeding mothers, as it may pass into breast milk and may also suppress the production of breast milk. Seek medical advice from your doctor.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
- Skin reactions at the patch application site, eg redness, itching, irritation, burning, blistering and inflammation.
- Disturbances of the gut, such as nausea and vomiting, diarrhoea, indigestion, abdominal pain.
- Sleepiness (somnolence).
- Difficulty sleeping (insomnia).
- Abnormal dreams.
- Dry mouth.
- Increase or decrease in blood pressure (hypertension or hypotension).
- False perceptions of things that are not really there (hallucinations).
- Difficulty performing voluntary movements, resulting in jerky or involuntary movements or muscle twitches (dyskinesia).
- Skin reactions such as rash, itching or sweating.
- Swelling of the legs and ankles due to excess fluid retention (peripheral oedema).
- Feeling weak or fatigued.
- Fainting (syncope).
- Blurred vision.
- Suddenly falling asleep (see warning section above).
- Inability to resist urges to gamble (pathological gambling) .
- Increased sex drive (libido) and excessive interest or involvement in sexual activity (hypersexuality).
- Increased heart rate.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already using, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while using this one, to ensure that the combination is safe.
This medicine should not normally be used in combination with the following medicines, as these work by decreasing the activity of dopamine in the brain and so may oppose the effect of rotigotine:
- antipsychotic medicines, eg chlorpromazine, flupentixol
There may be an increased risk of drowsiness and sedation if rotigotine is used with any of the following (which can also cause drowsiness):
- barbiturates, eg phenobarbital
- benzodiazepines, eg diazepam
- MAOI antidepressants, eg phenelzine
- sedating antihistamines, eg chlorphenamine, diphenydramine
- sleeping tablets, eg zopiclone
- strong opioid painkillers, eg morphine, codeine, dihydrocodeine
- tricyclic antidepressants, eg amitriptyline.
If this medicine is used in combination with levodopa (eg Madopar or Sinemet) there may be an increased chance of getting abnormal involuntary movements or muscle twitches (dyskinesias), or of these getting worse.
Other medicines containing the same active ingredient
There are currently no other medicines available in the UK that contain rotigotine as the active ingredient.